Febrile Seizures and Childhood Epilepsy Syndrome: What Parents Should Know

Febrile seizures are seizures that occur in children aged 6 months to 5 years due to fever with a body temperature above 38°C, without any obvious central nervous system infection. Febrile seizures are divided into two types, namely simple febrile seizures and complex febrile seizures. Simple febrile seizures are short-lived (less than 15 minutes), do not recur within 24 hours, and do not show focal signs. Meanwhile, complex febrile seizures can last longer, recur within 24 hours, or show focal signs. Although most febrile seizures are not dangerous, it is necessary to be aware of the possibility of brain abnormalities that are at risk of causing long-term disability, such as due to brain infections (encephalitis or meningitis), blood vessel disorders, or congenital abnormalities.

First Aid When a Child Has a Febrile Seizure
1. Stay calm and don't panic.
2. Do not put anything in the child's mouth, including spoons or fingers, because this can cause injury.
3. Position the child in a safe place, away from dangerous objects.
4. Place a pillow or soft object under the child's head to prevent injury.
5. Turn the child's body to prevent choking if there is vomit or excessive saliva.
6. Note the time of the seizure, because the duration of the seizure is important in determining next steps.
7. If possible, record a video of the seizure to assist the doctor in further evaluation.
8. Do not restrain the seizure movements or try to stop them in any way.
9. After the seizure stops, make sure the child is in a comfortable position and observe his consciousness.
10. If this is the first time your child has had a febrile seizure, immediately take him to the hospital for further evaluation.

Signs that your child must be immediately taken to the emergency room
1. The seizure lasts more than 5 minutes.
2. Recurrent seizures within 24 hours.
3. The child is unconscious or unresponsive after the seizure stops.
4. Seizures accompanied by repeated vomiting, neck stiffness, or difficulty breathing.
5. Seizures occur in babies under 6 months of age.
6. The child experiences focal seizures (only part of the body experiences seizures).
7. The child has a previous history of neurological disease or brain abnormalities.

Several Epilepsy Syndromes in Children Related to Febrile Seizures
1. West Syndrome
   - Often occurs in babies.
   - Characterized by the classic triad: infantile spasms, hypsarrhythmic EEG pattern, and developmental delay.
   - The typical EEG pattern shows hypsarrhythmia, in the form of irregular and repetitive sharp waves.
   - Some cases have a history of febrile seizures before developing West Syndrome.

2. Ohtahara Syndrome
   - Onset usually occurs in the neonatal period.
   - EEG shows burst suppression pattern.
   - Has a poor prognosis with severe developmental delays.

3. Lennox-Gastaut Syndrome
   - Onset usually occurs at the age of 1-8 years.
   - EEG shows a slow spike and wave pattern.
   - Often develops from West Syndrome.
   - The seizures are refractory to treatment.

4. BECTS (Benign Epilepsy with Centrotemporal Spikes)**
   - Often occurs in children aged 3-13 years.
   - Characterized by focal seizures that mainly occur during sleep.
   - The EEG pattern shows typical centrotemporal spikes.
   - Prognosis is very good, with the possibility of disappearance in adulthood.
   - Sometimes has a history of febrile seizures, although not always.

5. Dravet Syndrome
   - Onset is often before 1 year of age.
   - Associated with genetic mutations, especially SCN1A.
   - Characterized by seizures that are triggered by fever and develop into more complex seizures.
   - EEG can show changes in patterns as the child grows.
   - Often accompanied by developmental disorders and cognitive difficulties.

The Role of EEG in the Evaluation of Seizures in Children
EEG is not routinely used for simple febrile seizures, because this condition is usually benign and not related to epilepsy. However, EEG can be useful in certain situations, such as:
- If the seizures have atypical characteristics (for example, long-lasting, recurrent, or focal).
- If there is a family history of epilepsy.
- If there is a suspicion of certain epilepsy syndromes that can develop from febrile seizures.

Further evaluation with EEG and brain imaging can help determine whether a child is at risk of developing epilepsy or experiencing a more serious neurological disorder. Therefore, it is important for doctors to conduct a thorough evaluation of children with a history of unusual febrile seizures to ensure appropriate treatment (RIR)