Linking To, Excerpting From, And Embedding The Cribsiders’ “#18 Pediatric Seizures & Epilepsy: Shaking Things Up!” With Links To Additional Resources

Posted on August 25, 2026 by Tom Wade MD

In addition to today’s resource, please review:

Today, I review, link to, excerpt from, and embed The Cribsiders‘ “#18 Pediatric Seizures & Epilepsy: Shaking Things Up!”*

*Gaitanis J, Mao C, Chiu C, Berk J. “#18 Shaking Things Up: Pediatric Seizures & Epilepsy with Dr. John Gaitanis”. The Cribsiders Pediatric Podcast. https:/www.thecribsiders.com. February 3, 2020.

All that follows is from the above resource.

Summary

In this episode, we cover the full spectrum from febrile seizures all the way to status epilepticus with Dr. John Gaitanis, a pediatric neurologist who specializes in care for children with epilepsy. Dr. Gaitanis teaches us what to look out for on neurologic exam, how to counsel families about safety precautions, and the differential diagnosis for seizure-like activity in infants and children. We also discuss the exciting future of epilepsy treatment.

Pediatric Seizures & Epilepsy Pearls

  1. Simple febrile seizures in children who have a normal neurologic exam are largely a benign process and do NOT require lumbar puncture, EEG, neuroimaging, or treatment with AEDs (Subcommittee on Febrile Seizures, 2008 and 2011).
  2. Be on the lookout for infantile spasms, as these can be associated with serious developmental delay and increased risk of developing severe epilepsy.
  3. Antiepileptic drugs should be started after two unprovoked seizures (febrile seizures don’t count) and continued until at least two years seizure free.
  4. If you can’t get IV access during status epilepticus, consider temporary alternatives like rectal diazepam, IM/intranasal midazolam, or an intraosseous line.
  5. Don’t overlook alternatives like the ketogenic diet, surgery, and cannabidiol to help manage refractory seizures in certain types of epilepsy.

See also Febrile Seizures: A Systematic Review of Different Guidelines [PubMed Abstract] [Full-Text HTML] [Full-Text PDF]. Pediatr Neurol. 2024 Jun:155:141-148. doi: 10.1016/j.pediatrneurol.2024.03.024. Epub 2024 Apr 3.

Pediatric Seizures & Epilepsy Notes 

Febrile Seizures

Defined as seizures that occur in the setting of a fever (temperature >100.4ºF or 38ºC) in children aged 6 months to 5 years old without a known history of epilepsy. They are seen in 2-5% of all children (Subcommittee on Febrile Seizures, 2008). Thought to be a response to fever and cytokines in the setting of genetic predisposition towards seizure activity. Febrile seizures generally occur early in the course of illness and may be the presenting sign.

Types of Febrile Seizures

The distinction between simple and complex febrile seizures is based on focality, duration, and recurrence. 

Simple febrile seizures are generalized, last less than 15 minutes, and only occur once within 24 hours.

Complex febrile seizures are focal, prolonged (>15 minutes), and recur multiple times within 24 hours.

Tips for History and Exam

  • Ask about family history of seizures and epilepsy, including parental history of febrile seizures which can be reassuring
  • Concerning findings include focal neurologic defects or global delay (ex. extreme hypotonia, poor visual function)
  • Patients with simple febrile seizures should return to baseline quicker than children with epilepsy, with the postictal state resolving well before the 1 hour mark

Workup & Treatment – Simple Febrile Seizures

  • Lumbar puncture: NOT recommended…unless there are signs and symptoms of meningitis
  • EEG: NOT recommended
  • Neuroimaging: NOT recommended
  • Anti-epileptic drugs: NOT recommended even if multiple febrile seizures
  • Antipyretics: OK for comfort but do not prevent further febrile seizures

Recommendations from: AAP Subcommittee on Febrile Seizures (2008 and 2011)

What can we tell parents and caregivers about the prognosis?

  • Simple febrile seizures have a favorable prognosis but do recur in ⅓ of patients. Children with febrile seizures have a 1-2% risk of developing epilepsy later in life, which is only slightly higher than the general population risk of 0.5-1% (Subcommittee on Febrile Seizures, 2011).
  • Acknowledge that this can be a frightening experience and reassure them that the brain is resistant to injury, especially if their child is back to baseline.
  • On the other hand, the presence of obvious abnormalities on exam, seizures lasting greater than 30 minutes, and family history of epilepsy do raise the risk of developing epilepsy.
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