Febrile seizures in pediatric practice: Risk factors, clinical manifestations, and intensive therapy

Abstract

   Introduction. Febrile seizures (FS) is the most common type of epileptic seizure experienced by young children. Study of methods of intensive treatment (IT) of FS represents a vital area of research in today’s pediatric science.   The aim of this work: to assess the current approaches to risk factors, clinical manifestations and emergency care for patients with FS in pediatric practice. Materials and methods. The authors performed an analysis of publications that were found in the Cochrane Library, PubMed, eLibrary.ru, and Medscape databases using the following search terms: febrile seizures, children and adolescents, intensive treatment, anticonvulsants. A total of 64 published sources were chosen for review.   Results and Discussion. The risk factors for FS may be numerous, with the main etiological causes in children being genetic susceptibility, viral infections and vaccination. The clinical presentation of FS is characterized by the development of a generalized tonic-clonic seizure in the setting of a high body temperature (≥39°C). FS are subdivided into three main clinical types: simple, complex and febrile status epilepticus (FSE). History taking and physical examination represent the main diagnostic means for determining the type of FS and discovering the cause of infection. Laboratory tests, electroencephalography, neuroimaging studies and lumbar puncture are used on a limited basis, mainly in children with complicated FS accompanied by a brain infection. Hospitalization for IT is necessary if the child has prolonged febrile seizures or FSE. The drugs of choice for relieving FS are benzodiazepines. Barbituric acid derivatives and valproic acid also possess therapeutic efficacy against FS. Antipyretic agents are effective only in relieving the toxic syndrome, but have no effect on the severity of FS and do not prevent relapses. The main antipyretic medications used for treatment of FS in pediatric practice are paracetamol, ibuprofen and nimesulide. Besides benzodiazepines, IT of FSE involves the use of intravenous fosphenytoin, phenobarbital or levetiracetam.   Conclusion. Improvement of the quality of IT in pediatric practice may improve the therapeutic prognosis in patients with FS and bring down complication and mortality rates.