Download PDF
Pädiatrie up2date 2009; 4(3): 255-270
DOI: 10.1055/s-0029-1214991
Varia

© Georg Thieme Verlag KG Stuttgart · New York

Fieberassoziierte Anfälle

Michael  von Rhein, Markus  Knuf
Further Information

Publication History

Publication Date:
03 September 2009 (online)

Also available at
    Permissions and Reprints All articles of this category

Einleitung

Fieberassoziierte Anfälle sind ein Phänomen, mit dem sowohl ambulant als auch klinisch tätige Kinderärzte oft konfrontiert werden. Während die betroffenen Familien oft in der Akutsituation extrem verunsichert sind, stellen die Anfälle zumeist harmlose Epiphänomene fieberhafter Infekte dar (Abb. [1]). Fieberkrämpfe sind mit einer Inzidenz von 2 – 5 % zwischen dem 6. Lebensmonat und dem vollendeten 6. Lebensjahr die häufigste Manifestationsform zerebraler Anfälle beim Kind. Es handelt sich dabei um altersabhängige Anfallsereignisse bei neurologisch gesunden Kindern, welche durch erhöhte Körpertemperaturen ausgelöst werden.

Der versorgende Pädiater sollte daher:

einen febrilen Status Epilepticus (SE) nicht übersehen, differenzialdiagnostisch fieberassoziierte symptomatische Anfälle ausschließen und die Aufklärung und Beruhigung der Eltern nicht aus den Augen verlieren.

Merke: Grundsätzlich gilt es, Fieberkrämpfe von fieberassoziierten, symptomatischen Krampfanfällen zu unterscheiden.

Dass es sich bei einem fieberassozierten Anfall um die Erstmanifestation eines Epilepsie-Syndroms handelt, ist eher unwahrscheinlich.

Abb. 1 Fieberkrämpfe stellen die harmloseste und gleichzeitig häufigste Variante fieberassoziierter Anfälle dar. Quelle: PhotoDisc, Symbolbild.

