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Febrile seizure
Dr Harshuti shah
Child neurologist
Rajvee hospital
Helemt char rasta
Ahmedabad
END 2012
All went Fake
Anything
which
is
frightening is
not
life threatening
How far it is common?
2-4% of pediatric population
Commonest neurological emergensy to be presented in the clinic
Peak age of onset 1-3 year-i.e. 18 months
What is febrile seizure?
As the name implies,
Seizure associated with fever
“An event in infancy or childhood usually occurring between 3 months and 5 years of age, associated with fever but without evidence of intracranial infection or defined cause”
Confirmation of febrile seizure
Age group:1 month-
Occurrence after 6 year is uncommon
Temperature is usually high>38.5*c or 100.4 F
Generalised tonic-clonic But could be partial
How to categerise?
Simple febrile seizure(60-70%)
5 f’’Generalised
Lasts <10 min.
No recurrence in 24 hours(within same illness)
3 mo-5 year
No preictal/postictal aura
Complex febrile seizure(30-40%)
Focal
Lasts>15 min.
Recur within 24 hours(within same illnes)
Beyond 6 year
Postictal deficit
FAQ
Will anything happen to my child?
Self limiting
Not brain damaging
Extremely low mortality associated with febrile seizure
Even least with febrile status epilepticus
Do I need admission?
Admission
1. to identify the cause of fever
2. To know the recurrence in case of complex seizure
Least chances of recurrence with simple febrile seizure
Why does it occur?
Age specific reaction to systemic illness
Breakdown of threshold associated with rate of rise of temperature
Herpes-6 & Herpes -7 infections have highest rate of infection
Gastroenteritis infection has lowest incidence
What are investigations?
Total count-not much significant
(There might be pleocytosis,If blood is withdrawn at the time or immediately after the onset of seizure)
Electrolytes-low serum sodium after first febrile seizure is associated with the significant risk of recurrent febrile seizure
Whether it will happen again?
Simple febrile seizure-NO
Focal,afebrile,lethargic child-high chances of recurrence
Neurodevelopmentally delayed/deranged child-high chance of recurrence
Lumber puncture
Most imp. To r/o CNS infection in children
Varied and vague presentation in infants
Need careful evaluation by experienced doctor to avoid L>P.
Imp. Points
Focal seizure
Persistent lethargy
Child had been within 48 hours prior to onset of seizures for febrile illness
Or
Recurrence of seizure in 24 hours in chld <1 year
Conclusively,
All children<12 months old need lumber puncture
Do they need EEG?
GAP between evidence-practice continues
Consistent evidence that routine EEG does not predict
febrile seizure recurrence
Or
subsequent epilepsy
Hypnagogic spike-waves
Not to be suggested if diagnosis is confirmed.
I want CT scan/MRI
X –ray skull
CT scanNo proven benefitNot justified based on anxiety
MRI:May reveal the changes of acute inflammatory reaction on T2 weighted images but usually disappears (FEBSTAT study)
Does not carry future implication
Whether my child will develop epilepsy?
2% chance only for development of epilepsy
4-12% following complex febrile seizures
One must know….
High risk of development if epilepsy is with
Focal seizures,
Prolonged seizures
Developmental dysfunction
Neurological dysfunction
Epilepsy associated with family members
What are the probability of having recurrent febrile seizures?
If first seizure occurs before 1year of age
If seizure occurred within 1 hour of onset of fever-
Fever occurred after the onset of seizure
Seizure occurred at low temperature<100.4
Developmentally delayed child
What should be done at home in acute attack
Put the child on floor in open
Turn head on one side
Do not put any hard object nearby
Remedial measures at HOME
1.intranasal spray
2. Per rectal supoositary
3. Use of per rectal inj. Diazepam/benzodiazepam
DO NOT PUT ANYTHING IN MOUTH except maintaining airway.
Use of intranasal spray
Easily operable
Put the nasal spray as soon as the onset of seizure
No. of spray =1/2 of the no. of weight
Can be used intrabucally
Can be repeated thrice at the interval of 10 min.
Use of rectal suppository
Diazepam suppository readily available
May cause drowsiness and lethargy thereafter
If nothing ,
Inj. Diazepam (0.5mg/kg)/inj.lorazepam (0.1mg/kg)can be infused per rectally using feeding tube
REDUCES DURATION OF FEBRILE SEIZURE
RELIEF TO FRIGHTENED PARENT AS SENSE OF BEING IN CONTROL
In clinic for control of acute seizure
First step,
Use of intranasal spray
Inj. Lorazepam 0.2 mg/kg to be given i.v. slowly
Inj. Diazepam0.3mg/kg to be given I.v. slowly with the watch on respiration
Rectal diazepam can be given
What for Prevention of recurrent attack?
Should I prevent the rise of temp?
Seizures occurring at the height of temp. has less chance of recurrence(22%)
Reduction of temp. or use of prophylactic antipyretic does not help in preventing the recurrence of febrile seizures
RENDERS THE CHILD MORE COMFORTABLE
Recurrent febrile seizure despite of medicines given
Misperception of febrile seizure
Febrile myoclonus
Occurs along with febrile illness
During the sleep only
Occurs in form of jerky movements involving either of limbs non rhythmic ,erratic
Syncopal attacks
Very often
Always occur in upright posture
Characterised by uprolling of eyeball and generalised stiffening sometimes followed by few myoclonus
RIGORS
Consciousness is well retained
Do they need AED if the febrile seizures are frequent?
Regular AED is not an indication for no. of febrile seizures
Regular use of prophylaxis in the high risk for recurrence of febrile seizure usually suffices
What medicines to be used to prevent the recurrence of febrile seizure
IN INDIA,
Benzodiazepine 0.1 mg/kg to be given at the time of illness/fever orally i.e. clobazam
To be given at interval of 12 hours for 2 days
Phenobarbitone(gardinal)4-5mg/kg/day-effective but behavioural issues and intellectual dulling
Valproic acid-effective-but risk of fatal toxic hepatitis
Carbamazepine and phenytoin are not effective
What in long run?
Very good prognosis
Do not develop epilepsy in most(risk2%)
Risk of development of mesial temporal lobe sclerosis is only(2%)
Can lead to normal life
NO Effect on school performance and intelligence, academic progress
Inheritance
Autosomal dominant
Polygenic pattern
Positive history of febrile seizures in first or second degree relatives increases risk 2-3 fold
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