Febrile seizures in a child. Febrile seizures in a child: symptoms, causes and treatment Febrile seizures in a child without fever

When a baby has a high temperature, there is a risk of developing a convulsive syndrome. Most parents are aware of this. Because of what this happens, how likely it is and how to give the baby first aid, we will tell in this material.

What it is?

Convulsive muscle contractions during heat are a typical phenomenon in children. Adults do not suffer from such a complication of high temperature. Moreover, the likelihood of developing seizures decreases over the years. So, teenagers do not have them at all, but in infants from birth and in babies under 6 years old, the risk of reacting to fever and fever in this way is greater than anyone else. The peak of the disease occurs in children aged six months to one and a half years.

Convulsions can develop with any disease that is accompanied by a significant rise in body temperature.

Critical in terms of the likelihood of febrile seizures is considered to be a temperature that exceeds subfebrile values, when the thermometer rises above 38.0 degrees. Rarely enough, but this is not excluded, convulsions "start" at 37.8-37.9 degrees.

The likelihood that the child will begin such an unpleasant symptom is not too great. Only one out of 20 toddlers with a high temperature, according to statistics, is prone to convulsive syndrome. In about a third of cases, febrile convulsions return - if the child once experienced them, then the risk of a second seizure with another illness with fever and temperature is approximately 30%.

The risk group includes children who were born prematurely, underweight, babies with pathologies of the central nervous system, children born as a result of rapid birth. However, these statements are nothing more than the assumption of doctors and scientists. The true risk factors are still unknown.

True, one thing is known for certain - convulsions are more likely to occur in high heat in children whose parents or relatives in the second and third generation suffer from epilepsy or other convulsive ailments and conditions.

Genetic predisposition thus plays a decisive role.

How are they developing?

With a high temperature, the child's internal temperature rises, including the brain. The "overheated" brain itself is capable of a wide variety of "antics", but most often it simply starts sending the wrong signals to the muscles, which begin to contract involuntarily.

The question of how high temperature provokes seizures is one of the most controversial in medical science. The researchers did not come to a consensus. In particular, it is still not clear whether prolonged febrile convulsions can "start" the process of epilepsy in a child. Some scientists claim that these ailments are in no way related to each other, although they are similar in symptoms, others see a certain connection.

It is obvious that the age-related immaturity of the child's nervous system, the imperfection of its work, is related to the mechanism of the development of seizures. That is why, when it develops sufficiently, closer to the end of preschool age, febrile convulsions can be forgotten, even if up to this age they were repeated with enviable constancy with every disease in which the temperature increased.

The reasons

The causes that underlie febrile seizures are still being studied, it is difficult to judge them for certain. However, causative factors are known. High fever in a child can cause infectious and non-communicable diseases. Common infections include:

viruses (ARVI, influenza, parainfluenza);

bacteria (staphylococcal infection, scarlet fever, diphtheria, etc.);

Symptoms

Febrile convulsions do not develop immediately, but only a day after the temperature is set at high values. By themselves, convulsive contractions are simple and complex. Simple convulsions last from a few seconds to 5-15 minutes, with them all muscles contract evenly, there is a short-term loss of consciousness, after which the baby usually cannot remember what happened and falls asleep quickly enough.

Complex febrile convulsions are manifested by contraction and convulsions of separate limbs or only one half of the body. Attacks with atypical convulsions are long - more than a quarter of an hour.

If simple convulsions are usually single, not recurring during the day, then atypical convulsions can return several times a day.

What do they look like?

A febrile seizure always begins suddenly, without any prerequisites and precursors. The child just loses consciousness. The lower extremities are the first subject to convulsive contractions. Only after that the cramp covers the body and hands. The posture of the child in response to convulsive contractions changes and becomes characteristic - the baby arches its back in an arc and throws its head back.

The skin becomes pale, cyanosis may appear. Cyanosis usually appears in the region of the nasolabial triangle, and the eye sockets also look sunken. Brief pauses in breathing may occur.

The child comes out of the attack smoothly, all the symptoms develop in the reverse order. First, the natural color of the skin returns, cyanosis of the lips, dark circles under the eyes disappear, then the posture is restored - the back straightens, the chin falls. Lastly, the cramps of the lower extremities disappear and consciousness returns to the child.. After an attack, the baby feels tired, overwhelmed, lethargic, he wants to sleep. Drowsiness and fatigue persist for several hours.

First aid

Without exception, all parents of babies need to know the rules for providing first aid in case a child suddenly starts febrile convulsions:

Call an ambulance and fix the time of the onset of the attack, this information will be very important for the visiting team of doctors to differentiate seizures and decide on further treatment.

Lay the child on its side. Make sure that there is nothing foreign in the baby's mouth so that he does not choke. If necessary, the oral cavity is cleaned. The lateral position of the body is considered a universal "rescue posture", it prevents possible aspiration of the airways.

Open all windows, window, balcony door to provide fresh air access as soon as possible.