Literatur

  • 1 Nelson K B, Ellenberg J H. Febrile Seizures. New York; Raven Press 1981
    Google Scholar
  • 2 Fishman M A. Febrile seizures. In: McMillan JA et al., eds. Principles and Practice of Pediatrics. 3rd ed. Philadelphia; JB Lippincott 1999: 1949
    Google Scholar
  • 3 Aksu F, Tzitiridou M K. Febrile seizures. In: Panteliadis CP, Korinthenberg R, eds. Paediatric neurology – theory and practice. Stuttgart/New York; Thieme 2005: 523-530
    Google Scholar
  • 4 Stafstrom C E. The incidence and prevalence of febrile seizures. In: Baram TZ, Shinnar S, eds. Febrile seizures. San Diego/London; Academic Press 2002: 1-26
    Google Scholar
  • 5 Hauser W A, Kurland L T. The incidence of epilepsy in Rochester, Minnesota 1935 through 1967.  Epilepsia. 1975;  16 1-66
    CrossrefGoogle Scholar
  • 6 Hirose S, Mohney R P, Okada M. et al . The genetics of febrile seizures and related epilepsy syndromes.  Brain Dev. 2003;  25 304-312
    CrossrefGoogle Scholar
  • 7 Barlow W E. et al . The risk of seizures after receipt of whole-cell pertussis or measles, mumps, and rubella vaccine.  N Engl J Med. 2001;  345(9) 656-661
    CrossrefGoogle Scholar
  • 8 Dubé C M, Brewster A L, Baram T Z. Febrile seizures: Mechanisms and relationship to epilepsy.  Brain & Development. 2009;  31 366-371
    CrossrefGoogle Scholar
  • 9 Goldin A L. Mechanisms of sodium channel inactivation.  Curr Opin Neurobiol. 2003;  13 284-290
    CrossrefGoogle Scholar
  • 10 Stefanaki E, Aggelakou V, Orfanou M. et al . Epilepsy with a de novo missense mutation in the sodium channel a1 subunit: a case report.  Acta Paediatr. 2006;  95 1703-1706
    CrossrefGoogle Scholar
  • 11 Weber Y G, Jacob M, Weber G, Lerche H. A BFIS-like syndrome with late onset and febrile seizures: Suggestive linkage to chromosome 16p11.2-16q12.1.  Epilepsia. 2008;  49(11) 1959-1964
    CrossrefGoogle Scholar
  • 12 Loscher W, Ratin D, Siemes H. GABA in cerebrospinal fluid of children with febrile convulsions.  Epilepsia. 1981;  22 697
    Google Scholar
  • 13 Kawakami Y, Fukunaga Y, Kuwabara K. et al . Clinical and immunological significance of neopterin measurement in cerebrospinal fluid in patients with febrile convulsions.  Brain Dev. 1999;  21(7) 458-460
    CrossrefGoogle Scholar
  • 14 Ishizaki Y, Kira R, Fukuda M. et al . Interleukin-10 is associated with resistance to febrile seizures: Genetic association and experimental animal studies.  Epilepsia. 2009;  50(4) 761-767
    CrossrefGoogle Scholar
  • 15 Biervert C, Schroeder B C, Kubisch C. et al . A potassium channel mutation in neonatal human epilepsy.  Science. 1998;  279 403-406
    Google Scholar
  • 16 Steinlein O K. Genetic mechanisms that underlie epilepsy.  Nat Rev Neurosci. 2004;  5 400-408
    CrossrefGoogle Scholar
  • 17 Steinlein O K, Mulley J C, Propping P. et al . A missense mutation in the neuronal nicotinic acetylcholine receptor alpha 4 subunit is associated with autosomal dominant nocturnal frontal lobe epilepsy.  Nat Genet. 1995;  11 201-203
    CrossrefGoogle Scholar
  • 18 Tsuboi T, Endo S. Genetic studies of febrile convulsions: analysis of twin and family data.  Epilepsy Res. 1991;  Suppl 4 119-128
    Google Scholar
  • 19 Audenaert D, Van Broeckhoven C, De Jonghe P. Genes and loci involved in febrile seizures and related epilepsy syndromes.  Hum Mutat. 2006;  27 391-401
    CrossrefGoogle Scholar
  • 20 Nakayama J, Arinami T. Molecular genetics of febrile seizures.  Epilepsy Res. 2006;  70 190-198
    Google Scholar
  • 21 Johnson W G, Kugler S L, Stenroos E S. et al . Pedigree analysis in families with febrile seizures.  Am J Med Genet. 1996;  61 345-352
    CrossrefGoogle Scholar
  • 22 Berg A T, Shinnar S. Unprovoked seizures in children with febrile seizures: short-term outcome.  Neurology. 1996;  47 562-568
    Google Scholar
  • 23 Verity C M, Golding J. Risk of epilepsy after febrile convulsions: a national cohort study.  BMJ. 1991;  303 1373-1376
    CrossrefGoogle Scholar
  • 24 Scheffer I E, Berkovic S F. Generalized epilepsy with febrile seizures plus. A genetic disorder with heterogeneous clinical phenotypes.  Brain. 1997;  120(3) 479
    CrossrefGoogle Scholar
  • 25 Singh R, Scheffer I E, Crossland K, Berkovic S F. Generalized epilepsy with febrile seizures plus: A common childhood-onset genetic epilepsy syndrome.  Ann Neurol. 1999;  45 75
    CrossrefPubMedGoogle Scholar
  • 26 Scheffer I E, Harkin L A, Grinton B E. et al . Temporal lobe epilepsy and GEFS+ phenotypes associated with SCN1B mutations.  Brain. 2007;  130 100-109
    PubMedGoogle Scholar
