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Epilepsy: the facts-convulsions associated with fever EPILEPSY: THE FACTS-CONVULSIONS ASSOCIATED WITH FEVER
A convulsion which occurs in association with any illness, usually an infection, which causes a rise in temperature (fever), is known as a febrile convulsion.
Febrile convulsions are not a type of epilepsy. In the past it was thought that febrile convulsions could lead to epilepsy but this is now generally believed only rarely to be the case. There are at least three subgroups of febrile convulsions:
(a) The first and largest subgroup is made up of children who have seizures in response to fever as a result of an individual susceptibility that is usually inherited. These children develop normally and have normal EEGs and normal brain scans. This is the group which constitutes 'true' febrile convulsions.
(b) The second subgroup comprises children in whom the fever or high temperature acts as a trigger that unmasks epilepsy. In these children, seizures or fits without a fever soon develop and the children then can be seen to have definite epilepsy. Magnetic resonance imaging in these children usually shows subtle structural abnormalities, often in one temporal lobe. Before their first febrile convulsion, these children may have been developing more slowly than most children.
(c) A very small subgroup comprising children who convulse with fever due to meningitis or encephalitis—meaning respectively an inflammation or infection of the membranes covering the brain, or of the brain substance itself. Obviously it is critically important to recognize this subgroup in order that energetic curative treatment can be started as soon as possible.
'True' febrile convulsions, as defined in (a) above are common: 2-4 per cent of children between the ages of 6 months and 5 years will have at least one febrile convulsion. The most common age is between 12 and 20 months. One should be careful about accepting a diagnosis of a 'true' febrile convulsion in a child aged less than 6 months or older than 5 years—they are more likely to have epilepsy triggered by fever. Girls are more likely than boys to have a febrile convulsion. Up to a third of children, who have had one, will have a second febrile convulsion before the age of 5 years.
Most of the convulsions are tonic-clonic (grand mal), and last less than 4-5 minutes. This type of febrile convulsion is called 'simple'. 'Complex' or complicated febrile convulsions are ones that involve only one side of the body, last longer than 15 minutes, or are followed by weakness or loss of use of one side of the body. These 'complex' febrile convulsions are uncommon and account for no more than 10-20 per cent of all 'true' febrile convulsions. Complex febrile convulsions are more commonly seen in children in the other two groups—(b) and (c) described above.
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Epilepsy
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