Fieberkrämpfe

Zusammenfassung

Fieberkrämpfe stellen die häufigste neurologische Störung des Kindesalters dar. Sie betreffen 2-4 % aller Kinder. Das Zugrundeliegen einer bakteriellen Meningitis ist äußerst selten. Diese kann durch Anamnese und klinische Untersuchung mit hoher Sicherheit ausgeschlossen werden. Rund ein Drittel der Kinder erleidet weitere Fieberkrämpfe, wobei die Wahrscheinlichkeit durch genannte Risikofaktoren steigen kann. Das Risiko der Entwicklung einer späteren Epilepsie ist nach einfachen Fieberkrämpfen nur marginal erhöht. Die Prognose von einfachen Fieberkrämpfen ist hervorragend und unterscheidet sich nicht von der der Allgemeinbevölkerung. Eine antikonvulsive Dauertherapie zur Verhinderung weiterer Fieberkrämpfe ist nicht indiziert, die intermittierende Therapie mit Benzodiazepinen bei Fieber nur in Ausnahmefällen sinnvoll. Das ohnehin nur gering erhöhte Risiko dieser Kinder später eine Epilepsie zu entwickeln, senken beide Maßnahmen nicht.

Die antipyretische Therapie ist zur Fiebersenkung sinnvoll, verhindert aber nicht das Auftreten von Fieberkrampfrezidiven.

Wichtigste Maßnahme nach einem Fieberkrampfereignis ist die beruhigende Aufklärung der Eltern hinsichtlich Ursache und Prognose. Auf die Rezidivmöglichkeit sollte hingewiesen werden. Es sollte betont Aufklärungsarbeit mit den Eltern dahingehend geleistet werden, dass die Eltern weder durch häufiges Temperaturmessen noch durch strikte antipyretische Medikation einen Fieberkrampf zuverlässig verhindern können. Hier gilt es also definitiv, falschen medizinpädagogischen Druck von den Eltern zu nehmen. Als akute Interventionsmaßnahme für den seltenen Fall eines länger als drei Minuten dauernden Anfalls sollte Diazepam rektal empfohlen werden.

Zusammenfassend heißt evidenzbasierte Therapie des Fieberkrampfes vor allem eines: adäquate Aufklärung der Eltern und damit Reduktion des Faktors Angst.

Summary

Febrile seizures are the most common neurologic disorder in childhood, occuring in 2-4 % of all children. The incidence of bacterial meningitis as a cause of febrile seizures is below 0,5 % and can be excluded by anamnesis and clinical examination. One third of children suffer under recurrent febrile seizures, the risk of recurrence increases under presence of well defined conditions. The risk of subsequent epilepsy following simple febrile seizures is not substantially increased.

The prognosis of simple febrile seizures is excellent and does not differ from the one of children without febrile convulsions. There is no indication for a continous antiepileptic medication to prevent further febrile seizures, only in rare cases an intermittend anticonvulsive therapy is justified. Furthermore the risk of subsequent epilepsy can not be reduced by chronic or intermittend antiepileptic therapy against febrile seizures. As a rule febrile seizures doe not cause hippocampal pathology, but the possibility of a spezific subgroup of children with increased vulnerability of hippocampus against febrile convulsions is discussed.

Antipyretic treatement is indicated to lower body temperature, but there is no evidence that antipyretics could significant prevent further febrile convulsions.

Most important step after a febrile seizure is a composing information of the parents about causes and prognosis. The possibility of recurrence must be pointed out. Spezific educational work has to be achieved, that parents can not prevent recurrent febrile seizures by permanent measuring of body temperature or treating with antipyretics.