From the place where the child lies, everything sharp should be removed., dangerous so that he could not inadvertently injure himself in a convulsion. It is not necessary to hold the baby's body by force, it is also fraught with injury to muscles, ligaments, bones. It is enough to hold and observe slightly so that the child does not hurt.

Parents need to memorize or videotape all the features of the attack in as much detail as possible, while the ambulance team is driving - does the baby have a reaction to others, to light, loud sounds, the voices of parents, are the contractions of the limbs uniform or uneven, how intense is the convulsion. This information, together with the exact time of the duration of the attack, will help the doctor quickly understand the situation, make the correct diagnosis, exclude an epileptic seizure, meningitis and a number of other health-threatening diseases that are also accompanied by a convulsive syndrome.

What can not be done during an attack?

When convulsions occur, in no case should you do the following:

Sprinkle the child with cold water, immerse him in a cold bath, apply ice to the body. This can cause vasospasm, and the situation will become more complicated.

Straighten the limbs with convulsions, forcibly unbend the arched back. This can result in injuries to the bones, tendons, joints, spine.

Smear the child with fats (badger, lard), alcohol (and vodka too). This disrupts thermoregulation, which leads to even more severe overheating of the brain.

Insert a spoon into the child's mouth. The general opinion that a baby without a spoon can swallow his own tongue is nothing more than a common philistine misconception. Swallowing the tongue is basically impossible.

Thus, there is no benefit from the spoon, and the harm is great - in an attempt to unclench the teeth of a child with cramps, parents often break their teeth with a spoon, injure the gums. Fragments of teeth can easily get into the respiratory tract and cause mechanical suffocation.

Do artificial respiration. An unconscious child continues to breathe, even if there are brief pauses in breathing. It is not worth interfering in this process.

Pour water or other liquids into your mouth. In an attack, the child cannot swallow, so you need to drink his liquid only when the baby is conscious. Trying to pour water or medicine into the mouth during a febrile seizure can be deadly to a child.

First aid

The first aid from the arrived doctors of the "ambulance" will consist in the emergency administration of a solution of seduxen. The dosage can be different and is taken at the rate of 0.05 ml per kilogram of the child's weight. An injection is made intramuscularly or into the sublingual space - into the bottom of the mouth. If there is no effect, then after 15 minutes another dose of seduxen solution will be administered.

After that, the doctor will begin to interview parents in order to find out the nature, duration and characteristics of the convulsive syndrome. Visual examination and clinical picture will help to exclude other diseases. If the seizures were simple and the child is more than a year and a half old, doctors may leave him at home. In theory. On practice hospitalization is offered to all children at least for a day so that doctors can make sure that the child will not have repeated attacks, and if they occur, the baby will immediately be provided with qualified medical care.

Treatment

In a hospital setting, a child who has experienced an attack of febrile convulsions will undergo the necessary diagnostic examinations, the purpose of which is to identify disorders of the central nervous system, peripheral nervous system and other pathologies. Blood and urine will be taken from him for analysis, babies under one year old will definitely have an ultrasound of the brain through the “fontanelle”, an ultrasound scanner will allow you to consider the size and features of brain structures. Older children with a tendency to frequent seizures will be prescribed a CT scan.

If the attack recurs, then the child will be injected intramuscularly with a 20% solution of sodium oxybutyrate at a dose depending on the weight of the baby - from 0.25 to 0.5 ml per kilogram. The same drug can be administered intravenously with a 10% glucose solution.

If earlier children after febrile seizures were prescribed long-term use of anticonvulsants (in particular, Phenobarbital), now most doctors tend to believe that these drugs do more harm than potential benefit. In addition, it has not been proven that taking anticonvulsant drugs has any effect on the possibility of recurrence of seizures in the next illness with fever.

Consequences and predictions

Febrile convulsions are not particularly dangerous, although they seem extremely dangerous to parents. The main danger is in the untimely provision of assistance and common mistakes that adults can make when providing emergency care. If everything is done correctly, then there is no risk to the life and health of the baby.

Statements that febrile convulsions affect the development of epilepsy do not have a sufficient convincing scientific basis. Although some studies show a certain relationship between prolonged and frequent recurrent seizures against a background of high temperature and the subsequent development of epilepsy. However, it is emphasized that epilepsy in such children also has genetic prerequisites.

A child who suffers from convulsions with every illness with fever usually completely gets rid of this syndrome after reaching the age of six.

The connection between mental and physical developmental delay and febrile convulsive syndrome seems to doctors also insufficiently proven.

Is it possible to warn?

Although pediatricians advise monitoring the temperature of the child during illness and giving him antipyretic drugs with the wording “to avoid convulsions”, it is impossible to avoid febrile seizures. There are no preventive measures that would guarantee that there will be no seizures. If a child has a genetic predisposition, then neither shock doses of antipyretic drugs, nor constant measurements of body temperature will save him from an attack.

Experiments that were conducted in a clinical setting showed that children who took antipyretics every 4 hours and children who did not take antipyretics were equally prone to febrile convulsions.