  • 27 Ito M, Yamakawa K, Sugawara T. et al . Phenotypes and genotypes in epilepsy with febrile seizures plus.  Epilepsy Res. 2006;  70 199-205
    CrossrefGoogle Scholar
  • 28 Kanemoto K, Kawasaki J, Miyamoto T. et al . Interleukin (IL)1beta, IL-1alpha, and IL-1 receptor antagonist gene polymorphisms in patients with temporal lobe epilepsy.  Ann Neurol. 2000;  47 571-574
    CrossrefGoogle Scholar
  • 29 Caraballo R H, Fejerman N. Dravet syndrome: a study of 53 patients.  Epilepsy Res. 2006;  70 [Suppl 1] 231-238
    CrossrefGoogle Scholar
  • 30 Lossin C. A catalog of SCN1A variants.  Brain & Development. 2009;  31 114-130
    CrossrefGoogle Scholar
  • 31 Ronen G M, Rosales T O, Connolly M. et al . Seizure characteristics in chromosome 20 benign familial neonatal convulsions.  Neurology. 1993;  43 1355-1360
    CrossrefPubMedGoogle Scholar
  • 32 Depondt C, Van Paesschen W, Matthijs G. et al . Familial temporal lobe epilepsy with febrile zeizures.  Neurology. 2002;  58 1429-1433
    Google Scholar
  • 33 Fernandez G, Effenberger O, Vinz B. et al . Hippocampal malformation as a cause of familial febrile convulsions and subsequent hippocampal sclerosis.  Neurology. 1998;  50 909
    Google Scholar
  • 34 Merkenschlager A, Todt H, Pfluger T, Bernhard M. Development of hippocampal sclerosis after a complex febrile seizure.  Eur J Pediatr. 2009;  168 487-490
    CrossrefPubMedGoogle Scholar
  • 35 Sokol D K, Demyer W E, Edwards-Brown M. et al . From swelling to sclerosis: acute change in mesial hippocampus after prolonged febrile seizure.  Seizure. 2003;  12 237-240
    CrossrefGoogle Scholar
  • 36 Scott R C, King M D, Gadian D G. et al . Prolonged febrile seizures are associated with hippocampal vasogenic edema and developmental changes.  Epilepsia. 2006;  47 1493-1498
    CrossrefGoogle Scholar
  • 37 Takanashi J, Oba H, Barkovich A J. et al . Diffusion MRI abnormalities after prolonged febrile seizures with encephalopathy.  Neurology. 2006;  66 1304-1309, 1291
    CrossrefGoogle Scholar
  • 38 Dube C, Chen K, Eghbal-Ahmadi M. et al . Prolonged febrile seizures in the immature rat model enhance hippocampal excitability long term.  Ann Neurol. 2000;  47 336
    CrossrefGoogle Scholar
  • 39 Waruiru C, Appleton R. Febrile seizures: an update.  Arch Dis Child. 2004;  89 751-756
    CrossrefPubMedGoogle Scholar
  • 40 Shinnar S, Glauser T A. Febrile seizures.  J Child Neurol. 2002;  17 44-52
    CrossrefGoogle Scholar
  • 41 Van Stuijvenberg M, de Vos S, Tijang G CH. et al . Parents‘ fear regarding fever and febrile seizures.  Acta Paediatr. 1999;  88 618-622
    CrossrefGoogle Scholar
  • 42 Carroll W, Brookfield D. Lumbar puncture following febrile convulsion.  Arch Dis Child. 2002;  87 238
    CrossrefGoogle Scholar
  • 43 Baumer J H. Evidence based guideline for post-seizure management in children presenting acutely to secondary care.  Arch Dis Child. 2004;  89 278-280
    CrossrefGoogle Scholar
  • 44 Armon K, Stephenson T, MacFaul R. et al . An evidence and consensus based guideline for the management of a child after a seizure.  Emerg Med J. 2003;  20 13-20
    CrossrefPubMedGoogle Scholar
  • 45 American Academy of Pediatrics. . Provisional Committee on Quality Improvement, Subcommittee on Febrile Seizures. Practice Parameter: The neurodiagnostic evaluation of the child with a first simple febrile seizure.  Pediatrics. 1996;  97 769
    PubMedGoogle Scholar
  • 46 Chin R F, Neville B G, Scott R C. Meningitis is a common cause of convulsive status epilepticus with fever.  Arch Dis Child. 2005;  90 66
    CrossrefGoogle Scholar
  • 47 Chin R F, Neville B G, Peckham C. et al . Incidence, cause, and short-term outcome of convulsive status epilepticus in childhood: prospective population-based study.  Lancet. 2006;  368 222
    CrossrefGoogle Scholar
  • 48 Sadleir L G, Scheffer I E. Febrile seizures.  BMJ. 2007;  334 307
    CrossrefGoogle Scholar
  • 49 Teng D. Risk of intracranial pathologic conditions requiring emergency intervention after a first complex febrile seizure episode among children.  Pediatrics. 2006;  117 304
    CrossrefPubMedGoogle Scholar
  • 50 Knudsen F U. Practical management approaches to simple and complex febrile seizures. In: Baram TZ, Shinnar S, eds. Febrile seizures. San Diego/London; Academic Press 2004: 273-304
    Google Scholar
  • 51 Mitchell W G, Conry J A, Crumrine P K. et al . An open-label study of repeated use of diazepam gel (Diastat) for episodes of acute breakthrough seizures and clusters: safety, efficacy and tolerance.  Epilepsia. 1999;  40 1610-1617
    CrossrefGoogle Scholar