Schlüsselwörter

Fieberkrämpfe - evidenzbasierte Medizin

Keywords

Febrile seizures - evidence based medicine

• Literatur

• 1 Al-Eissa YA. Lumbar puncture in the clinical evaluation of children with seizures associated with fever. Pediatr Emerg Care 1995; 11: 347-350.
• 2 American Acadamy of Pediatrics Committee on Drugs:. Behavioral and cognitive effects of antivon-vusant therapy. Pediatrics 1995; 96: 538-540.
• 3 American Acadamy of Pediatrics:. Provisional Committee on Quality Improvement: Practice parameter: The neurodiagnostic evaluation of the child with simple febrile seizure. Pediatrics 1996; 97: 769-775.
• 4 Annegers JF, Hauser WA, Shirts SB. et al. Factors prognostic of unprovoked seizures after febrile convulsions. N Engl J Med 1987; 316: 493-498.
• 5 Annegers JF, Blakely SA, Hauser WA, Kurland LT. Recurrent of febrile convulsions in a population-based cohort. Epilepsy Res 1990; 66: 1009-1012.
• 6 Anthony J, Hawke S. Phenobarbital compared with carbamazepine in prevention of recurrent febrile convulsions. Am J Dis Child 1983; 137: 892-895.
• 7 Autret E, Billard C, Bertrand P. et al. Double-blind, randomized trial of diazepam versus placebo for prevention of recurrence of febrile seizures. J Pediatr 1990; 117: 490-494.
• 8 Chang YC, Guo NW, Wang ST. Working memory of school-aged children with a history of febrile convulsions: a population study. Neurology 2001; 57: 37-42.
• 9 Commission on Epidemiology and Prognosis, International League Against Epilepsy: Guidelines for epidemiologic studies on epilepsy. Epilepsia 1993; 34: 592-596.
• 10 Bacon C, Mucklow J, Rawlins M. et al. Placebo-controlled study of phenobarbital and phenytoin in the prophylaxis of febrile convulsions. Lancet 1981; 11: 600-603.
• 11 Berg AT. The epidemiology of seizures and epilepsy in children. Shinnar S, Amir N, Branki D. Childhood seizures. Basel: Karger; 1995: 1-10.
• 12 Berg AT, Shinnar S, Hauser WA. et al. Predictors of recurrent febrile seizures: A prospective study of the circumstances surrounding the initial febrile seizure. N Engl J Med 1992; 327: 1122-1127.
• 13 Berg AT, Shinnar S. Unprovoked seizures in children with febrile seizures: Short term outcome. Neurology 1996; 47: 562-568.
• 14 Berg AT, Shinnar S, Darefsky AS. et al. Predictors of recurrent febrile seizures. Arch Pediatr Adolesc Med 1997; 151: 371-378.
• 15 Berg AT, Shinnar S, Levy SR. et al. Childood-onset epilepsy with and without preceding febrile seizures. Neurology 1999; 53: 1742-1748.
• 16 Doose H, Maurer A. Seizure risk in offspring of individuals with a history of febrile convulsions. Eur J Pediatr 1997; 156: 476-480.
• 17 Doose H, Ritter K, Völzke E. EEG longitudinal studies in febrile convulsions. Genetic aspects. Neuropediatrics 1983; 14: 81-87.
• 18 Caroll W, Brookfield D. Lumbar puncture following febrile convulsion. Arch Dis Child 2001; 87: 238-240.
• 19 Chamberlain JM, Gorman RL. Occult bacteremia in children with simple febrile seizures. Am J Dis Child 1988; 142: 1073-1076.
• 20 Ellenberg JH, Neslon KB. Febrile seizures and later intellectual performance. Arch Neurol 1978; 35: 17-21.
• 21 Farwell J, Lee YJ, Hirtz DG. et al. Phenobarbital for febrile seizures-Effects on intelligence and on seizure recurrence. N Engl J Med 1990; 322: 364-369.
• 22 Green MA, Rothock SG, Clem KJ. et al. Can seizures be the sole manifestation of meningitis in febrile children?. Pediatrics 1993; 103: 1307-1309.
• 23 Hirose S, Mohney R, Okada M. et al. The genetics of febrile seizures and related epilepsy syndromes. Brain and Dev 2003; 25: 304-312.
• 24 Kimia A, Ben-Joseph EP, Rudloe T. et al. Yield of lumbar puncture among children who present with their first complex febrile seizure. Pediatrics 2010; 126 (01) 62-69.
• 25 Kimia A, Capraro A, Hummel D. et al. Utility of lumbar puncture for first simple febrile seizure among children 6 to 18 months of age. Pediatrics 2009; 123 (01) 6-12.
• 26 Knudsen FU, Paerregaard A, Anderson R, Andresen J. Long term outcome of prophylaxis for febril convulsions. Arch Dis Child 1996; 74: 13-18.
• 27 Mathern GW, Babb TL, Mischel PS. et al. Childhood generalized and mesial temporal epilepsies demonstrate different amounts and patterns of hippocampal loss and mossy fibre synaptic reorganisation. Brain 1996; 119: 965-987.
• 28 Maytal J, Shinnar S. Febrile status epilepticus. Pediatrics 1990; 86: 611-616.
