Melanie Cole, MS (Host): There's no handbook for your child's health, but we do have a podcast featuring world-class clinical and research physicians covering everything from your child's allergies to zinc levels. Welcome to Kids Health Cast by Weill Cornell Medicine. I'm Melanie Cole. And today, we're talking about febrile seizures and other types of seizures, including epilepsy that children can experience.

Joining me today is Dr. Asim Shahid. He's an Associate Attending Pediatrician at New York-Presbyterian Hospital, Weill Cornell Medical Center, and an Associate Professor of Clinical Pediatrics at Weill Cornell Medical College, Cornell University. Dr. Shahid, thank you so much for joining us today. So, let's get into febrile seizures first. And I told you off the air this happened to me when my child was a baby. It was literally one of the scariest things I've ever experienced. So, tell us what a febrile seizure is and how it correlates with an elevated temperature in children.

Asim Mohammad Shahid, MD: Yeah, absolutely. Thank you for having me. So, febrile seizures are pretty common actually. If you look at the prevalence, it's about 2-5% of children will have febrile seizures in the U.S. And elsewhere in the world, the prevalence is as high as 15%. When you compare that to epilepsy, which is about 1%, this is much higher.

So, the elevated temperature is in response to an infectious agent. Someone gets sick, ear infection, viral infection. So, our body tries to fight that off by elevating the body temperature. So even though these are febrile seizures, the actual cause of the seizures might be the chemicals that elevate the body temperature. So, not necessarily the temperature itself, but the chemicals. And in addition, there are also all these genetic components that we think might also be responsible for febrile seizures in children. So if you combine the two, the chemicals, the genetic components, as well as the immaturity of the brain-- the brain is still growing-- you have this perfect recipe for a febrile seizure. So, febrile seizures are in a very select group of children. So, we say the onset is about six months of age to about five years of age. And after that, the children usually grow out of febrile seizures. So, common, but very scary as you said earlier.

Melanie Cole, MS: And when I talk to my pediatrician, she's like the odds that this won't ever happen again are pretty good. And she's like, you know, it can happen again. So, we were always watching, certainly if she got a cold or a fever or whatever, but it never did happen again. And so, as scary as that was, I thank you telling us some of those causes and that's so interesting that there's chemicals, possibly genetics.

Now, you probably heard some myths or concerns right now certainly, Dr. Shahid, with all of the concerns about the safety of vaccinations. I'd like you to speak about that and tell parents about what you'd like them to know, if there is any correlation, which I'm highly doubting with vaccinations and febrile seizures.

Asim Mohammad Shahid, MD: Yeah. No, that's a great question that we hear in our daily practice also. Every time a child comes in after a febrile seizure, that's one of the first few questions that the parents ask, "Hey, you know, he got vaccinations and then had a seizure. So, could there be a relationship with the vaccination?" So, the short answer is no. Majority of the time, what parents think is that there's something in the vaccination itself that may have caused the seizure, which is not really true. There are certain vaccinations that you take the vaccination and your body temperature goes up, you just spike a fever about five days, seven days later. And the perfect example is the MMR vaccine. And the chemicals that build up in response to the vaccination that caused the temperature to go up and resulting in a seizure as opposed to the components of the vaccination. So, a very common misconception, that vaccination or something in the vaccine in itself is causing the febrile seizure. Now, getting vaccinations is extremely, extremely important because it prevents a child from getting very serious diseases. You know, mumps, rubella is one. So, there are all of these severe serious illnesses that we prevent with vaccinations.

Melanie Cole, MS: Well, thank you for clearing that up. I know we have to clear that kind of misconception up many times, but people do hear it. And so, it's great that we do it. Now when a child does have a FEE-brile seizure or FEH-brile seizure-- however we're pronouncing it-- what should parents do? I mean, I called 911 because it scared me so much. And I mean, the child could be limp or nonresponsive. And we know, Dr. Shahid, that fevers are a good thing. They're the body's protective mechanism in our children. They're fighting off something. But when this happens, what do we do? Do we drive them to the ER? Do we call 911? Is this that emergent?

Asim Mohammad Shahid, MD: Yeah. So, I mean, when you have a first-time febrile seizure, for the parent, it's really scary because they don't know what's happening, they don't know what to expect. And the child has a fever, they're irritable, just because they're not feeling well. And with the first time seizure, I would say, the safe thing to do would be just call 911, so have the child evaluated. Because once the child comes to the emergency room, the main thing that the emergency room doctors want to evaluate and rule out is more serious infection. For example, an infection of the brain, something we call meningitis. So, you want to make sure that it's not anything that is serious or concerning. If the child looks well and there are no signs suggestive of meningitis, then we can all be relieved that it's not anything serious.

Outside of that, the important things that I would advise the parents to do are make sure that the child is safe. Do not put anything in the mouth. Roll the child to the side. Time the seizure, see how long it has been going on. And again, if at any point the parent feels uncomfortable with how long the seizure has been going on, or how the child looks like, just be safe and call 911.

Melanie Cole, MS: I agree. I mean, it is just odd is what it is because they're just like lying there. And so, you're really, really not quite sure. So, thank you for that good advice and for the reassurance that this is something that can be evaluated and that we shouldn't be quite as scared. Although, I mean, I don't know the odds of that happening. But yes, that certainly is true.

Now, other types of seizures, and I'd like you to speak, Dr. Shahid, about seizures themselves, because they come in many forms as we're just talking about febrile. That was sort of a non-responsive child thing, but other seizures have different ways of presenting themselves. They can just look at a wall. They can have that full on seizure like you've seen on TV. Tell us, seizures, what other types of seizures might children experience and how do they tend to present themselves?