If febrile convulsions have already happened once, then the child simply needs increased control. Parents should be prepared for the development of a convulsive syndrome at any time of the day, even at night in a dream. You should act according to the scheme of emergency care indicated above.

For information on what to do with febrile seizures in children, see the following video.

Many parents have experienced febrile seizures at least once in their lives. They usually occur in young children when the body temperature rises to high levels. To avoid the consequences associated with such a symptom, it is necessary to provide the child with assistance and be examined by specialists.

As a rule, convulsions themselves are not dangerous, but they signal serious disorders in the body, so you should consult a doctor at the first such sign. Causes of seizures are usually life threatening if left untreated, and are often associated with epilepsy and serious neurological disorders.

Definition

Febrile seizures are a neurological disease in which there is a spasm of muscle tissue at a body temperature of 38 degrees. Typically, this pathology affects children of younger and preschool age, less often schoolchildren and extremely rarely adult patients.

It is worth noting that if convulsions occur without an increase in temperature, then they are not called febrile. In addition, febrile convulsions can transform into afebrile ones, that is, they can occur without an increase in temperature, in which case the disease can be complicated by epilepsy.

The reasons

The provocateur of febrile convulsions are infections that easily enter the weak and imperfect body of a small child. Most of the children who were diagnosed with febrile convulsions were sick precisely against the background of infectious diseases. The herpes virus type 6 is especially dangerous.

Also, other factors of a non-infectious nature can provoke febrile convulsions, in which there is a sharp increase in the temperature of the child's body:

hereditary predisposition. The mechanism of inheritance of the pathology is not fully understood, but according to statistics, most children who suffer from febrile convulsions have relatives with the same pathology. In a quarter of all patients, parents suffered from pathology, and only 20% of patients did not have a single mention of convulsions in their family.
An increase in temperature due to endocrine disruptions, mental trauma, due to disorders of the central nervous system.
An increase in temperature as a protective reaction during teething in babies;
Violation of the exchange of certain microelements;
Fever after vaccination.

It is worth noting that febrile convulsions are not fully understood, so it is difficult to name the exact reason why they occur. But when examining a child, doctors often find various pathologies that require immediate treatment, so we can say that convulsions are a kind of manifestation of some kind of malfunction in the body.

Symptoms

Symptoms of febrile seizures are very similar to an epileptic seizure, but they are not. Usually, with febrile seizures, the limbs are symmetrically affected, but sometimes the seizure can occur in another way. There are two types of febrile seizures with characteristic symptoms:

Typical.

Tonic convulsions occur suddenly, the child falls, straightens his legs and presses his arms to his chest, throws his head back and rolls his eyes. Then the child begins to shudder rhythmically, often at first, but gradually less and less often, until the attack completely passes.
With atonic convulsions, the baby abruptly becomes lethargic, stops doing anything, his body becomes limp, he stops moving, including stopping his gaze, while the skin becomes pale. Most often, such an attack lasts no more than 5 minutes, in rare cases it can reach 10-15 minutes.

Atypical.

Such convulsions usually take a long time, sometimes more than 15 minutes. After them, delays in speech and motor development are often observed. Atypical seizures may occur asymmetrically, affecting only one half of the body, and often there is movement of the eyeballs or their retraction to the side.

If a child is prone to the appearance of febrile convulsions, then they most often appear on the first day after the temperature rises, and sometimes even in the first hours. It should be noted that the duration and type of seizure do not depend on the height of the temperature, but with febrile convulsions it is always above 38 degrees.

First aid

Most parents who first encounter a febrile seizure in their child usually panic, but this is absolutely not recommended, you need to remain calm and provide first aid to the child in a timely manner to avoid any complications.

If a child has signs of a febrile seizure, you need to act immediately:

First of all, you need to put the child on a flat, soft, but not too soft surface, it can be a bed, a soft carpet, or a table covered with a blanket, and on the street you can lay the child on the grass. This is necessary to eliminate the risk of injury during convulsions, since the child can literally beat his head and whole body against the surface on which he lies. Do not place your child on a pillow or a very soft bed, as they may roll over and suffocate.
It is necessary to ensure that the child does not choke on saliva and does not choke on vomit. To do this, it is recommended to put the child on its side and hold it slightly so that it does not collapse. On the side it will be easier to breathe and in case of vomiting, it will freely come out.
As soon as the child has been moved to the required surface, it is urgent to call an ambulance.
You can not press the child to the surface with force to stop the convulsions. This will not give a positive effect, and careless movements can damage the limbs of the child, even provoking fractures.
You can not put anything in the child's mouth. The fact that the baby can choke on the tongue is a myth, and to avoid closing the airways, you need to put the child on its side - this will be enough. The introduction of various objects into the oral cavity can lead to injuries to the teeth and jaw, in addition, the object or teeth can break due to such manipulations, while there is a risk of fragments entering the lungs and even death.
It is impossible to give water or medicine to the child during convulsions, the child can simply choke. You need to wait at least 15 minutes after the attack and make sure that the baby has come to his senses.
It is strongly not recommended to leave a child alone during an attack even for a second, this can lead to irreversible consequences.