  • 52 McIntyre J, Robertson S, Norris E, Appleton R. et al . Safety and efficacy of buccal midazolam versus rectal diazepam for emergency treatment of seizures in children: a randomised controlled trial.  Lancet. 2005;  366 205-210
    CrossrefGoogle Scholar
  • 53 Appleton R, Sweeney A, Choonara I. et al . Lorazepam versus diazepam in the acute treatment of epileptic seizures and status epilepticus.  Dev Med Child Neurol. 1995;  37 682-688
    Google Scholar
  • 54 Vestergaard M, Giørtz Pedersen M, Østergaard J R. et al . Death in children with febrile seizures: a population-based cohort study.  Lancet. 2008;  372 457-463
    CrossrefGoogle Scholar
  • 55 American Academy of Pediatrics, Committee on Quality Improvement, Subcommittee on Febrile Seizures. . Practice parameter: long-term treatment of the child with simple febrile seizures.  Pediatrics. 1999;  103 1307-1309
    CrossrefGoogle Scholar
  • 56 Baldy-Moulinier M, Covanis A, D’Urso S. et al . Therapeutic strategies against epilepsy in Mediterranean countries: a report from an international collaborative survey.  Seizure. 1998;  7 513-520
    CrossrefGoogle Scholar
  • 57 Fukuyama Y, Seki T, Ohtsuka C. et al . Practical guidelines for physicians in the management of febrile seizures.  Brain Dev. 1996;  18 479-484
    CrossrefGoogle Scholar
  • 58 Rosman N P, 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
    CrossrefGoogle Scholar
  • 59 Pavlidou E, Tzitiridou M, Panteliadis C. et al . Indikation der intermittierenden Diazepamprophylaxe bei Fieberkrämpfen.  Klin Padiatr. 2006;  218 264-269
    Article in Thieme ConnectGoogle Scholar
  • 60 Sulzbacher S, Farwell J R, Temkin N. et al . Late cognitive effects of early treatment with phenobarbital.  Clin Pediatr. 1999;  38 387-394
    CrossrefGoogle Scholar
  • 61 Uhari M, Rantala H, Vainionpää L. et al . Effect of acetaminophen and of low intermittent doses of diazepam on prevention of recurrences of febrile seizures.  J Pediatr. 1995;  126 991-995
    Google Scholar
  • 62 Van Stuijvenberg M, Derksen-Lubsen G, Steyerberg E W. et al . Randomized, controlled trial of ibuprofen syrup administered during febrile illnesses to prevent febrile seizure recurrences.  Pediatrics. 1998;  102 51
    CrossrefGoogle Scholar
  • 63 Kolahi A, Tahmooreszadeh S. First febrile convulsions: inquiry about the knowledge, attitudes and concerns of the patients’ mothers.  Eur J Pediatr. 2009;  168 167-171
    CrossrefGoogle Scholar
  • 64 Aksu F, Püst B. Klinik, Behandlung und Verlauf von Fieberkrämpfen.  Monatsschr Kinderheilkd. 2007;  155 419-424
    CrossrefGoogle Scholar
  • 65 Frantzen E, Lennox-Buchthal M, Nygaard A. Longitudinal EEG and clinical study of children with febrile convulsions.  Electroencephalogr Clin Neurophysiol. 1968;  24 197
    Google Scholar
  • 66 Berg A T, Shinnar S, Darefsky A S. et al . Predictors of recurrent febrile seizures. A prospective cohort study.  Arch Pediatr Adolesc Med. 1997;  151 371
    CrossrefGoogle Scholar
  • 67 Offringa M, Bossuyt P M, Lubsen J. et al . Risk factors for seizure recurrence in children with febrile seizures: A pooled analysis of individual patient data from five studies.  J Pediatr. 1994;  124 574
    CrossrefPubMedGoogle Scholar
  • 68 Pavlidou E, Tzitiridou M, Kontopoulos E, Panteliadis C P. Which factors determine febrile seizure recurrence? A prospective study.  Brain Dev. 2008;  30 7
    CrossrefGoogle Scholar
  • 69 Knudsen F U. Recurrence risk after first febrile seizure and effect of short term diazepam prophylaxis.  Arch Dis Child. 1985;  60 1045-1049
    CrossrefGoogle Scholar
  • 70 Chang Y C, Guo N W, Huang C C. et al . Neurocognitive attention and behaviour outcome of school-age children with a history of febrile convulsions: a population study.  Epilepsia. 2000;  41 412-420
    CrossrefGoogle Scholar
  • 71 Verity C M, Greenwood R, Golding J. Long-term intellectual and behavioral outcomes of children with febrile convulsions.  N Engl J Med. 1998;  338 1723
    CrossrefGoogle Scholar
  • 72 Annegers J F, Hauser W A, Shirts S B. et al . Factors prognostic of unprovoked seizures after febrile convulsions.  N Engl J Med. 1987;  316 493-498
    CrossrefGoogle Scholar
  • 73 Covanis A. Panayiotopoulos syndrome: a benign childhood autonomic epilepsy frequently imitating encephalitis, syncope, migraine, sleep disorder, or gastroenteritis.  Pediatrics. 2006;  118 1237-1243
    CrossrefGoogle Scholar

Dr. med. habil. M. Knuf

Arzt für Kinder- und Jugendmedizin, Neonatologie,
Neuropädiatrie und Pädiatrische Intensivmedizin
Zentrum für Kinder- und Jugendmedizin
Johannes-Gutenberg-Universität Mainz

Czernyweg
55131 Mainz

Phone: 06131/17-0

Fax: 06131/17-66-46

Email: knuf@kinder-klinik.uni-mainz.de