Febrile (fever) seizures are the most common type of seizure in the world, affecting from 2-5% of children (see the video on this site), occurring between the ages of 6 months and 5 years of age. Febrile seizures are divided into two types: simple and complex. A simple febrile seizure lasts less than 15 minutes, is generalized (nonfocal), does not recur within 24 hours, results from a fever but not a brain infection, is not associated with other neurological problems, and occurs in a child with no previous seizures that are not due to fever. Complex febrile seizures last longer than 15 minutes and are associated with previous or current other neurological findings.

The Italian League Against Epilepsy has recommended guidelines for treating febrile seizures, in an article in the journal, Epilepsia 2009 volume 50, supplement 1, pages 2-6. For a first simple febrile seizure in a child less than 18 months who appears well, admission is not recommended. If previous simple febrile seizures have occurred, admission is not recommended at any age, but other diagnoses should be considered. An EEG or brain imaging with CT or MRI is not recommended for simple febrile seizures. Lumbar puncture (spinal tap) to look for meningitis is recommended for children with a stiff neck or headache or those younger than 18 months. If the child appears well, observation for 24 hours can replace lumbar puncture. Simple febrile seizures are not treated in the emergency room, unless they persist for longer than three minutes.

Febrile seizures return in about one-third of children, but rarely lead to epilepsy in later life, and treatment of the febrile seizure does not measurably influence this risk. Chronic treatment of simple febrile seizures with antiepileptic drugs is not recommended, because the side effects outweigh the risks of having other febrile seizures. In special circumstances, ongoing daily treatment with phenobarbital or valproic acid may be used, for example, for seizures longer than 15 minutes or four or more seizures in a single year. Parents can have on hand diazepam (Diastat) for rectal administration at the start of a seizure or onset of a fever. Treatment for complex febrile seizures must be individualized, and the Italian League provided no specific guidelines.

Doctors are not required to follow guidelines and in fact are encouraged to tailor treatment to the individual patients. But doctors are expected to be influenced by the best-practice evidence used to formulate guidelines, and this article provides a helpful summary.