Diagnostics

Parents whose children have suffered febrile convulsions should first show the child to a neurologist. Most often, convulsions are one of the symptoms of a serious pathology that requires urgent and adequate treatment.

First of all, the doctor examines the patient, checks the reflexes and interviews the parents. It is necessary to remember whether there were people with similar problems in the family, you need to remember how long the attack lasted for the child and in what position the baby was.

To confirm the diagnosis and identify various pathologies, the doctor sends a small patient to a series of studies:

Blood tests;
Urinalysis;
ultrasound of the brain;
MRI if necessary;
Sometimes a puncture of the cerebrospinal fluid may be indicated;
The doctor also checks the level of development of the child according to age, how he moves, says whether he holds objects normally, and so on.

Based on the studies described above, the doctor makes a diagnosis and prescribes the appropriate treatment. It is important to understand that the earlier the parents asked for help and began to treat the baby, the less likely the complications. Often, febrile convulsions become a symptom of very serious illnesses that can even lead to disability.

Treatment

During an attack, first of all, you need to give the child first aid so that he does not get injured and does not choke. It is also worth noting that the body temperature is usually very high at this moment, so the child should be undressed and wiped with a wet towel, while the water should not be ice cold. You should not use vinegar or water for these purposes, it is very dangerous for young children, as harmful substances easily enter the body through thin skin and can cause intoxication.

It is also possible to use drugs during an attack. Usually, psychotropic substances or tranquilizers help with convulsions, they are prescribed only by a doctor if there are serious indications. Such drugs cannot be used uncontrollably, especially given to young children, it can be very dangerous.

For febrile seizures, the following medications are prescribed:

Diazepam is a psychotropic and antiepileptic drug.
Lorazepam is a psychotropic drug.
Phenobarbital is an antiepileptic and hypnotic drug.

Treatment after an attack is primarily in the suppression of high temperature. If the infection is the cause of the fever, then the small patient will be prescribed an antiviral or antibacterial agent, and the use of drugs such as parcetamol and nurofen is also indicated, they relieve fever and inflammation.

To avoid repeated seizures, it is necessary to identify the cause of their occurrence, if neurological disorders are detected, the child will be prescribed the appropriate treatment for the diagnosis. Febrile seizures themselves are treated only in cases where they often recur and harm the child, for example, cause inhibition in development. Long-term antiepileptic drugs may be prescribed.

It is important to understand that in order to prescribe treatment, it is imperative to undergo an examination by an experienced specialist who can identify the cause of seizures and prescribe the appropriate treatment for a particular child. Self-administration of psychotropic drugs to a baby is as dangerous as complete inaction, it is necessary to find a middle ground with the help of an experienced doctor and cure the child.

Prevention

Healthy children do not need any special prophylaxis for febrile seizures. Parents should provide the child with a healthy and wholesome diet, regular walks and timely examinations by a pediatrician and a neurologist. Such measures will help strengthen the body, notice changes in development in the early stages and take the necessary measures to prevent complications.

In children who have already suffered febrile convulsions, only a doctor prescribes prophylaxis. This may be a course of treatment with sedative drugs, and strengthening of general immunity also plays an important role in order to reduce the risk of infection and the temperature rise to high levels again.

Do not give your child any sedatives or antiepileptic drugs at your own discretion, unless the doctor recommended it. It is important to understand that all children develop differently, so even seizures do not always have to be treated with medication.

Every parent should know that sedative drugs have a very strong effect on the baby's nervous system and can greatly depress it. Even the regular use of ordinary valerian by a small child without indications led to a serious violation of the growth and development of the child, since valerian slows down brain activity. The same thing happens with the use of psychotropic drugs, only the effect is stronger.

Complications and prognosis

An accurate prognosis for a particular patient can only be given by the attending physician, since the consequences may be different. The severity of complications depends on the type of febrile seizures, their duration, frequency. Often no complications occur and the child recovers completely after a course of treatment, in this case, convulsions occur only once.

Complex forms of febrile seizures can turn into epilepsy, this occurs in 10% of all cases. But after seizures, the child often has developmental delays, this is due to neurological disorders. Such complications are most often found in the atypical form of febrile convulsions.

Particularly dangerous are seizures in babies under 6 months old, since the child's body during this period is still very weak. Parents who suffered from a similar pathology in childhood should regularly show the baby to a neurologist and monitor the child's condition, and prevent the child from coming into contact with infections.

Unfortunately, febrile convulsions are not yet fully understood, so the exact causes of the onset of the disease and ways to avoid it are not known. All that parents can do is to regularly examine the baby and provide him with a quality and healthy life.

Clinically, FS is manifested by loss of consciousness with arching of the back, twitching of the limbs, blanching of the skin. Treatment consists in taking non-steroidal anti-inflammatory drugs, antiepileptic drugs, tranquilizers. Upon reaching the age of six, as a rule, temperature cramps disappear. In rare cases, they can transform into epilepsy.

