American Medical Association Family Medical Guide - American Medical Association [187]
Children who have had a febrile seizure have a 30 percent chance of having another one within the next 6 months. Although alarming for parents to watch, febrile seizures usually have no serious, long-term effects on the brain. Children who have had a simple seizure have a 2 to 4 percent chance of developing epilepsy later in life (compared with a 1 percent risk for the general population). If the seizure was complex, if the child has other brain abnormalities, or if epilepsy runs in the family, the child’s risk of developing epilepsy rises to 10 percent.
Symptoms
A child with a simple febrile seizure has convulsions that produce a rhythmic jerking of the arms and legs, rolling of the eyes, unresponsiveness, and, sometimes, bluish skin around the mouth and at the tips of the fingers and toes. For the next half hour, the child looks drowsy and confused. As his or her temperature returns to normal, the child may become his or her usual self again. Occasionally, simple febrile seizures produce no convulsions, only a temporary loss of consciousness and stiffening of the body.
Diagnosis and Treatment
If you think your child is having a febrile seizure, take him or her to the doctor or to a hospital emergency department for an evaluation. If your child is older than 18 months, the doctor will probably examine him or her for signs of meningitis (inflammation of the membranes covering the brain and spine; see page 692). If no signs of meningitis are present, your child will not need any treatment, although the doctor may recommend acetaminophen or ibuprofen to reduce the fever.
Children younger than 18 months often fail to show signs of meningitis, so doctors routinely order a lumbar puncture (see page 693) to detect any of the microorganisms that cause meningitis. To perform a lumbar puncture, the doctor inserts a hollow needle into the lower part of the spine and takes a sample of the cerebrospinal fluid for examination under a microscope. There is no specific treatment for viral meningitis, which is usually mild and clears up on its own in about 1 week. Bacterial meningitis requires large doses of antibiotics delivered intravenously (through a vein).
Doctors sometimes prescribe the short-term use of an anticonvulsant medication or the tranquilizer diazepam, given when the child has a fever, to prevent febrile seizures in the future.
Reye’s Syndrome
Reye’s syndrome is a rare, life-threatening disorder that causes swelling of the brain and liver, most frequently in children between ages 4 and 16 who are recovering from a viral infection such as a cold (see page 648), chickenpox (see page 439), or influenza (see page 649). The swelling damages the brain, liver, and kidneys. Research has shown that Reye’s syndrome is often (but not always) linked to taking aspirin or other medications that contain salicylates (such as over-the-counter cold medications) to relieve the symptoms of a viral infection. For this reason, doctors recommend that children younger than 18 years take acetaminophen or ibuprofen instead of aspirin.
Symptoms
The initial symptom of Reye’s syndrome is uncontrollable, forceful vomiting that occurs over a period of about 3 hours to 3 days. As the brain swells, it begins to malfunction and the child becomes drowsy, lethargic, confused, and disoriented. Other symptoms that may develop include slurred speech, memory loss, hallucinations (abnormal perceptions not based on reality), and sudden episodes of aggressive behavior. Severe swelling of the brain can lead to seizures, coma, an abnormal heartbeat, and cessation of breathing. Severe swelling of the liver causes jaundice (yellowing of the skin and the whites of the eyes), and damage to the kidneys can lead to kidney failure (see page 817). Reye’s syndrome is a medical emergency. If your child has symptoms of Reye’s syndrome, take him or her to the nearest hospital emergency department immediately. Early detection and treatment of Reye’s syndrome is essential