Asim Mohammad Shahid, MD: Yeah, absolutely. Again, a great question. So, the way I think of seizures is they come in all different shades, flavors, however you want to think about it. They can look very different. As you said, some seizures are just a child staring off into space briefly for 10 seconds or so, and then they come out of it. And those can be seen multiple times, you know, 20, 30, 40, 50 times a day. That's something we call absence seizures. Then, there are other seizures where the child is staring off. And then, making some other movements, either lip smacking or little finger movements, picking movements. So when I see someone coming into my office for evaluation of seizures, I ask all those questions to try to figure out what kind of seizures they're having. And then, of course, the big scary ones that we called tonic-clonic or generalized tonic-clonic seizures. So, the reasons are many different.

So in children, most of the time, we see genetic reasons. Those are the seizures that start very early on. For example, the staring seizures, or we call them absence seizures, because it's just like your absent from your environment. Those are genetic. So, genetics plays a huge role in pediatric-onset epilepsies.

Sometimes we also see other reasons like what we call malformations. And so, as the brain is developing, a certain part does not develop normally. So, there's a little extra wrinkle in the brain or a little damage in the brain when the brain was forming. And those can also result in seizures early on in children. Majority of this we see when a child is under 10 years of age.

Melanie Cole, MS: So when we think of epilepsy, Dr. Shahid, as we learn more about this particular condition, tell us a little bit about what's going on today in that world and the criteria for it to be even diagnosed as epilepsy, because a child could have a seizure, but that doesn't necessarily mean-- and parents need to hear that-- that this is what's going on.

Asim Mohammad Shahid, MD: Correct. So just to define epilepsy, this is basically a recurrence of unprovoked seizures. So when we say unprovoked, we're talking about that there's no fever, because then it would be febrile seizures as we talked about those earlier; there were no medications, there was no trauma. So if they're unprovoked and recurrent, meaning they repeat, then by definition we call it epilepsy.

And there are different types-- something we call generalized, which is basically starting in the brain all at the same time, the seizure covers the whole brain-- versus focal, which is just one part of the brain that may be irritable and may produce seizures. So, the treatments are different for those two types.

The first line of treatment is we use medications and there are quite a few medications available. Some very new, some are still in the pipeline. And some are old, but tried and tested it. So, we use all of those medications. But if a child has difficult-to-control seizures coming from one part of the brain, then there is a surgical solution to those seizures, some of the patients. So, we can evaluate them and we can say this is a small part of the brain, there's an extra wrinkle in the brain that's causing the seizures, and we can evaluate that through our tests. And if that's the case, then there could be cure for those focal, surgically remediated epilepsies. And then, there are other types where we use medications, and there are a lot of new medications coming out. There are a lot of clinical trials going on. And Weill Cornell is a part of a good majority of those clinical trials, to be honest. So, we have different modalities.

Then, the third thing that we can use is something called ketogenic diet. I'm sure a lot of listeners have heard of it. So, this is a high fat, very low or no carb diet that is also supposed to help with a select group of patients. And it has been used, believe it or not, for the longest time. There were original studies done in the 1920s. And then, again 1970s, it gained popularity and we've been using it for a long time.

Melanie Cole, MS: Yeah, we're learning more and more about diet and that ketogenic diet. I mean, it's not something that's that easy to follow. But once you kind of get into the groove of it, then it's even something, you know, that the whole family can get in on helping.

So, when you're working with patients, Dr. Shahid, what do you tell them about all of these things, not being so afraid and really, the most important thing, speaking to their pediatrician, whether it's about epilepsy or fevers or vaccinations or febrile seizures, all these scary things? I mean, being a parent, let's just face it, it's not for sissies, right? It can be scary. But you guys, you're our gold standard and you're the ones there to help us raise our kids healthy, safe, and happy. So, what would you like parents to know and the key takeaways?

Asim Mohammad Shahid, MD: I think the biggest thing we try to do is educate them. We educate them on febrile seizures, what causes it, what to look for. If they do see their child having a seizure, first things are just make sure the child is safe. How does the child look? How long was the seizure? So, I think education is extremely important. And again, going back to when we were talking about vaccinations, that vaccines are still safe. You do not stop giving vaccinations.

And as far as the pediatricians are concerned, same thing, we reach out to the pediatricians and we educate them. We talk to them about the type of epilepsy, the child may have by the generalized, focal, what are we doing, what are the treatment side effects? Because everything has side effects. I joke that, even when you drink coffee, you get a little jittery. So, even coffee has side effects. So, anything you put in your body is going to have some kind of side effects. And medications are no exception.

So, we try to basically present this as something that you can control. And then, we help the families and the pediatricians to have a better control on these seizures, whether they be febrile or afebrile or epilepsy. So, I think the biggest part is just a lot of education. I ask the parents, if you have any questions at any time, just reach out. Instead of guessing, I think you can reach out and I'll be more than happy to talk to you and just go over things, as many times as they wish.

Melanie Cole, MS: You're lovely. And I imagine your patients feel very lucky to have you as their physician because, really, I can hear the compassion and the passion in your voice for what you do. Dr. Shahid, thank you so much for joining us today and sharing your incredible expertise on things that are especially scary for parents that they don't know a lot about, but you really taught us a lot today. So, thank you again.

And Weill Cornell Medicine continues to see our patients in person as well as through video visits, and you can be confident of the safety of your appointments at Weill Cornell Medicine. That concludes today's episode of Kids Health Cast. We'd like to invite our audience to download, subscribe, rate, and review Kids Health Cast on Apple Podcast, Spotify, iHeart, and Pandora.

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