Ear Infections and Febrile Seizures

Febrile seizures are seizures associated with fever in young children. They most commonly occur between ages 6 months and 5 years, often during an illness that causes a rapid rise in body temperature.

Middle ear infections (otitis media) commonly cause fever, especially in young children. Because ear infections and febrile seizures are both common in childhood, a fever from an ear infection may sometimes trigger a febrile seizure.

There are two main types of febrile seizures:

• Simple febrile seizures — Generalized seizures that last less than 15 minutes and happen only once within a 24-hour period.
• Complex febrile seizures — Seizures that last 15 minutes or longer, have focal features (affecting one area or part of the body), or happen more than once within a 24-hour period.

Most febrile seizures are brief, typically lasting one to two minutes, and most children recover fully without any lasting neurologic issues.

Causes and risk factors for febrile seizures include:

• Infection (viral or bacterial)
• Family medical history of febrile seizures
• Younger age

In rare instances, childhood vaccinations can cause a low-grade fever, which in turn may slightly increase the risk of a febrile seizure.

If your child experiences a febrile seizure for the first time, they should receive prompt medical evaluation. Seek emergency care if the seizure lasts longer than five minutes, breathing is impaired, or your child doesn’t return to their usual level of alertness afterward.

Bacterial Versus Viral Infections and Seizures

Many people ask whether seizures are more likely to be triggered by bacterial or viral infections.

The answer is that both bacterial and viral infections can contribute to seizures, but usually not because of the infection itself. Instead, seizures due to infection often occur because of fever.

Viral illnesses are among the most common causes of febrile seizures in young children, but bacterial infections that produce high fevers may also trigger febrile seizures.

When an Infection Becomes Dangerous

Most ear infections improve without causing serious complications. However, an infection can become dangerous if it spreads beyond the ear or affects the brain and spinal cord.

Seek immediate medical attention for symptoms such as:

• Severe headache
• Persistent high fever
• Neck stiffness
• Confusion
• Vomiting

These symptoms may indicate a serious infection involving the central nervous system and require urgent evaluation.

Febrile Seizures Don’t Indicate Epilepsy

Between 2 percent and 5 percent of children experience at least one febrile seizure, but it’s important to note that most children who have a febrile seizure don’t develop epilepsy later in life.

However, children who experience complex febrile seizures may have a higher risk of developing epilepsy than children who have simple febrile seizures. The risk appears to be higher when seizures are prolonged, focal, or recurrent.

If you’re concerned about your child’s neurological development, consider visiting a neurologist — a doctor who specializes in brain and nerve disorders.

Ear Infections in People With Epilepsy

If you or someone you love has epilepsy, you may wonder if an ear infection can be a seizure trigger. Members of MyEpilepsyTeam have shared their experiences with this situation.

One member said, “Every time my ears are infected or fluid is in them, I have a seizure.”

Another shared, “I found I had a bad ear infection. That’s why my seizures were acting up.”

“I couldn’t work out why I had three myoclonic seizures in the past two weeks,” one member of MyEpilepsyTeam said. “I hadn’t had a seizure in almost 10 months. I went to the doctor, and after a few checks, he discovered I had an inner ear infection. So we worked out the trigger.”

Many illnesses can trigger seizures, including head colds, sinus infections, and lung infections. The seizure trigger may not be the infection itself but, rather, the result of symptoms such as:

• High fever
• Vomiting, which may lead to dehydration or missing a dose of seizure medicine
• Poor sleep

Over-the-Counter Medications and Risk of Seizures

People with epilepsy need to be careful when considering their treatment options for infections. Some over-the-counter (OTC) drugs that reduce the symptoms of ear infections and other illnesses may cause seizures or make them worse.

It’s important to know that, for example:

• Diphenhydramine, used for sleep and colds, may increase epileptic seizures in some people.
• Pseudoephedrine, used as a decongestant, may lower seizure threshold in some people and has been associated with seizure reports. However, it doesn’t predictably cause seizures in everyone with epilepsy. Ask your healthcare provider or pharmacist whether pseudoephedrine is appropriate for you.
• Ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID) to relieve pain, generally isn’t considered a seizure-triggering medication when used at recommended doses. Seizures have mainly been reported in cases of severe toxicity or overdose.
• Dextromethorphan is used for cough suppression. Exercise caution with epilepsy, as overdoses might trigger seizures. Additionally, be mindful of interactions and the risk of serotonin toxicity when using serotonergic medications.

Be sure to talk with your healthcare provider about the benefits and risks of taking OTC medications.