In this post I would like to talk about seizures in children. Seizures are among the most common conditions for which pediatric neurologists are consulted. Seizures in children differ from seizures in adults. Also the etiology of seizures in children differs from that in adults. There are many epilepsy syndromes which have been described in the pediatric age group, each has its own natural history and prognosis.
Typical febrile convulsion: as the name suggests this is a seizure (convulsion) associated with fever. Febrile seizures/ convulsions are mostly seen in the age group of 6 months to 6 years of age. Classically the child has high fever (may be on account of a sore throat or any other condition), as the fever is rising, the child is noted to have a brief seizure/ convulsion. I used the word brief because in its typical form a febrile seizure is brief lasting for a few seconds to minutes. Also in a typical febrile seizure, the seizure is a generalized tonic clonic seizure (the child stiffens up and then shakes). Typical febrile seizure has a good prognosis and does not lead to epilepsy later on in life. As a result these children need not be treated with anti-epileptic drugs. Children outgrow the seizures after the age of 6 years or so. All we advise parents is to keep the fever down. At times the neurologist might prescribe rectal diazepam. This is marketed under the name Diastat. Rectal diazepam is a benzodiazepine drug which can be given by the rectal route. Parents can give it by themselves, the drug is rapidly absorbed across the rectal mucosa and may abort a prolonged febrile convulsion. Usually febrile seizures run in the family and if a careful history is taken, one finds that one of the child’s parents too had febrile seizures as a child.
Atypical febrile convulsion: a febrile seizure is said to be atypical when either it is very prolonged (remember I said febrile seizures are usually brief) or when it is not generalized but rather focal (one arm or limb shakes not the whole body). Sometime the seizure may occur without fever or even with temperature less than 100 F. Atypical febrile seizures may lead to epilepsy later in life and hence these children have to be closely followed. If a child has multiple febrile seizures or has a seizure everytime he or she has fever, your doctor may recommend an anti-epileptic drug for a short time. The drug most commonly used in this age group is phenobarbital. Phenobarbital is a safe drug which has been around for awhile now. Its most common side-effect is sedation.