What is FS

Febrile seizures in pediatrics are classified as a neurological disorder. They are tonic or tonic-clonic seizures: in the first case, muscle spasm is prolonged, in the second case, muscle contractions alternate with periods of relaxation. They can also be typical (in 90% of patients) or atypical. They develop against the background of a rise in the child's body temperature above 37.8 ⁰С and loss of consciousness.

FS is a fairly common phenomenon: among children aged six months to 6 years, it occurs in 2-5% of cases. Most often, temperature cramps are observed in one and a half year old babies, with the majority being boys. It has been established that heredity is one of the main causes of this type of convulsive syndrome. In a quarter of children, parents suffered from it in childhood, and in 80% of convulsive syndromes of various etiologies are present in the anamnesis of the family. After reaching the age of six, such seizures, as a rule, do not occur.

The reasons

The causes and mechanism of development of febrile convulsions have not been reliably elucidated. Presumably, seizures against the background of hyperthermia are a consequence of the immaturity of the central nervous system in early childhood. Due to the predominance of excitation over inhibition, the stimulus (in this case, high temperature) leads to a generalization of the process. Thus, any conditions and diseases in which hyperthermia is observed can be attributed to provoking factors:

viral infections, usually caused by herpesvirus type 4;
infectious and inflammatory processes of bacterial origin (diseases of the gastrointestinal tract, respiratory organs;
psychogenic, endocrine and other pathologies accompanied by fever;
changes in water and electrolyte balance (hypercalcemia);
teething;
reaction to some vaccines (MMR or DTP).

Genetics are also potential causes of febrile seizures in children. If parents or other family members had such seizures in early childhood, then the probability of their occurrence in offspring reaches 25%.

Symptoms

Temperature cramps for the first time can be observed in a child aged from six months to 18 months. After the temperature rises to 37.8 ⁰С and more during the day, the characteristic symptoms of a seizure appear. It proceeds according to the type of generalized epileptic in the following sequence:

loss of consciousness;
spasm of the muscles of the limbs;
tonic convulsions of the whole body (the child arches and throws back his head due to the rigidity of the occipital muscles);
pallor and even cyanosis of the skin;
convulsions of the arms and legs.

After that, the attack ends, and the symptoms disappear in the reverse order. Having regained consciousness, the baby remains drowsy and lethargic for some time. The duration of the seizure usually does not exceed one minute, which is typical for a typical FS variety. In the atypical form of the disorder, an increase in the period of convulsions is observed.

Focal symptoms may be added to the general symptoms; in this case, changes in the electrical activity of the brain are noted on the EEG. If spasms are repeated already against the background of a decrease in temperature, we are talking about subfebrile convulsions in children. Atypical seizures are less common and usually indicate the presence of congenital pathologies of the central nervous system or birth trauma.

Diagnostics

The diagnosis begins with a physical examination of the child by a pediatrician and a history taking. When interviewing parents, the doctor specifies the age at which temperature cramps first occurred, the duration of the attack, and the presence of such disorders in the family history. Additionally, the somatic state of a small patient, his neurological status, and the level of psychophysical development are determined. If it is possible to observe a seizure, its duration and the presence of focal signs are assessed.

A urinalysis is prescribed, according to which hypercalcemia can be detected - a violation of the water and electrolyte balance. In order to detect chromosomal mutations as a probable cause of pathology, a genetic study (karyotyping) is indicated. All subsequent diagnostic manipulations are aimed at differentiating subfebrile seizures from other diseases with similar symptoms. EEG, MRI and CT are performed to exclude intracranial hypertension and CNS developmental anomalies. A lumbar puncture is done if encephalitis or meningitis is suspected.

First aid

Since such seizures develop suddenly and look quite frightening, the natural reaction of an unprepared adult is panic. What should parents do? First of all, calm down: the attack in most cases lasts no more than a minute and passes by itself.

With febrile convulsions in children, first aid is to give a safe position to the body. The child should be laid on its side to prevent aspiration of the contents of the stomach if vomiting occurs, and kept in this position. With convulsions of the limbs, this should be done carefully, since you can inadvertently cause injury.

After the convulsions are over, measures should be taken to reduce the temperature (open the window, give the baby an antipyretic, wipe it with water), then seek qualified help.

Treatment

Drug therapy for febrile convulsions in children is reduced to stopping the attack. For this, first of all, antipyretics (Paracetamol), natural cooling and rubbing the body with water are used. If the listed funds do not have the desired effect, non-steroidal anti-inflammatory drugs - Ibuprofen are indicated. In the future, if the child falls ill again with an increase in temperature, the timely use of antipyretics can prevent a seizure.

The convulsive syndrome is stopped by tranquilizers that are effective and safe for the child. The most commonly used drugs are the benzodiazepine group - diazepam injection intravenously, for example. If febrile convulsions in a child are atypical, carboxamide derivatives and barbiturates are used. It is possible to prescribe a course of tranquilizers and diuretics in order to prevent the occurrence of repeated attacks.

