Febrile Seizures……By Eghosa Imasuen
Full disclosure: I suffered febrile convulsions as a child.
A Febrile seizure is a convulsion that is associated with a significant rise in body temperature in children aged from six months to five years. Families in Africa can tell an episode is on when the child suddenly goes into a fit when he/she has a fever caused by malaria, or other culprits like respiratory infections, ear infections, urinary tract infections etc.
This is what happens: The child suddenly goes stiff, the limbs start twitching and the eyes roll back in the head. A typical episode lasts for less than a minute, a period when the mother’s terror makes it seem like hours, ages even. The child may poo or pee, may breathe irregularly, and turn darker. There is almost no sequela after an episode. And most children will outgrow these episodes before they reach the age of five.
And because of the peculiarities of our environment—malaria, viral infections, bacterial sepsis, genetics—we have children who are exceptionally prone to these.
One sign in African adults who suffered febrile seizures as children are the “fever marks”—small facial scarifications. You must have seen them in friends; two small vertical lines, a few centimetres long, on either cheek. Thankfully incidence of these facial marks are declining as more and more parents become educated about what to do when a child convulses during a fever.
My mom tells me stories about my episodes. Of how, on the day of my first birthday party, I went swiftly from a fever to a fit as I had done a few months before, and she and Dad rushed me to the hospital. But as soon as I was in the car, with the wind rushing in and the lulling drone of the engine I suddenly relaxed and slept the rest of the way to the clinic. They had a hard time convincing the doctor of what had just happened. She says the doctor gave me paracetamol syrup, told her to continue the chloroquine she had already started giving me and the birthday went ahead as planned.
She recalls how she had to fight off my granny who wanted me to receive the facial marks, so that the convulsions would stop. She also remembers the old wives tales and other supposed remedies: palm kernel oil applied all over the child’s body will stop the convulsion immediately. Put the child’s feet in the fire, that will drive the demons away. Swathe the child in warm blankets so he can sweat the convulsion away.
None of those treatments work, and may actually worsen things. You see, no one knows what really causes febrile convulsions are. There is a genetic link, as having a first degree relative—parent, sibling—who suffered from febrile convulsions predisposes one to it. The only thing doctors are sure of is that the parent or care-giver must endeavour to bring down the temperature of the child. This can be via physical methods—tepid sponging, i.e., using slightly-above-room-temperature water to douse the child—or via oral doses of paracetamol or ibuprofen syrup.
The main concern for your doctor is to promptly distinguish your child’s febrile convulsion from more sinister causes of seizures in children. Thus when you get to the hospital, your doctor will ask about the duration of the seizure; doctors set a benchmark of fifteen minutes as the cutoff point between simple febrile seizures and complex febrile seizures. The doctor will ask if the seizures occurred at the height of a fever. He will ask how long the child had been sick. He will ask for a description of the attack, if the whole body was involved or if only a part. He will ask for a family history of such seizures. He will ask what the child did after the seizures—did he go back to playing; did he look normal. All these questions are to confirm what is probably true—that the child suffered from a self-limiting, albeit terrifying to watch, condition.
And you? What are you supposed to do? Keep the child away from danger. Never take a small rise in body temperature for granted. Expose the child, tepid-sponge him, give him Emcap paracetamol suspension or any other paracetamol suspension (please do this while he is still awake, not when he is fitting. And go to the hospital as soon as possible.
What should you never do? Do not rub palm kernel oil all over the child, it will cause a rise in temperature and worsen things. Do not put the child’s feet in the fire. Do not stick a spoon in the child’s mouth in a misguided attempt to prevent him from biting his tongue; you will just end up worsening things. And, finally, do not mark the child’s face.