Convulsions that occur in children, usually between six months and five years of age, are associated with a high fever but not caused by an acute infection of the central nervous system.

A sudden rise in body temperature, often due to upper respiratory or gastrointestinal infections, can trigger these attacks. Parents often do not notice that the child has a fever, or it is a challenge for them to reduce the temperature by using antipyretics, soothing baths or compresses.

Predisposing factors for febrile seizures include difficulty at birth, delayed development of early neurologic function, and a family history of febrile seizures in parents or siblings. These seizures can manifest as tonic-clonic muscle contractions, loss of muscle tone, or stiffness. They can occur during an increase in temperature, while the temperature is high or during its decrease.

The clinical picture of fevers accompanying convulsions can be dramatic for parents. The child may lose consciousness while experiencing generalized tonic-clonic muscle contractions, with suffocation and cyanosis (blue skin). Long-term apnea is also possible, when the child stops breathing. Attacks usually last from 3 to 10 minutes, rarely longer, and usually stop spontaneously. Attacks can sometimes be repeated several times in one day, and their duration can vary.

Manifestations of fevers accompanying cramps may include:

• Loss of consciousness
• Muscle twitching (generalized or partial)
• Decreased muscle tone
• Stiffness (increased muscle tone)
• Short-term loss of contact with the environment (absence epileptic seizure, often described by parents as “seizures in which the child stares into space”)

After an attack, you should consult a pediatrician or a pediatric neurologist to rule out central nervous system infection. Some institutes recommend performing a lumbar puncture after the first attack of fevers accompanying the spasms.

There are typical and atypical bouts of fever that accompany the spasms. For typical attacks, continuous prophylaxis is not necessary. Instead, intermittent prophylaxis is used as needed, using diazepam suppositories or rectal gels. For children with atypical febrile attacks accompanied by convulsions, continuous prophylaxis with the use of phenobarbitone (4-5 mg/kg) or primidone is recommended.

First aid measures for parents of children prone to febrile seizures accompanying convulsions include:

• Keeping the child at home when he is sick and has a temperature above 38°C.
• Ensuring that the child remains well hydrated.
• Regular monitoring and measurement of the child’s body temperature.
• Administration of appropriate antipyretic drugs such as paracetamol (acetaminophen) when the child’s rectal temperature exceeds 38.5°C.
• For children older than one year, use 125 mg suppositories, 3 times a day.
• For children older than two years, use 250 mg suppositories, 3 times a day.
• Use of lukewarm water for baths and compresses if the temperature does not drop.
• In cases where children have already had seizures during previous illnesses, diazepam gel is administered rectally when the rectal temperature exceeds 38.5°C. The dose is 5 mg for children up to 10 kg and 10 mg for those who weigh between 10 and 15 kg.
• If the child continues to have seizures despite these measures, another diazepam gel suppository is administered. Lay the child on its side to prevent aspiration, and seek medical attention immediately. Only a doctor can determine whether these are “benign” seizures or more serious seizures that may indicate inflammation of the brain or meninges and require prompt treatment.

It is important to remember that diazepam is not a substitute for antipyretic drugs and will not reduce a child’s elevated body temperature. Therefore, it is also necessary to take antipyretic measures and frequently monitor the child’s body temperature.

Seizures that last longer than 20 minutes can lead to brain damage. In the initial phase, the volume of the heart increases. Tachycardia and hypertension increase cerebral blood flow, increasing oxygen and glucose consumption in the brain. Attacks accompanied by increased salivation and bronchial hypersecretion lead to hypoxia and hypercapnia.

Brain oxygen demand exceeds available supply, resulting in impaired cerebral autoregulation of blood flow, arterial hypotension, and reduced cerebral perfusion. There is damage to the mitochondrial system, cellular acidosis and an increase in lactic acid in the cerebrospinal fluid. The constant seizure activity causes calcium to enter the cells, leading to irreversible neuronal damage.

The prognosis varies and is difficult to predict. Patients may die during the status episode or in the postictal phase due to respiratory or cardio-circulatory disturbances. Severe cases may result in transient or permanent neurological deficits. A better prognosis is associated with prompt and appropriate treatment, where the time from the onset of seizures to treatment is shorter.

Treatment strategies include:

• Maintenance of vital functions
• Reducing fever with antipyretics, compresses and lukewarm baths
• Administration of diazepam intravenously (0.2-0.3 mg/kg) or, in newborns, by continuous infusion (0.3 mg/kg/hour, diluted with normal saline)
• Lorazepam can also be used, with a similar rapid onset of action but longer duration of action.
• Midazolam, another benzodiazepine, can be administered with a rapid onset and short duration of action.
• For more severe cases, thiopental (10 mg/kg slowly infused over 30 minutes) can be used.

Laboratory tests are important, including assessment of acid-base balance, ionogram, urea, ammonia, glucose, acetone, and aminoaciduria. Ophthalmological examination, biochemical, cytological and bacteriological analysis of cerebrospinal fluid, EEG and serum monitoring of antiepileptic drugs are recommended. Therapy should be carefully adjusted based on the results obtained.