Etiology and Risk Factors of Febrile Seizure – An Update

Febrile seizures (FS) are the most common convulsive event in children. This condition has been described since the time of Hippocrates. The etiology of the febrile seizures are still unclear. In FS, there is a strong familial predisposition. This does not exclude infections as a causative factor because subtle genetic polymorphisms have been demonstrated to affect the course of infections. In an earlier review of the world literature (1924-1964), except for roseola infantum, viral infections as a cause of febrile seizures were rarely diagnosed. Reports of viral infections in the etiology of febrile seizures have increased in number in the past decade. In the first half of the twentieth century, infections identified with febrile seizures were mainly upper respiratory in type and the etiologic agent was unknown or bacterial. We review i) the role of infection – viral and bacterial; ii) the role of genetic and environmental factors; iii) the role of electrolyte and metabolic factors; and iv) the role of cytokines. With the help of new diagnostic tools such as PCR, the viral agents are detected in CSF far more often than previously thought, even in the absence of pleocytosis of the CSF. This makes it difficult to distinguish FS from acute encephalitis. FS may be caused by neuroinvasion or intracerebral activation of viruses. By reviewing etiology and risk factors of FS we can identify the points to be focused in therapeutic interventions and trials and also the fields of future studies will be explored. Key word: Febrile seizure, Etiology and Risk factors. 1. Consultant, Dept. of pediatrics, BIHS Hospital, Dhaka. 2. Assistant professor, Dept. of Psychiatry, Holy Family Red Crescent Medical College, Dhaka, Bangladesh. 3. Honorary medical officer, Dept. of Gynaecology and obstetrics, BSMMU, Dhaka. 4. Consultant, Paediatric Cardiology, Ibne Sina Hospital, Dhaka 5. Associate Professor, Paediatric Neurology, BSMMU, Dhaka Correspondence: Gopen Kumar Kundu Introduction The sociodemographic and epidemiological transition in developing countries has changed the morbidity and mortality pattern among communities. This has brought non-communicable diseases to the forefront of the health care delivery system. Within this group, neurological disorders constitute a significant proportion affecting morbidity, mortality, disability and quality of life 1. Although childhood febrile seizures in most cases are benign and self-limiting, witnessing such seizures is a terrifying experience for most parents. Febrile seizures are one of the most common childhood neurological disorders. There has been a lot of confusion regarding the necessary evaluation of a patient with febrile seizures. The American Academy of Pediatrics (AAP) has recently published practice parameters for the evaluation and treatment of simple febrile seizures. International League Against Epilepsy and Italian League Against Epilepsy recently has published a recommendation addressing the instructions for management of the first febrile seizures, giving criteria for hospital admission, diagnosis, differential diagnosis, and treatment of a prolonged seizure 2. An understanding of the febrile seizures will enable the physician to reassure the families and provide appropriate counseling and management while avoiding unnecessary diagnostic and therapeutic interventions.