Afebrile seizures: definition and next steps

During a seizure, abnormal electrical activity in the brain can temporarily change movement, awareness, sensation, behaviour or responsiveness. An afebrile seizure may involve stiffening and rhythmic jerking, but some events cause staring, confusion or brief unusual sensations instead. The word afebrile describes the absence of fever; it does not identify the underlying cause or confirm epilepsy.

A clinician may consider a first unprovoked seizure as well as triggers unrelated to fever. Low blood glucose, alcohol withdrawal, medicines, head injury and infections affecting the brain or its coverings can matter. Fainting, sleep movements and some migraine symptoms can also resemble a seizure, so an eyewitness account is useful.

Move nearby hazards away, cushion the head and note when the episode starts. Do not restrain the person or put anything in their mouth. When the movements stop, place them on their side if you can do so safely, check that they are breathing and remain with them while awareness returns.

Arrange medical assessment after a first suspected afebrile seizure, even if recovery seems complete. Record what happened before, during and after the episode, including any missed medicines, alcohol change, injury, unusual sensation or prolonged confusion. Until assessed, avoid driving, swimming alone, heights and operating dangerous machinery.

Call emergency services if the seizure continues for several minutes, another begins before the person recovers, breathing remains difficult, serious injury occurs, or the person is pregnant or has diabetes. Emergency help is also appropriate for a first seizure, a seizure in water, or persistent weakness, severe headache, stiff neck, unusual rash or reduced consciousness afterward.

Ask whether the description fits a seizure, which blood tests or brain tests are appropriate, whether any medicine could have contributed, and what safety restrictions apply. If treatment is proposed, clarify its purpose, possible side effects and what to do if another event occurs.