Evaluating and treating the child with a febrile seizure

Approximately 3% to 5% of children will experience a febrile seizure before the age of 5 years, with the peak onset in the second year of life. The majority of these seizures are "simple" (generalized, lasting less than 15 minutes, occurring only once in a 24-hour period), carry few risks of complications, and have excellent short- and long-term prognoses. Children with comlex febrile seizures (focal features, lasting more than 15 minutes, occuring more than once in a 24-hour period) have higher rates of coexisting problems (electrolyte disturbances and meningitis) and are at greater risk of recurrence and epilepsy than their counterparts with simple febrile seizures. A bacterial source for the fever is rarely found; a combination of host susceptibility in concert with viral trigger is believed to be responsible. Routine "screening tests" are unnecessary, and evaluation should be directed by the results of individual history and physical examination. Antipyretics have not been shown to decrease the incidence of recurrence in susceptible children. Oral and rectal diazepam have been shown to decrease recurrent seizures only in a select subset of children at high risk for recurrence.