Management of Febrile Status Epilepticus

Abstract

Abstract The majority of seizures that arise with fever in infants and children are brief and cause few long-term consequences. A subset of the seizures is prolonged and, when lasting >30 minutes, are termed febrile status epilepticus (FSE). Human and experimental animal data indicate that FSE may be associated with injury to the hippocampus and subsequent temporal lobe epilepsy (TLE) and cognitive problems. Current clinical approaches in the treatment of febrile seizures recommend administration of benzodiazepines to abort the seizure and prevent the evolution of FSE. However, the minimal duration of FSE that leads to epilepsy and memory deficits is unclear, and the first FSE in a child—which is sufficient to provoke long-term consequences—is often difficult to anticipate and abort. Ongoing human and experimental animal studies are beginning to uncover the mechanisms by which FSE can lead to injury, epilepsy, and cognitive deficits in both normal and predisposed individuals. These mechanisms include neuroinflammation and large-scale changes in neuronal gene expression and synaptic connectivity within hippocampal circuits. Future therapy will focus on aborting adverse FSE-induced consequences using mechanism-based interventions.