Evaluation and Treatment
of the Child with Febrile Seizure
JAMES S. MILLAR, M.D., University of Oklahoma–Tulsa College of Medicine, Tulsa, Oklahoma
F
ebrile seizures are common, with 2
to 5 percent of children in North
America experiencing at least one;
the majority (65 to 90 percent) of
these are simple febrile seizures. Children
with febrile seizures are usually six months
to five years of age; the peak occurrence
is in children 18 to 24 months of age. The
1993 International League Against Epilepsy
defined a febrile seizure as “an epileptic sei-
zure occurring in childhood associated with
fever, but without evidence of intracranial
infection or defined cause. Seizures with
fever in children who have experienced a pre-
vious nonfebrile seizure are excluded.”1 The
clinical evaluation process is based on the
nature of the febrile seizure and the under-
lying illness that triggered the initial fever.
Febrile seizures are broadly defined as simple
or complex (Table 12).3
Risk Factors
The primary risk factors for a first febrile sei-
zure are day care center attendance, develop-
mental delay, having a first- or second-degree
relative with a history of febrile seizure, and a
neonatal nursery stay of more than 30 days.4
Case-control studies5 have found the male
to female ratio to be 1.4:1. Children with any
two of the four risk factors have a 28 percent
chance of experiencing at least one febrile
seizure. For children with a febrile illness, the
prime risk factors are the height of the fever
and a family history of febrile seizures. Spe-
cifically, 10 percent of siblings and 10 percent
of offspring of a person who had a childhood
febrile seizure also will have seizures with
fever.5 In one study,6 mean ferritin levels were
lower in children who had a seizure with fever,
suggesting a possible factor in febrile seizures.
The risk factors for recurrent seizures are
provided i