In the treatment of a typical form of FS, not associated with heredity, pathologies and injuries of the CNS, the therapy of the primary disease is of great importance. In case of infections, antiviral or antibiotics are used, the water-electrolyte balance is restored. If there is information in the anamnesis about a similar reaction to vaccination, then after revaccination, a prophylactic course of Paracetamol is indicated.

Forecast

In general, the prognosis is favorable, since in the vast majority of cases, after reaching the age of six, no seizures are observed against the background of high temperature. At the same time, there is no effect on intellectual abilities and psychophysical development. An alternative to complete recovery is the transformation of febrile seizures into epilepsy, which occurs in 5-15% of the total. This group usually includes children with atypical SF.

15.01.2018 2780

Febrile seizures (FS) are a benign age-dependent genetically determined condition in which the brain is susceptible to epileptic seizures that occur in response to high temperature.

Seizures are noted in children aged 3 months to 5 years. According to the draft classification of epilepsy 2001, AF is classified as a group of conditions with epileptic seizures that do not require a diagnosis of epilepsy.

AF is the most common pathological condition in childhood, their prevalence in the population is 2-5%. The diagnosis of AF is exclusively clinical, establishing the fact of the presence of epileptic seizures against the background of elevated body temperature in children under the age of 5 years.

A detailed history of the eyewitness of the attack, a complete somatic and neurological examination are especially important at the initial stage to exclude neuroinfection, as well as other diseases, the debut of which may be febrile convulsions. Considering that AF is an urgent condition, a doctor of any specialty needs to know the tactics of therapeutic measures for this pathology.

Therapeutic tactics in AF When deciding on the therapeutic tactics in AF, two points should be taken into account. The first is positive: the overall risk of transforming AF into epilepsy is no more than 10%. The second is negative: an increased risk of AF recurrence and the risk of developing epilepsy, as well as the likelihood of severe brain damage with prolonged AF.

It is impossible not to take into account such a factor as "convulsive phobia" in the families of patients. So, some parents at the first AF believe that their child is dying, and in the future they are afraid of a recurrence of convulsions. In most cases, seizures in AF last a few minutes and end before the child arrives at a medical facility. If the attack is prolonged, lasting more than 20 minutes, it must be stopped on the spot. Emergency treatment of AF consists of parenteral administration of antiepileptic drugs at the time of onset of convulsions. The purpose of this method of therapy is to stop AF and avoid a prolonged attack and a status with a possible damaging effect on the brain. According to the literature, diazepam in rectal tubes (0.5 mg/kg) is almost always administered to relieve an attack in EU countries. The indisputable advantage of the drug is its high efficiency - it is quickly absorbed, interrupts the onset of an attack and protects against prolonged, severe and repeated attacks in a short period of time, as well as ease of use in emergency conditions.

Sometimes it is recommended to use it twice a day at a single dose of 0.5 mg / kg per day during fever for the prevention of AF. In our country, diazepam in rectal tubes is not registered, so two groups of drugs are used to stop an attack: benzodiazepines and valproates for parenteral administration. Of the benzodiazepines, diazepam (Relanium, Seduxen, Valium), which is administered intravenously or intramuscularly (2 ml of the solution contains 10 mg of the drug) in a single dose of 0.25 mg / kg, has found use; it is possible to use 2 times a day. The daily dose of diazepam is not more than 5 mg for children under 5 years old; 20 mg for children 6-12 years old and 40 mg for children over 12 years old. The second group of parenteral drugs for the relief of developed AF is valproate. In Russia, depakine for injection is used, which is available in vials complete with a solvent (water for injection 4 ml), one vial contains 400 mg of sodium valproate. With intravenous jet administration of the drug, the dosage is 10-15 mg / kg per day (a single dose is administered slowly over 5 minutes), and with intravenous drip (on isotonic sodium chloride solution) - up to 1.0 mg / kg per hour. The average daily dose of the drug is 20-30 mg / kg, but not more than 2500 mg. The therapeutic concentration of the drug in the blood is established after 3-5 minutes of administration, while the optimal concentration is 75 μg / ml. The advantages of the drug include the absence of a sedative effect, respiratory depression, bradycardia, arrhythmias, arterial hypotension.

A significant drawback is the difficulty of using the drug by the parents of a child with AF at home (the impossibility of intramuscular administration), therefore depakine for injection can be one of the drugs of choice for stopping long-term AF by an ambulance team or a family doctor. With an increase in temperature in children who have previously undergone AF, measures are taken to reduce body temperature (including physical cooling and rubbing). Nurofen is used in suspension at a dose of 5-10 mg / kg every 6-8 hours, up to a maximum of 300 mg per day; eferalgan in rectal suppositories. With high fever, the introduction of lytic mixtures intramuscularly (analgesic + no-shpa + antihistamine) is indicated.

