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Symptoms and Signs of Febrile Seizures (Seizures and Fever)

Doctor's Notes on Febrile Seizures (Seizures and Fever)

Febrile seizures are a sign and symptom of a potentially serious underlying medical problem, especially if they occur in adults. Signs and symptoms of febrile seizures include fever, followed by when the person makes a moaning or unusual sound or becomes stiffened and is not responsive or alert. Frequently, symptoms progress to abnormal rhythmic jerking of the arms and/or legs; the person usually falls down. Incontinence of urine is common. The patient may not appear to be breathing; however, if the seizure is of brief duration, the patient actually may be taking short breaths that are not noticeable. In most individuals, during the seizure, the eyes are open but the person is not responsive. Some individuals may be somewhat combative briefly as a return to consciousness gradually happens over a few minutes. Some individuals may have mild seizures with only staring spells and/or stiffening without rhythmic jerking. Others may have abnormal movements of a single limb.

The first seizure, especially if it is associated with fever, is a medical emergency in adults or if seizures last more than five minutes, the patient has breathing difficulty, is injured during the seizure or has persistent confusion or unconsciousness.

In children, simple febrile seizures are common; they usually last only a few minutes and produce the following signs and symptoms – rolling the eyes, moan or make others sounds, becoming unconscious, vomiting and/or urinate during the seizure, and convulse, shake or twitch during the seizure. In most instances, fever seems to be the cause of seizures; febrile seizures in children cause no long-term problems and are usually treated with over-the-counter fever medications except for aspirin and/or tepid baths. Complex febrile seizures last longer than 10 minutes, usually occur more than once in 24 hours; medical caregivers should examine the child.

The cause of a febrile seizure is not clear but virus infections and bacterial infections are usually associated with febrile seizures. If bacterial infections that are related to fever and seizures are suspected, emergent medical care should occur.

Medical Author:
Medically Reviewed on 3/11/2019

Febrile Seizures (Seizures and Fever) Symptoms

By definition, febrile seizures occur when the child has a fever. Most febrile seizures are generalized. In other words, the whole body may be involved.

During a generalized seizure, any or all of the following may be seen:

  • Stiffening of the entire body
  • Jerking of the arms and legs
  • Complete lack of response to any stimuli
  • Eyes deviated, staring, rolling back, moving back and forth
  • Tightness of the jaws and mouth
  • Urinary incontinence (wet their pants)
  • Noisy breathing, labored, slower than normal (unusual for a child to stop breathing completely)
  • Although it may seem like an eternity if you are witnessing a seizure, most of these episodes last only 1-5 minutes. Afterward, the child is typically drowsy but usually starts to become responsive within 15-30 minutes.
  • Following a seizure, a child may remain somewhat “twitchy,” with intermittent small jerks of the arms or legs. It can be difficult to distinguish these movements from seizure activity, but the caregiver should be reassured if the child’s body tone has become relaxed, breathing is regular, and the child begins to show some signs of responding to stimulation (will respond if talked to, for example).
  • Focal seizures are less common and, as the term implies, involve only a part of the body. Abnormal movements may be seen only in the face (eye blinking, lip smacking, other movements of the mouth) or one side of the body. Variable degrees of alteration in consciousness are seen in focal seizures. Some seizures begin as focal ones and then become generalized.

Febrile Seizures (Seizures and Fever) Causes

Febrile seizures are classified into 2 types:

  • Simple febrile seizures are more common and are characterized by generalized seizures that last less than 5 minutes.
  • Complex febrile seizures are those that are either prolonged (longer than 15 minutes), focal (meaning they involve only a part of the body, such as the face), or recurring within a 24-hour period.

Children who have experienced a complex febrile seizure may be at risk for these outcomes:

  • A somewhat higher risk of having a serious infection
  • More likely to have preexisting neurologic abnormalities
  • A higher risk for developing epilepsy later

Most fevers associated with febrile seizures are due to the usual causes of fever in young children—namely, common viral and mild bacterial infections such as ear infections. Although perhaps only 1% of children with febrile seizures have a serious infection of the central nervous system such as meningitis, this possibility should always be carefully considered in a child who has had a febrile seizure.

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REFERENCE:

Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.

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