Convulsão febris em crianças: aspectos clínicos e diagnósticos

Abstract

Introduction: Febrile seizures are a common and age-dependent neurological disorder, affecting 2 to 4% of children under five years of age. They are simple, generalized seizures lasting less than 15 minutes and do not recur within 24 hours. Although they may recur in early childhood in 33% of cases, they are benign in origin and are associated with a future risk of epilepsy only slightly higher than in the general population. Those febrile seizures that are focal, prolonged or multiple in the first 24 hours are defined as complex, with greater recurrence and heterogeneity of associated conditions. Objective: to discuss risk factors, clinical presentation and diagnosis of febrile seizures. Methodology: Integrative literature review from Scielo, PubMed and BVS databases, from January to April 2024, with descriptors “febrile seizures”, “clinical features”, and “evaluation”, registered in DeCS/MeSH and operator “AND”. Articles from 2019-2024 (total 96) were included, excluding other criteria and selecting 05 full articles. Results and Discussion: Febrile seizures have a peak incidence between 12 and 18 months of age. There is a slight male predominance, with an estimated ratio of 1.6:1. In addition to age, the most common risk factors include high fever, viral infection, recent immunization (after triple and tetraviral) and family history of febrile seizures. Most present febrile seizures on the first day of the disease and, in some cases, as the first symptom. They last less than 15 minutes, without focal characteristics, one in 24 hours. They are characterized as generalized tonic-clonic seizures but can also be atonic or tonic in nature. Complex febrile seizures are distinguished by episodes lasting more than 15 minutes, focal or postictal paresis and recurrence within 24 hours. The differential diagnosis of febrile seizures should always consider CNS infection (meningitis/encephalitis). Febrile seizures are a clinical diagnosis. In children with a typical history and a reassuring and non-focal examination, diagnostic tests are unnecessary. Lumbar puncture and laboratory tests, neuroimaging and electroencephalography (EEG) may be performed if meningitis or intracranial infection is suspected. Therefore, febrile seizures should be considered: seizure with temperature > 38°C; age between 6 months and 5 years; absence of CNS infection; absence of acute systemic metabolic abnormality; no history of previous afebrile seizure. Conclusion: Febrile seizures are common in early childhood, as long as they occur with fever, without evidence of intracranial infection or defined cause. They are not considered a form of epilepsy, which is characterized by recurrent non-febrile seizures.