In severe cases, corticosteroid hormones are added. In case of repeated atypical AF, when establishing the diagnosis of severe myoclonic epilepsy of infancy or the syndrome of "febrile convulsions plus", long-term administration of antiepileptic drugs (AED) is recommended in accordance with the form of epilepsy and the nature of the seizures. In most cases, the drug of choice is valproic acid. Depakine chrono is used at a dose of 500-1500 mg per day (20-40 mg / kg per day) orally twice a day. In the structure of AF prevention, in addition to stopping the seizure attack itself with early parenteral administration of drugs, it is possible to intermittently prescribe AEDs orally during fever.

Intermittent prophylaxis is given to children with AF. AEDs are prescribed for the entire period of fever and 2-3 days after it.

Treatment begins with phenobarbital, which is used at a dose of 50-100 mg per day (3-5 mg / kg per day) in 2 doses with a 12-hour interval during fever and several days after it. Phenobarbital, which has many severe side effects, is practically safe for such short-term use.

The second choice drug is clobazam (frizium, the drug is not registered in Russia). It is prescribed at a dose of 5-10 mg per day (about 0.5 mg / kg per day) in 2 doses with a 12-hour interval, with a total duration of 3-7 days. It is also possible to prescribe valproates in the form of prolonged tablets at an average dose of 30 mg / kg per day (300-900 mg per day) twice, lasting up to 7 days, or in the form of microgranules at a dose of 30 mg / kg per day. The microgranular form (depakynchronosphere) is especially convenient in young children, as it can be used from 6 months of age, allows you to accurately dose the drug and avoid choking.

The main advantages of valproates in this case are good tolerability with no effect on cognitive functions and the possibility of rapid simultaneous withdrawal of the drug. It should be borne in mind and explained to parents that the use of AEDs for fever cannot guarantee complete protection against the onset of AF and does not protect against further transformation of AF into epilepsy. First, when taken orally, the drugs are absorbed relatively slowly, and for about 30 minutes after taking them, the patient remains "unprotected". Secondly, even the presence of a therapeutic concentration of AEDs in the blood cannot fully guarantee protection against the onset of AF. At the same time, the prophylactic use of AEDs for fever in a significant number of cases protects children from the occurrence of severe, prolonged AF that can cause brain damage.

There is sufficient convincing evidence that the use of antipyretic drugs does not reduce the risk of recurrent AF. Many authors point to good parental preparation as the first step in preventing AF recurrence.

The role of the family doctor in advising parents on the provision of assistance with AF and their prevention is great. The main thing in the treatment of AF is the relief of the attack itself, however, the periodic prophylactic administration of AF is also not rejected by clinicians.

Fever with a body temperature above 38 ° C provokes febrile convulsions in children, fortunately, without affecting their further psychomotor development. Mothers tend to over-dramatize such an event as a seizure in children. Seizures last from 20 seconds to 10 minutes, which can seem like an eternity to adults. What are the reasons for the appearance of this type of seizures in childhood, how to help babies?

According to WHO, 3-4% of children under 6 years of age are susceptible to febrile seizures, 50% of them had only one episode, every second seizures are repeated 2-3 times. If there are no symptoms of meningitis, no metabolic disorders and epilepsy, then febrile convulsions pass without a trace, as they grow older they no longer recur.

Febrile convulsions provoked by hypothermia in children after 5 years of age occur less frequently than at the age of 1–1.5 years. When a strong stimulus causes an excitation process in the brain, the limbs and / or the whole body begin to respond. The baby turns pale, breathing becomes intermittent or rapid. Seizures can spread to the muscles of the face, can cause loss of consciousness, respiratory arrest.

A fever attack occurs with a rapidly rising body temperature, as well as at a temperature above 38–39 ° C.

The total duration of febrile seizures reaches 10-15 minutes. Repeated cases often occur with subfebrile convulsions in children when the body temperature is below 38 ° C, as well as with more prolonged seizures. The reason for the long stay of a child without consciousness may be intoxication caused by dangerous infections. There is a risk of developing epilepsy after the first seizures, but without aggravating conditions, it is only 1%. An epileptic seizure that lasts more than 15 minutes, unlike fever, more often causes disturbances in psychomotor development.

Types of seizures

It seems to non-specialists that convulsive reactions follow one “scenario”: children lose consciousness, fall, they begin to convulse. Indeed, there is much in common in how the next or first attack proceeds. The child loses emotional connection with others, does not respond to stimuli.

Doctors distinguish several types of seizures according to their localization, the coverage of certain groups or all muscles by the process of excitation.

With a clonic seizure, children experience facial twitching, the same involuntary twitching of the arms and legs. With tonic convulsions, the baby's legs are straightened, his arms are bent at the elbows and pressed to the chest. All the muscles tense up, the head throws back, and the eyes roll back. With a local - local - nature of seizures, twitching occurs only in the muscles of the face, arms and / or legs of children. A generalized attack is characterized by the fact that all muscle groups are involved. After a while, the process fades, then stops completely.

