When to see the doctor
Go to the doctor if:
- it is your child’s first convulsion
- your child has several convulsions
- convulsions occur often.
Febrile convulsions (seizures which occur due to fever) are relatively common, occurring in approximately 4% of children between the ages of six months and five years. The majority of these children will only ever have one fit; most will occur while the child is less than three years old. Those children who have their first febrile convulsion before the age of one year have a higher risk of having recurrent febrile convulsions. This type of convulsion tends to run in families, and to affect boys more often than girls. Even though it can be very frightening to see your child having a febrile convulsion, remember that children do not die from this, nor do they suffer long-term consequences or brain damage.
What causes them?
Convulsions are due to sudden, abnormal electrical activity in the brain. There are many causes for convulsions which do not occur in relation to fever; the most common is scarring of brain tissue which may occur after head injury. Convulsions in some children may be triggered off by flashing lights, such as a strobe light, or looking at patterns on a TV or cinema screen. There is usually a family tendency towards having convulsions.
Febrile convulsions occur as a direct result of a high fever which may accompany an infection. For reasons that are unclear, the rapid rise in temperature causes an abnormal electrical discharge in the brain, which results in the seizure.
What are the symptoms?
There are a number of different types of convulsions, but they are usually characterised by the sudden onset of a stiffening of the body, followed by jerking movements, after which the child usually sleeps deeply for an hour or so. Most convulsions do not last longer than several minutes. Convulsions can be partial, affecting only one part of the body, or general, involving the whole body.
Some convulsions (petit mal) do not involve jerking body movements, but simply appear as an ‘absence’ from activities. The child stares for a few seconds, and then continues with what they were doing as if nothing has happened. Epilepsy is the term given to the condition where the child has more than one seizure, and there is an abnormal EEG.
The characteristics of a febrile convulsion are similar to those of a general convulsion. The episode is usually brief, lasting less than five minutes, and the child makes a complete recovery afterwards, although they may be a little drowsy for an hour or so. The child will also have symptoms of the condition that caused the fever, such as a runny nose, earache or cough. Occasionally the febrile seizure will be associated with a more serious condition such as meningitis so it is important to see a doctor in all cases.
Is there a test?
If your child has a convulsion which is not due to fever, your doctor will suggest that an EEG be performed, and occasionally a CT scan of the brain.
Investigations are rarely indicated for febrile seizures. Sometimes blood or urine tests, or a chest X-ray, may be performed to find the condition which caused the fever. An EEG is performed if there are repeated febrile convulsions but it is usually not indicated after a single episode.
How are they treated?
The long-term treatment of general convulsions will depend on their cause and severity.
A febrile convulsion usually lasts only a few minutes, and almost always stops by itself before any treatment is given. If the seizure is prolonged, the child is taken to the doctor or hospital where medication is given (intravenously or rectally) to stop the seizure. It is not usually necessary to hospitalise a child following a febrile seizure, unless there is concern about the condition which caused the fever (such as pneumonia or meningitis). Generally, the child is assessed, the underlying condition treated, and the child is sent home.
How can I prevent them?
To prevent recurrences of febrile convulsions, you should try to lower your child’s fever (for example, using paracetamol) as soon as you become aware of the problem. However, sometimes the seizure will be the first indication of a fever. There is no point at all in giving your child anticonvulsant medication whenever they develop a fever, because it takes several days to build up sufficiently high blood levels of the drug.
If your child has recurrent febrile seizures, your doctor may consider prescribing anticonvulsant medications to be taken on a continual basis for several years, to prevent the seizures from occurring. However, this should only be instituted and managed by a paediatrician or paediatric neurologist.
Prevention of non-febrile convulsions will depend on the diagnosed cause.
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