Perspectives of febrile convulsions among parents: a local cross-sectional study

Globally, febrile convulsions (FC) constitute a respected prevalence scale among pediatric population. This usually induces a high parental anxiety. To investigate the local community diversity of perception as regards FC. A cross-sectional anonymous Arabic questionnaire-based study took place targeting the Saudi community. The study included parents with at least a child who underwent FC. Excluded, were those who have children with convulsions due to other causes rather than FC. Eight hundred participants have fulfilled the study inclusion criteria. Majority of them (84%) were mothers. While 10.9% had only one child diagnosed with FC. Participants believed that FC may induce brain damage (41.4%). Others expressed FC attacks to be life-threatening events (52.9%). They were convinced that FC is not related to epilepsy (40.2%). However, a respected percentage of participants denoted the importance of using oral protective devices during the attacks (41.4%). Overall, most study population (84%) had poor perception of the different aspects of FC. Social perception of FC problems may be significantly related to the educational level and profession of the parents. The majority of the study subjects have poor perception as regards FC. Therefore, holistic socially oriented educational programs are needed to orient the population about the problem. They may be implemented via various approaches.


Background
Febrile convulsions (FC) are among the commonly encountered benign clinical conditions within the pediatric population. They usually present among infants and children up to the age of 5 years [1].
FC are defined by The International League Against Epilepsy (ILAE) as seizures that occur in children since their early infantile age because of fever and not related to the central nervous system (CNS) causes [2].
They occur when the temperature reached more than 38 °C [1,3]. FC are not related to previous neonatal and/ or unprovoked seizures. Moreover, they do not simulate other acute symptomatic seizures [2,3].
Although the prevalence of FC have been discussed and highlighted in the literature [4][5][6][7][8], little were published as regards Saudi populations [3]. None the less, there is no international agreement concerning FC prevalence. It was reported that the peaked FC is around 2-3 years of life with an average rate 6.92% [5].

Open Access
Egyptian Pediatric Association Gazette FC have an unclear etiology, yet, they proofed to have a familial tendency [1]. They may present as simple or complex seizures. Simple seizures account for 80-85% of FC [7]. However, those children with complex FC usually suffer of prolonged drowsiness that follows the increased temperature [7,9].
Most parents, especially those who had an FC child for the first time, may be terrified as they consider it a lethal condition [10][11][12].
Most of them are intimidated by the notion that FC may lead to epilepsy, brain damage, as well as long-life physical disabilities [1,13].
Hence, most parents do not properly respond to FC management [7,14].
It is of paramount importance that knowledge about FC should be available to all society members.
The current study aimed to gauge the nation-wide parental perception of FC problem. Obtained results would be assets to create a realistic and holistic socially oriented educational program related to FC.

Method
The current study took place on a national level. It recruits the whole parental population. The questionnaire was designed and validated based on initial pilot study. Validation was done with applying the Cronbach alpha equation aiming to measure the internal consistency and validity of the questions within the questionnaire.
The questionnaire constituted three sections: the first was the participants' demographical data such as age, sex, professions, and education.
The second section was concerned with the children's data such as gender, age, presence of FC, etc.
The third section included questions related to the parents' knowledge, concern, attitude, and practice towards FC.
The study initially involved 1000 participants. Yet, 800 were indulged as they met the inclusion criteria.
The excluded two hundred responders were those who have no children or did not fully respond to the questionnaire. Also, children with previous afebrile seizures, neurological disorders, CNS infections, and seizures with drug withdrawal were excluded.
Re-validation of the questionnaire as well as statistical analysis of the obtained data were done using Statistical Package for the Social Sciences (SPSS) version 22. Data were analyzed using two-tailed tests. A p value less than 0.05 was considered statistically significant.

Results
Eight hundred participants responded to the questionnaire. Out of them, 674 (84%) were mothers. Their ages ranged from 18 to 60 years with a mean of 43.6 ± 12.4 years. Six hundred and twenty-nine (78.6%) were university graduates. Sixteen (2.0%) had not completed secondary school education. Parents' professions and parity levels are shown in Table 1.
Information of families who have children with FC is illustrated in Tables 2 and 3.
Tables 4 thoroughly express the result for the rest of the questions. Table 5 highlights the relationship between knowledge in relation to education and the profession of the parents. The parents' perception about their future progeny is shown in Fig. 1.
A Low percentage of perceptions is considered when below 60.

Discussion
Febrile seizures are commonly presented as benign convulsions among the pediatric population. The condition is highly intimidating to the children's family [1]. The current qualitative study took place to investigate this notion.
Eighty-seven (10.9%) of the study population showed only one FC child. Prevalence of the initial attack among their children was (29.9%). In a similar study, the FC prevalence was reported as 37% in the same pediatric age group [12]. On the other hand, a report from a different geographical area stated a higher percentage (50%) of toddlers with FC [15].
In the current study, 52 (59.8%) of children were girls. Among them, about 37% have repeated FC attacks. This data contradicts other literature that express a higher incidence of FC among boys compared to girls [1,12,[15][16][17].
Parents' ages at our study ranged from 18 to 60 years. Majority of them were university graduates. This partially coincides with a similar publication that showed an age range from 15 to 50 years, yet, more than 50% of the participants attained primary education [15]. In contrast, others reported 100% of mothers have no formal education [14].
It was reported that variations in educational level are the main pivot for the different parental FC perception [12,17,18]. In contrast, most of our study population was university graduates; yet, they showed limited knowledge and information about the FC problem.
Parents were highly concerned about FC complications. A quite respected percentage (41.4%) of them had the concept that FC may lead to irreversible brain   [1,15,19]. The different concepts might be explained by the differences in educational and social background. Many reported a high FC recurrence rate among children who had their initial seizures below the age of 15 months [7,9,19]. Children with precures suffering of epilepsy have a higher susceptibility rate to have the complex type of FC-related seizures [7,20].
Such complex FC are also highly presented among children with neurodevelopmental growth retardation [7,18]. Overall, FC are generally considered a self-limited pathology with a good prognosis among the pediatric population. The recurrence rate is about (4%) [7].
We reported 52.9% of participants believing that FC is a life-threatening condition. They also thought that it may cause brain damage with a strong affection of their future mental and intellectual development. These conceptual ideas are supported by previously published reports [7,9,12,18]. This may be attributed to parental fear and anxiety during the attack [1,12,14].
Contradicting other studies, 77% of our participants did not believe in herbal medicine as a treatment tool for FC [15,17,19,21]. Interestingly, the majority of our subjects (94.3%) did not consider FC as a shameful condition, compared to others who reported more than 50% of participants believing FC is a stigmatic event [22].
A considerable percentage (40.2%) of the study population were convinced that FC are not a type of epilepsy  and needs not any antiepileptic therapy. Others denoted 73% of the population considering FC as an epilepsy that requires pharmacological therapy [15]. The reason is related to the disparity of educational level that may have influenced their overall perception about the problem [12,13,15,17,21].

Conclusion
It may be concluded that FC social perception is highly related to parents' educational level. The current study subjects showed a limited perception of FC and its allied diseases. Therefore, it is recommended to design and implement special social oriented educational programs to holistically transfer the FC-related information to the community. Audiovisual tools, internet, and newspapers as well as other media tools may be helpful in fulfilling this task. Also, social workers and physicians should play an important role in the matter.