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Febrile Seizures : A Practical Approach to Freaked-Out
Parents
*Febrile seizures are convulsions in a child triggered by fever
(>100 degrees F).
Occur without any brain or spinal cord infection or other
neurologic cause
- Occurs in about 3-5% otherwise healthy children aged between 6
months
and 5 years-Risk factors: Rapid rise in temperature; history of
febrile seizures in close
relative
-
*One Seizure Epilepsy
Seizure = sudden change in neurologic activity (e.g. behavior,
movement, sensation
caused by excessive synchronized discharge of cortical neurons
in a limited (focal)
or generalized distribution of the brain
Epilepsy = condition of recurrent seizures -- more common among
children with
early, recurrent febrile seizures, especially if there is a
family history of epilepsy
Classification of Febrile Seizure
Simple: A short-duration (< 15-minute), generalized seizure
with one seizure in a
24-hour period. High fever (> 39C) and fever onset within
hours of the seizure are
typical.
Complex: A long-duration (> 15-minute) or focal seizure, or
multiple seizures in a
24-hour period. Low-grade fever for several days before seizure
onset may be
present.
For your H&P
-Have parents describe the seizure. Good approach: Why did you
suspect
something was wrong? What was the child like after the
episode?-Any precipitating illness?
_Classify the fever onset and possible etiologies
-Rule outs: hypoglycemia, breath holding spell, head trauma,
toxic ingestion
-Seizure mimickers - motor tics, myocloncus, Sandifers
syndrome,
pseudoseizures
-Family history of febrile seizures 8q13-21 (FEB1) and 19q
(FEB2) have been
linked support for autosomal dominant, polygenic, and
multifactorial inheritance
-On physical exam, are they toxic appearing?
-
Risk of Recurrence..
Risk after the first febrile seizure is about 33%, and about 9%
will have three or morerecurrences.Risks are: occurrence of the
first febrile seizure at a young age; family history of febrile
seizures; short duration of fever before the seizure; relatively
low fever at the time of the
initial seizure; and possibly a family history of an afebrile
seizure
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What tests should we perform??
--Lumbar Puncture?
18 months - Do it if meningeal symptoms are present.--Ask if the
child has taken antibiotics recently
~13-16% of kids w/ meningitis seizures are the presenting sign
of disease--EEG? No evidence exists that abnormal EEGs after the
first febrile seizure are
predictive for either the risk of recurrence of febrile seizures
or the development of
epilepsy
--Blood glucose level??
--Neuroimaging??
**Should direct evaluations toward the diagnosis of the causes
of the childrens
fevers
How are we going to treat it??
-Overall, anti-epileptics are not recommended when one considers
their side effects
weighed against the fact that a febrile seizure recurrence is
likely to be of little harm
to the child
-Drugs reviewed by AAP:
*Effective in preventing recurrence of simple febrile seizures:
Phenobarbital,
Priidone, Valproic Acid
*Ineffective: Carbamazepine, Phenytoin
*Rectal diazepam 0
Reassurance and Points to Send Home With Parents
--Simple febrile seizures DO NOT: *Cause brain damage* *Usually
dont recur*
*Do not lead to incd risk of epilepsy*
-What to do if he/she seizes again??
References:1. UptToDate, Febrile Seizures.
www.uptodate.com/contents/febrile-seizures2. Lissauer, Tom.
Illustrated textbook of paediatrics.3. American Academy of
Pediatrics (Steering Committee on Quality Improvement and
Management, Subcommittee on FebrileSeizures). Clinical Practice
Guideline: Febrile Seizures: Clinical Practice Guideline for the
Long-term Management of the Child
with Simple Febrile Seizures. .Pediatrics.
2008;121:1281-1286.
4. American Academy of Pediatrics (Provisional Committee on
Quality Improvement, Subcommittee on Febrile Seizures).Practice
parameter: The neurodiagnostic evaluation of the child with a first
febrile seizure.Pediatrics. 1996; 97: 769-772.
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