Review on Febrile Seizures in Children

Abstract

Background: Febrile seizures are a common, yet benign neurological disorder and characterized by convulsions associated with fever in childhood due to the effect of fever on the immature brain. All treating clinicians must understand the nature and evaluation of this benign condition.
 Objective: To provide up-to-date knowledge on febrile seizures and their evaluation.
 Methods: A search was conducted with key terms “febrile seizures” or “febrile convulsion” in various databases and writings. The literature included clinical trials, descriptive and observational studies, meta-analyses, and randomized control trials. 
 Results: Febrile seizures occur between the ages of 6 months to 5 years in all ethnic groups. The exact mechanism has been still unknown although several etiologies have been proposed including genetic and environmental factors. Febrile seizures can be either simple or complex. Febrile seizures generally occur within the first day of fever but rarely happen after 24 hours. Most of the time, febrile convulsions are short-lasting and self-limiting. The diagnosis is mainly based on the clinical description, and investigations have a limited role. Children less than one year of age with suspicion of bacterial infection need lumbar puncture to exclude meningitis. Management mostly depends on control of fever and the treatment of underlying conditions which precipitate fever. Some children can have prolonged convulsions which need anticonvulsants to abort an acute attack. Otherwise, long term prophylactic anticonvulsants have an insignificant role in the prevention of recurrences of febrile seizures. Physical methods also play an insignificant role. As the condition commonly carries a favorable prognosis, unnecessary interventions should be avoided. Since febrile seizures recur in a significant proportion of children, they may bring needless fears and anxieties in parents. However, proper health education for parents by health care personnel might alleviate the anxiety and improve the quality of life of children with febrile seizures.
 Conclusion: Febrile convulsions are benign and self-limiting. Continuous use of anticonvulsants to prevent the recurrence of febrile seizures is not endorsed. Intermittent prophylaxis at the time of fever is also not routinely recommended. Both physical methods and antipyretics have limited value in the prevention of febrile seizures.

Tatalaksana Kejang Demam pada Anak Terkini

“…Jika kejang terjadi 3 hari setelah awitan demam, perlu dipikirkan penyebab lain seperti infeksi SSP. 21 Deskrip-si kejang yang diperlukan adalah bentuk kejang (umum, fokal/fokal menjadi umum), durasi kejang, kesadaran selama kejang, serta kondisi pasca kejang. Selain itu gejala yang menyertai demam untuk mencari sumber infeksi penyebab demam.…”

“…25 Pemeriksaan EEG dapat dipertimbangkan pada kasus kejang berulang tanpa keterkaitan yang jelas dengan demam, kejang lama atau status epileptikus. 21 Pemeriksaan pencitraan (CT scan atau MRI kepala) tidak rutin dilakukan pada anak dengan kejang demam sederhana. 26 Pemeriksaan tersebut dilakukan bila terdapat indikasi, seperti kelainan neurologis fokal yang menetap, misalnya hemiparesis atau paresis nervus kranialis.…”

“…20 Kejang demam yang atipikal/tidak khas perlu dibedakan dengan epilepsi yang mengalami kekambuhan karena demam, GEFS+ (Generalized/genetic epilepsy with febrile seizures plus), dan FIRES (Febrile infection-related epilepsy syndrome). 21…”

“…30 Intervensi rutin untuk mencegah kejang berulang tidak diperlukan pada kasus kejang yang berhenti sendiri. 21 Meskipun demikian, komplikasi kejang lama/kejang berulang dapat terjadi. Oleh karena itu, tatalaksana terbagi 3: (1) Tatalaksana pada saat kejang, yang tidak akan dibahas disini; (2) Terapi profilaksis terbagi menjadi profilaksis intermiten dan kontinyu/rumatan ;(3) Terapi anti piterik.…”

“…39 Bahkan pada anak dengan status neurologi normal, kejang yang lama pun tidak menimbulkan kerusakan otak. 21 Setiap orang tua anak dengan KD harus dijelaskan bahwa KD adalah benign dengan prognosis yang baik sehingga tidak perlu kekhawatiran yang berlebihan. 21…”