Febrile seizure is
define as seizure that occurred in association with fever in a child aged 3 month
to 6 years old, without any evidence of intracranial pathology or metabolic
derangement. Febrile seizure can be simple or complex. Complex febrile seizure
is diagnosed when the duration is more than 15 minutes, there was multiple
episodes within 24 hours, presence of neurological deficit post ictal such as
Todd’s paralysis and also with the presence of focal features. Other than that
it is considered as simple febrile seizure.

There were many
proposed risk factors for a child developing febrile seizure. (Sharawat, I.K., et al, 2016) study shows that male gender (70%),
family history of febrile seizures (31.4%), core body temperature and antenatal
complications such as bleeding (13%) or difficult labour (21%) are the risk
factors associated with the occurrence of first episode of febrile
seizure 

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While a study by (Sit, S.P.,
et al, 2016) suggested iron deficiency as a risk factor for simple
febrile seizure. In their case control study, they found 64% out of 50 simple
febrile seizure cases had iron deficiency anemia compared to control group
which is only 22%. The difference among this two groups in relation to iron
deficiency anemia was significant. This is supported by another case control
study by (Saha,
A.K., et al, 2016) where they found haemoglobin,
haematocrit, mean serum ferritin and serum iron, were significantly low in the
febrile seizure group as compared to control group.

The prognosis of
febrile seizure is good. If patient do develop complication, the numbers are
minimal. This is shown where out
of 207 patient who were followed for a minimum of 8 years, 10% had neurological
complication and only 6% of the children developed subsequent epilepsy (MacDonald, B.K., et al,
1999). When
comparing to simple febrile seizure, a greater amount of the children who had a
complex first febrile seizure developed epilepsy but it is not significant (Verity,
C.M. and Golding, J., 1991). According
to (Trinkaa, E., et al, 2002), factors that consistently increase the risk for
developing epilepsy following febrile seizure include family history of
epilepsy, complex febrile fit, and early onset neurodevelopmental
abnormalities.

(Verity, C.M., et al,
1998) have observed
long term intellectual and behavioural outcome in children with febrile
seizures. Their study are done in United Kingdom shows that those with febrile
seizures perform as well as other children without febrile seizure in term of academic
performance, intellectually and behaviourally when assessed at 10 years of age.
The result also shows that there are no difference in this aspect between the
children with recurrent episodes of febrile seizure compared to those children
with only one episode each. However, they did find that children who had
febrile seizure in the first year of life (8%) need special schooling more than
those who had febrile seizure later in life (2%).

Febrile
seizure might be terrifying to parent especially for those who deal with it for
the first time such as in this patient. According to (Baumer, J.H., et al, 1981), among parents whose children was
admitted to hospital with their first febrile seizure, when interviewed shortly
after the event, majority said they had thought the child was dying or likely
to die. So It is important to take note parents concern, as the consequences of parental fear will lead to repetitive
temperature measurements (25% measured five times per day or more), sleeping in
the same room (24%) and 13% remained awake at night (Van Stuijvenberg, M., et al, 1999). This may cause severe impairment to the family daily life.

In
a study by (Huang, M.C., et al, 2002), data shows fewer than
5% tried to protect the child on a soft and safe surface during the initial
febrile seizure occurrence. On the other hand, 53% shook and try to wake the
convulsing child, 35% tried to insert something into the child’s mouth and more than 85% of the parents rushed the
child to a hospital or clinic. Arousing a convulsing child and putting
something in their mouth is a widespread misconception that we commonly see
here in Malaysia. They also have the fear that this seizure might turn into
epilepsy. So patient education and reassurance is important in our management
plan. They need advices on the common nature of
febrile seizures, the rare association with epilepsy, and reassurance that the
tendency diminishes with age as the brain matures (Patel, N., et al, 2015)

Parent’s
education is significant as it will improves parent’s confidence and their capability
to manage seizure at home. It is best achieved by verbal counselling including explaining possible event that will
happen, recommended first aid during
attack and emotional support, rather than only mailed pamphlet. (Huang,
M.C., et al, 2002).

Parents
also should be warned on the possibility of recurrence. Recurrence is common in
those who present with complex febrile seizure (93%)
as compared to simple febrile seizure (67%). It is also increase in those who
have a family history of febrile seizure (35%)
or epilepsy (13%), those that had febrile seizure within 24 hours of onset of
fever (70%) and parental consanguinity (22.2%) (Rane, M., et al, 2015). Similarly, (Jamal, M.M. and Ahmed, W., 2015) study shows
that those who have a mild rise in body temperature at the onset of
seizure, younger age at first occurrence, onset of seizure within 6 hours of fever
and those have atypical presentation will have higher chance of recurrence.
Another risk factor proposed for recurrence is febrile status epilepticus on
first occurrence (Hesdorffer, D.C., et al, 2016).

If
recurrence occurs first aid measures advices that can be given to parents, is
first to remain calm and note the onset of the seizure and the character of it.
It helps to loosen the child’s clothing especially around the neck. Then place
the child in a left lateral position with the head lower than the body. Parents
can wipe any vomit or secretion from the mouth however do not put anything inside
the mouth as this can lead to injury. Also avoid from giving any fluid or drug
orally. Parents need to stay near the child to protect the child during seizure
and comfort the child when seizure is over.

Febrile seizure is
a common case in the ward. In paediatrics we not only want to manage the
disease itself but we aim to manage the patient as a whole. Parents play an
important role in helping us in treating the patient. So parent’s education and
proper explanation is important in making sure that the child get the optimal
care that the parents can give with our help.