Complex Febrile Seizures: An Update

Abstract

Febrile seizures are the most common seizures in childhood. Febrile seizures are divided into two groups: simple and complex. Simple febrile seizures (SFS) are generalized, short, and occur only once in 24 hours. Complex febrile seizures are prolonged, focal, or repeat more than once in 24 hours. Around 35% of children experience complex features as part of their initial seizure event. These children have more chances of complex recurrences than children with SFS. While the guidelines for SFS remain clear, there are no clear guidelines for the evaluation of children with complex febrile seizures. The conflicting results about electroencephalography (EEG) utilization preclude drawing meaningful conclusions. An EEG can be obtained in children with persistent alteration of consciousness after the seizure, and emergent neuroimaging is not required in most cases. Due to low incidence of bacterial meningitis in the post-vaccination era, it is reasonable to perform lumbar puncture (LP) only if there is clinical concern for central nervous system infection. LP should also be considered in children between 6 and 12 months of age with incomplete or unknown vaccination status or who have been previously treated with antibiotics. Further, antipyretics are used to make children more comfortable during the febrile process, but are ineffective in reducing the rate of seizure reoccurrence. Continuous antiepileptic therapy and intermittent oral diazepam are effective in the prevention of subsequent febrile seizures, but they do not reduce the risk of epilepsy and have potential unwanted side effects. In specific circumstances, the benefits of antiseizure medications may outweigh the risks. Treatment may be a consideration in cases of febrile status: patients with electroclinical features suggesting a specific epilepsy syndrome or children with limited access to health care services.