Section 6. Brain, Spinal Cord, and Nerve Disorders

Chapter 85. Seizure Disorders

Topics: Introduction | Infantile Spasms and Febrile Seizures

Infantile Spasms and Febrile Seizures

Infantile spasms and febrile seizures occur almost exclusively in children.

In infantile spasms (salaam seizures), a child lying on his back suddenly raises and bends the arms, bends the neck and upper body forward, and straightens the legs. These spasms last for only a few seconds, but they may recur many times a day. They usually occur in children younger than 3 years. In many children, the spasms evolve into another type of seizure disorder later in life. In most children with infantile spasms, neurologic function develops slowly, and mental retardation is present. Usually, adrenocorticotropic hormone (ACTH) or another corticosteroid is used to treat these spasms. Usually, anticonvulsants are not effective in stopping the spasms; however, clonazepam and nitrazepam may have some benefit.

Febrile seizures (convulsive seizures) are seizures that are triggered by a fever. They occur in about 4% of children aged 6 months to 5 years but most often occur in children aged 9 to 20 months. Febrile seizures tend to run in families. Most children who have a febrile seizure have only one, and most seizures last for less than 15 minutes. Febrile seizures may be simple or complex. In simple febrile seizures, the entire body shakes (in a generalized seizure) for less than 15 minutes. In complex febrile seizures, the entire body shakes for more than 15 minutes, only one side of the body shakes--a partial seizure--for more than 15 minutes, or seizures occur at least twice within 24 hours. Children who have complex febrile seizures are slightly more likely to develop a seizure disorder later in life.

Children with febrile seizures should be taken to the emergency department for evaluation. Whether a child has meningitis or encephalitis may not be clear, and these disorders must be assessed and treated if present (see Section 6, Chapter 89). Usually, no treatment is given for a simple febrile seizure other than drugs to reduce the fever. For simple febrile seizures that recur or for complex febrile seizures, phenobarbital may be given to prevent seizures. However, phenobarbital can markedly interfere with the ability of the child to learn. Other anticonvulsants may be used instead.