Febrile seizures

Febrile convulsions or Febrile seizure review on A4Medicine

A seizure accompanied by fever 
( temp > = 100.4 ° F or 38° C by any methods ) without CNS infection 
that occurs in infants and children 6 through 60 months of age Occurs in 2-5 % of all children ( neurologically healthy ) Most common convulsive event in children < 60 months No previous neonatal or unprovoked seizure Simple febrile seizures represent 65-90 % of febrile seizures

SIMPLE Less than 15 mins Generalised tonic-clonic No previous neurological problems Do not not recur within 24 hrs OR
within the same febrile illness No post-ictal pathology  COMPLEX-Duration of > 15 mins Focal onset or focal features Recurrence within 24 hrs OR
within same febrile illness Febrile status epilepticus + 30 mins

Risk factors first seizure- High fever Viral infection Developmental delay Day care attendance Family history
○ 1ST degree relative who has had FS
○ a relative with epilepsy Certain vaccinations – 
unclear if a risk factor or not ( Barlow et al- immunization is rarely followed by a febrile seizure )

Pathophysiology-Mechanism causing FS is poorly understood Heterogeneous condition with a complicated
( yet unclear ) genetic and pathophysiological basis Rate of body temperature rise as a cause – frequently quoted theory but unsupported by evidence ie it is uncertain if

Degree of fever OR
Rate of rise of temp

history-Fever associated with seizure
 Typical features of FS’s as
○ child 6 months to 5 yrs of age 
○ duration 3-6 minutes
○ generalised tonic-clonic type presenting with
 body stiffening
 twitching – face , arms , legs
 eye rolling
 jerking of arms and legs
 loss of consciousness
 Full recovery within 1 hour May occur in a child with a previous h/o FS’s Ask about – 
○ family history
○ previous seizures 
○ recent antibiotics use
○ immunization history

When to admit-First seizure Subsequent seizure and child not seen by paeds Diagnostic uncertainty Complex seizure Child < 18 months of age Focal neurological deficit No serious findings but currently taking antibiotics or has recently been taking them Parental anxiety/failure to cope Suspected serious cause No obvious apparent focus of infection

Rectal diazepam dose as per CKS