CONCEPT

Fever convulsion are those produced during high fever episodes.

INCIDENCE

• They affect 1% to 5% of population.
• They’re associated to a fever scenario, but with no evidence of cranial infection.
• There is a genetic predisposition to suffer from them.
• The age of first manifestation is between 6 months and 5 years, 55% of cases during the second year of life.
• Generalized in 80% to 90% of all cases.
• Brief, with a duration of less than 15 minutes.
• It’s a one time manifestation in 65% of all cases; only 13% of patients present two episodes, and 9% three episodes or more, during the same fever process. In general, they recur in the next six months of the first episode, being more frequent in patients younger than 15 months, and in patients with family antecedents.
• Risk of later epilepsy after the fever convulsions is at 2% at 7 years of age and at 7% at 25.

ASSESSMENT

• General and neurological exploration, to clarify the fever’s origin and dismiss and infection of the central nervous system (CNS). In some cases a lumbar puncture (cephalorraquideal fluid extraction for further analysis).
• Electroencephalogram (E.E.G). It isn’t strictly necessary to perform an E.E.G after a sole convulsion episode. If it is performed, it must be done at least two weeks after the first episode. It doesn’t have predictive value, although the current custom is to do one and then later an annual check up.

TREATMENT AND PREVENTION

Fever Control. with medicine (Paracetamol, Ibuprofen, Aspirine®, etc) and physical measures (warm water baths, application of cloths or compresses moistened in warm water, to be applied on the body).
 
Prophylactic treatment of new convulsions: a controversial issue, with no clear evidence that it can reduce the risk of epilepsy, although it appears to reduce the recurrence of fever crises. There are several alternatives, with a similar effectiveness (from 12% to 15% of therapeutic failures in all cases):

• Diazepam. Rectal administration of diazepam, exclusively during the fever episodes, in a prophylactic way every 8 hours. It’s not advisable in the presence of serious respiratory depression.
   
• Phenobarbital. 5 mg/Kg/a day, orally, in a continuous way. It requires periodical control of blood levels. It presents secondary effects on the neuropsychic development (irritability, sleep disorders, hyperactivity, and learning and concentration problems).
   
• Valproic acid. It also produces secondary effects (liver alterations, hyperactivity, irritability and coagulation disorders). It is necessary to control the blood levels periodically and the liver function during the first months of treatment.

INDICATIONS OF THE PROPYILACTIC TREATMENT

• Age: younger than 12 months.
• Third episode of fever convulsion.
• Prolonged Convulsion (more than 15 minutes).
• Focal Convulsion (not generalized).
• Recurrent Convulsion during the same fever process, especially in the first 24 hours.
• Prolonged post crisis.
• Transient or permanent abnormal neurological exploration.
• The prophylactic treatment is effective in regard to the prevention of recurrence.