• 29 Maytal J, Steele R, Eviatar L, Novak G. The value of early postictal EEG in children with complex febriel seizures. Epilepsia 2000; 41 (02) 219-221.
• 30 Merkenschlager A. Therapeutische und diagnostische Leitlinien beim Fieberkrampf im Kindesalter. Kinder- und Jugendmedizin 2002; 2: 239-241.
• 31 Ngwane E, Bower B. Continuous sodium valproate or phenobarbitone in the prevention of “simple” febrile convulsions. Arch Dis Child 1980; 55 (03) 171-174.
• 32 Newton RW. Randomised controlled trials of phenobarbitone and valproate in febrile convulsions. Arch Dis Child 1988; 63: 1189-1191.
• 33 Offringa M, Beishuizen A, Derksen-Lubsen G, Lubsen J. Seizures and fever: can we rule out mengitis on clinical ground alone?. Clin Pediatr 1992; 9: 514-522.
• 34 Offringa M, Bossuyt PMM, Lubsen J. et al. Risk factors of seizures recurrence in children with febrile seizures: A pooled analysis of individual patient data from five studies. J Pediatr 1994; 124: 578-584.
• 35 Rantala H, Tarkka R, Uhari M. A meta-analytic review of the preventive treatment of recurrences of febrile seizures. J Pediatr 1997; 131 (06) 922-925.
• 36 Rich SS, Annegers JF, Hauser WA, Anderson VE. Complex segregation analysis of febrile convulsions. Am J Hum Genet 1987; 41: 249-257.
• 37 Rosman NP, Colton T, Labazzo J. et al. A controlled trial of diazepam administered during febrile illnesses to prevent recurrence of febrile seizures. N Engl J Med 1993; 329: 79-84.
• 38 Saltik S, Angay A, Özkara C. et al. A retrospective analysis of patients with febrile seizures followed by epilepsy. Seizures 2003; 12: 211-216.
• 39 Schlachter K, Gruber-Sedlmayr U, Stogmann E. A splice site variant in the sodium channel gene SCN1A confers risk of febrile seizures. Neurology 2009; 72 (11) 974-978.
• 40 Schnaiderman D, Lahat E, Sheefer T, Aladjem M. Antipyretic effectiveness of acetaminophen in febrile seizures: ongoing prophylaxis versus sporadic usage. Eur J Pediatr 1993; 152: 747-749.
• 41 Shah SS, Alpern ER, Zwerling L. et al. Low risk of bacteremia in children with febrile seizures. Arch Pediatr Adolesc Med 2002; 156: 469-472.
• 42 Shinnar S, Berg AT. Does antiepileptic drug therapy prevent the development of “chronic” epilepsy?. Epilepsia 1996; 37: 701-708.
• 43 Shinnar S, Pellock JM, Berg AT. et al. Short-term outcomes of children with febrile status epilepticus. Epilepsia 2001; 42: 47-53.
• 44 Shinnar S, Glauser TA. Febrile seizures. J Child Neurol 2002; 17: 44-52.
• 45 Sweeney A, Gibbs J, Monteil F. et al. The management of febrile seizures in the Mersey region. Dev Med Child Neurol 1996; 38: 578-584.
• 46 Trainor JL, Hampers LC, Krug SE. et al. Children with first-time simple febrile seizures are at low rik of serious bacterial illness. Acad Emerg Med 2001; 8: 781-787.
• 47 Trinka E, Unterrainer J, Haberlandt E. et al. Childhood febrile convulsions - which factors determine the subsequent epilepsy syndrome? A retrospective study. Epilepsy Res 2002; 50: 283-292.
• 48 Uhari M, Rantala H, Vainionpaä L, Kurttila R. Effect of acetaminophen and low intermittend doses of diazepam on prevention of recurrences of febrile seizures. J Pediatr 1995; 126: 991-995.
• 49 Van Stuijvenberg M, Derksen-Lubsen G, Steyerberg EW. et al. Randomized, controlled trail of ibuprofen syrup administered during febrile illness to prevent febrile seizure recurrences. Pediatrics 1998; 102: 1-7.
• 50 Vining EPG, Mellits ED, Dorsen MM. Psychologic and behavioral effects of antiepileptic drugs in children: A double-blind comparison between phenobarbital and valproic acid. Pediatrics 1987; 80: 165-174.
• 51 Verity CM, Ross EM, Golding J. Outcome of childhood status epilepticus and lengthy febrile convulsions: findings of national cohort study. BMJ 1993; 307: 225-258.
• 52 Verity CM, Grennwood R, Golding J. Long-term intellectual and behavioral outcomes of children with febrile convulsions. N Engl J Med 1998; 338: 1723-1728.
• 53 Wallace SJ, Smith JA. Successful prophylaxis against febrile convulsions with valproic acid or phenobarbitone. BMJ 1980; 280: 353-354.
• 54 Wolf SM, Labazzo JL, Colton T. Factors predisposing to afebrile seizures after febrile convulsions and preventive treatment. Ann Neurol 1989; 78: 291-295.
• 55 Yücel O, Aka S, Yazicioglu L, Ceran O. Role of early EEG and neuroimaging in determination of prognosis in children with complex febrile seizure. Pediatr Int 2004; 46 (04) 463-467.