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February 13, 2011
The child who has a first seizure with a fever does not necessarily need special x-rays or brain scans.
Fever lowers the brain’s threshold for seizures and thus may provoke them. Indeed, as noted earlier, a seizure can be induced in anyone if the temperature is sufficiently high. Young children have a lower seizure threshold anyway, and thus are more susceptible to a seizure when a rapidly rising fever further lowers this already low threshold. This is the reason why such seizures tend to occur in young children. The threshold gradually increases over the first years of life as the brain becomes more mature, which is why these infants and young children outgrow the tendency to febrile seizures as they grow older. Febrile seizures are very uncommon after age five or six.
Susceptibility to febrile seizures appears to have a genetic base. Such seizures tend to occur in certain families.
These three factors—the lower threshold of the infant (ages three months to two or three years), the height and rapidity of rise of the fever, and the genetic threshold—all three in combination may lower the seizure threshold sufficiently to cause a seizure. A higher fever or more rapid rise in fever in an infant without a family history of seizures may be enough to trigger a seizure; a lower fever in an infant with such a family history may be enough. In an older child, whose threshold is higher, a high fever may be sufficient with a family history of febrile or afebrile (nonfebrile) seizures, but insufficient to trigger a seizure without a family history of seizures.
The first seizure with fever can be terrifying to a parent. Occasionally the seizure may be mild and brief (no more than slight slumping and loss of consciousness, or a rolling of the eyes back in the head), but often there is stiffening, a jerking, and loss of consciousness. Nine out of ten febrile seizures last only a few minutes, usually fewer than ten, but even they seem to last a lifetime to parents who have never seen a seizure before and who believe that their child is choking, or swallowing his tongue, or even dying.
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