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is any other concern about the child’s neurological state hospital assessment is appropriate.
A lumbar puncture may be necessary to exclude meningitis in the minority of cases,
particularly in children younger than 18 months. Ideally this decision should be made by an
experienced doctor. Investigations are not routinely indicated after febrile convulsions  the
EEG is not helpful and brain scans are rarely indicated.

Subsequent medication
If febrile convulsions are prolonged it may be appropriate to teach parents to administer
buccal midazolam or rectal diazepam at home to prevent further prolonged episodes. There
is no convincing evidence that antipyretic measures reduce the frequency of febrile
recurrences or that the administration of intermittent or continuous prophylactic
anticonvulsant medication reduces the risk of later epilepsy. Prophylactic medication is now
not generally advised for children with febrile convulsions.

Information for carers
Many parents/carers are very distressed when they witness febrile convulsions in their
children and it should be a priority to inform them about the essentially benign nature of most
febrile convulsions. When assessing the prognosis it is relevant to consider the type of febrile
convulsion and the clinical context in which it occurs, but parents can be reassured that for
the majority of children with febrile convulsions the outcome is good and that medication is
rarely indicated. Ideally, written information should supplement the interview and there are
now excellent videos that provide advice and support for parents.

References

1. ROBINSON, R.J. (1991) Febrile Convulsions. Further reassuring news about prognosis. Br. Med. J. 303, 1345-
1346.

2. ANNEGERS, J.F., HAUSER, W.A., ELVEBACK, L.R. et al (1979) The risk of epilepsy following febrile
convulsions. Neurology 29, 297-303.

3. ANNEGERS, J.F., HAUSER, W.A., SHIRTS, S.B. et al (1987) Factors prognostic of unprovoked seizures after
febrile convulsions. N. Engl. J. Med. 316, 493-498.

4. ANNEGERS, J.F., BLAKLEY, S.A., HAUSER, W.A. et al (1990) Recurrence of febrile convulsions in a
population-based cohort. Epilepsy Res. 5, 209-216.

5. FORSGREN, L., SIDENVALL, R., BLOMQUIST, H.K. et al (1990) A prospective incidence study of febrile
convulsions. Acta Paed. Scand. 79, 550-557.

6. FORSGREN, L., SIDENVALL, R., BLOMQUIST, H.K. et al (1990) An incident case-referent study of febrile
convulsions in children: genetical and social aspects. Neuropaediatrics 21, 153-159.

7. FORSGREN, L., SIDENVALL, R., BLOMQUIST, H.K. et al (1991) Pre- and perinatal factors in febrile
convulsions. Acta Paed. Scand. 80, 218-225.

8. ELLENBERG, J.H. and NELSON, K.B. (1978) Febrile seizures and later intellectual performance. Arch. Neurol.
35, 17 -21.

9. NELSON, K.B. and ELLENBERG, J.H. (1976) Predictors of epilepsy in children who have experienced febrile
seizures. N. Engl. J. Med. 295, 1029-1033.

10. NELSON, K.B. and ELLENBERG, J.H. (1978) Prognosis in children with febrile seizures. Pediatrics 61, 720-727.
11. OFFRINGA, M., HAZEBROEK-KAMPSCHREUR, A.A.J.M. and DERKSEN-LUBSEN, G. (1991) Prevalence

of febrile seizures in Dutch schoolchildren. Paed. Perinatal Epidemiol. 5, 181-188.
12. VERITY, C.M., BUTLER, N.R. and GOLDING, J. (1985) Febrile convulsions in a national cohort followed up

from birth. I. Prevalence and recurrence in the first five years of life. Br. Med. J. 290, 1307-1310.
13. VERITY, C.M., BUTLER, N.R. and GOLDING, J. (1985) Febrile convulsions in a national cohort followed up

from birth. II. Medical history and intellectual ability at 5 years of age. Br. Med. J. 290, 1311-1315.
14. VERITY, C.M. and GOLDING, J. (1991) Risk of epilepsy after febrile convulsions: a national cohort study. Br.

Med. J. 303, 1373-1376.
15. VERITY, C.M., ROSS, E.M. and GOLDING, J. (1993) Outcome of childhood status epilepticus and lengthy febrile

convulsions: findings of national cohort study. Br. Med. J. 307, 225-228.
16. VERITY, C.M., GREENWOOD, R. and GOLDING, J. (1998) Long-term intellectual and behavioural outcomes

of children with febrile convulsions. N. Engl. J. Med. 338, 1723-8.
17. AICARDI, J. (1994) Febrile convulsions. In: Epilepsy in Children. Second Edition. International Review of Child

Neurology Series, pp. 212-235. Raven Press, New York.
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(Eds J. Roger et al), pp. 45-52. John Libbey, London.
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369. Chapman and Hall, London.
20. CROSS J.H. (2012) Fever and fever-related epilepsies. Epilepsia Suppl 4:3-8.