Baylor Family Medicine Residency Program, Garland, TX 75042, USA.
Am Fam Physician. 2012 Jan 15;85(2):149-53.
Febrile seizures are common in the first five years of life, and many factors that increase seizure risk have been identified. Initial evaluation should determine whether features of a complex seizure are present and identify the source of fever. Routine blood tests, neuroimaging, and electroencephalography are not recommended, and lumbar puncture is no longer recommended in patients with uncomplicated febrile seizures. In the unusual case of febrile status epilepticus, intravenous lorazepam and buccal midazolam are first-line agents. After an initial febrile seizure, physicians should reassure parents about the low risk of long-term effects, including neurologic sequelae, epilepsy, and death. However, there is a 15 to 70 percent risk of recurrence in the first two years after an initial febrile seizure. This risk is increased in patients younger than 18 months and those with a lower fever, short duration of fever before seizure onset, or a family history of febrile seizures. Continuous or intermittent antiepileptic or antipyretic medication is not recommended for the prevention of recurrent febrile seizures.
热性惊厥在生命的头五年很常见，许多增加惊厥风险的因素已被确定。初步评估应确定是否存在复杂惊厥的特征，并确定发热的来源。不推荐常规进行血液检查、神经影像学和脑电图检查，也不再推荐对无并发症的热性惊厥患者进行腰椎穿刺。在罕见的热性惊厥持续状态的情况下，静脉注射劳拉西泮和口腔咪达唑仑是一线药物。在初次热性惊厥后，医生应让家长放心，因为长期影响（包括神经后遗症、癫痫和死亡）的风险很低。然而，初次热性惊厥后前两年的复发风险为 15%至 70%。在 18 个月以下的患者以及发热较低、发热开始前惊厥持续时间较短或有热性惊厥家族史的患者中，复发风险增加。不建议为预防复发性热性惊厥而连续或间断使用抗癫痫或退热药物。
