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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



NHS inform has a page which answers all questions that parents may ask

NHS on febrile seizures

An incredibly useful video has been produced by British Red Cross on how to manage a child who is having a febrile seizure

A colour coded Febrile Seizure Fact Sheet

Nationwide children’s org – info on febrile seizures

Aboutkidshealth Canada information for parents

National Institute of Neurological Disorders and Stroke – info on febrile seizures


Epilepsy society on febrile convulsions

American Family Physician Febrile Seizures: Risks, Evaluation and Prognosis

American Academy of Paediatrics Febrile Seizures: Clinical Practice Guideline for the Long-Term Management of the Child With Simple Febrile Seizures

Management of Pediatric Febrile Seizures in Int J Enviorn Res Public Health  2018 by Daniela Laino et al


References Febrile Seizures : Four Steps Algorithmic Clinical Approach : Mahmoud Mohammadi MD Clinical Approach Iran J Pediatr Mar 2010 Vol 20 ( No 1 ) Pp 5-15 Management of Febrile seizures in Children Khawaja Tahir Mahmood et al J Biomed Sci and Res , Vol 3 ( 1) , 2011 ,353-357 Febrile Convulsions Patient UK Dr Colin Tidy , June 2015 Febrile Seizures : Risks , Evaluation and Prognosis Am Fam Physician . 2012 Jan 15 ; 85 (2) :149-153 Febrile seizures Paediatr Ann . 2013 Dec ; 42 (12 ) : 249-54 ( Abstract ) Armon K Stephenson T , MacFaul R , et al An evidence and consensus based guideline for the management of a child after a seizure . Emergency Medicine Journal 2003 ; 20: 13-20 Febrile seizure Clinical Knowledge Summaries October 2013 Febrile Seizure : Guideline for the Neurodiganostic Evaluation of the Child With a Simple Febrile Seizure Pediatrics February 2011 , Volume 127 / Issue 2 BMJ Best Practice Febrile Seizure November 2017 ABC of One to Seven Febrile Convulsions BMJ Volume 306 June 1993 Febrile seizures BMJ 2015 ; 351 Pediatric Febrile Seizures Robert J Baumann et al emedicine.medscape Nov 2017 Febrile Seizures Mohamad A Mikati et al Nesons Textbook of Paediatrics








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