Causes and symptoms of febrile seizures

Upper respiratory tract infections, acute respiratory infections, inflammation of the middle ear - this is the beginning of the list of triggers or triggers for the development of an attack in children. Seizures can occur even in relatively low-risk situations for babies, for example, as a result of hyperthermia after vaccination. Spasms with fever, a sharp increase in body temperature occur in children, because the brain has not yet formed and is especially susceptible to strong stimuli. The faster hyperthermia develops, the higher the likelihood of seizures.

All causes of febrile seizures in children deserve the attention of parents and doctors in order to exclude serious diseases that can cause the same symptoms (epilepsy, hydrocephalus). Also dangerous is the condition of the child during a generalized tonic-clonic seizure, when he loses consciousness. The whole complex of signs is observed within 30-120 seconds, but during this short period the baby should not be left without the help of adults.

Symptoms of tonic-clonic seizures:

Integuments at a high temperature turn red (hyperemic).
Sometimes the child cries a lot at the beginning of the attack.
There is pallor, a cold sticky sweat covers the forehead and body.
The kid does not respond to the words addressed to him, does not respond to stimuli.
There are twitching of the limbs (clonic convulsions).
The tonic period of the attack - the head is thrown back, the body is stretched.
Eyes roll back, teeth clench, lips turn blue, foam is shown.
The bladder and intestines are involuntarily emptied.

After the first febrile seizure, which can last 10–30 seconds, recurrent seizures may occur. This happens while maintaining the action of a strong stimulus on the brain, if the baby has a hereditary tendency to a similar reaction to hyperthermia. It is necessary to stop repeated convulsions in a timely manner, because with their prolonged course, the risk of a negative effect on the psychomotor development of children increases.

How to give first aid for seizures

All parents should know how to act if febrile convulsions have begun in children. You should call an ambulance, but experience shows that in 90% of the total number of cases, the spasm passes before the doctor arrives. It is recommended not to transfer the child to another place unless absolutely necessary. You can not shake and shake the baby, wipe his body with a cold washcloth.

Children must be protected from injury, do not try to hold by force, do not insert any hard objects into their mouths.

In case of a febrile attack, adults provide first aid to children by laying them on their knees or on the floor. Treat febrile seizures at home with antipyretics. It is better to use in such cases syrups and suppositories based on ibuprofen or paracetamol. When body temperature drops to normal levels, the influence of the main trigger of febrile seizures on the brain decreases.

Babies are given antipyretics, since at high temperatures there is a risk of a recurrence of a tonic-clonic attack. The World Health Organization recommends the use of paracetamol for the treatment of febrile conditions in children. A single dose of the active substance is 10–15 mg per 1 kg of the child's body weight. Until the children regain consciousness, they are not allowed to drink drops or tablets. Body temperature can be tried to reduce by wiping the body with lukewarm water.

Parent action algorithm

What should adults do with a seizure in infants? Parents should free the baby's mouth and nose from food, vomit, mucus. This action will help clear the airways if they are clogged. To cleanse the oral and nasal cavities, the pharynx of babies, parents can use a disposable syringe without a needle, a rubber bulb. For older children, the mouth is released mechanically - with a finger wrapped in a bandage. If there is an air duct, then it is installed to prevent the tongue from falling.

Algorithm of action of adults with convulsions in children:

Children who are conscious are given sedative valerian drops. The dosage of the tincture is determined based on age. So, a baby needs only one drop diluted in a teaspoon of water. A two-year-old child is given two drops of valerian tincture dissolved in a small amount of boiled water.

Treatment of febrile seizures

An effective antipyretic, paracetamol is a first-line drug that does not cause severe adverse reactions in children. Ibuprofen belongs to the group of non-steroidal anti-inflammatory drugs (NSAIDs). This is a second-line antipyretic, it is given for intolerance or insufficient effectiveness of treatment with paracetamol. However, NSAIDs cause damage to the gastric mucosa and other serious consequences.

The use of antipyretic drugs directly for hyperthermia during an illness in a child is much more effective than other measures to prevent seizures.

If a high temperature persists even after taking paracetamol syrup or suppositories, the ambulance nurse will inject analgin intramuscularly. But experts warn that it is not advisable to take antipyretics like other drugs - courses. With incessant convulsions, a diazepam solution is administered intramuscularly or intravenously. Long-term administration of anticonvulsants does not prevent the recurrence of febrile seizures.

After an attack, children remain lethargic, do not understand what is happening to them. When the convulsions pass and the baby's condition returns to normal, the doctor should still examine him. If the seizure lasts more than 15 minutes, then children need treatment with special medications. Hereditary predisposition to convulsive reactions is of great importance for the choice of therapy.

When a mother or father had convulsions in childhood in a family, the likelihood of recurrence in offspring increases several times.

It is necessary to contact a pediatric neurologist to determine the exact cause of the attack(s). The doctor will clarify the circumstances with relatives, explain what the consequences of a convulsive syndrome may be. After vaccinations, such as DTP, the doctor prescribes paracetamol to infants with febrile convulsions on the first or second day. With the introduction of live vaccines, children take paracetamol from the 5th day.

Febrile seizures in children - what should parents do? updated: February 21, 2016 by: admin