Febrile Seizures

Definition
Occur in 2-3% of children, following respiratory, GI or urinary tract infections
Simple: single, brief (<15minutes), generalized during fever (>38) in developmen
tally and neurologically normal children between 6mo and 5yr without intracrania
l infection or other cause
Complex: febrile seizure that lasts longer than 15 minutes, is focal or that rec
urs within 24hr
Differential diagnosis
Eplilepsy
CNS infection
Anoxia/stroke/bleed
Trauma
Intoxication
Metabolic encephalopathy
Neurodegenerative disorder
Brain tumor
Neurocutaneous syndromes
Previous brain injury
History
Seizure: length, description
Previous history of seizures (febrile or afebrile)
1/3 of children with one simp
le febrile seizure will have another
Precipitating factors: height and duration of fever, length and symptoms of prec
eding illness, head trauma, possibility of ingestion
Past medical history: gestation, birth, general health, growth and development
Risk factors: Family history, slow milestones, Roseola/Shigella, DTP and measles
vaccinations, males>females
Neurological findings: H/A, vomiting, lethargy, weakness, sensory deficits, chan
ge in vision/behaviour/balance/gait
Physical exam
rule out meningitis, look for focus of infection
Vitals, head circumference
HEENT (meningismus)
Neurologic (papilledema)
Standard physical exam
Investigations
CBCD, lytes, Ca, glucose, toxicology
Lumbar puncture (<18 months)
EEG (once well, will be normal if typical must do if atypical)
MRI
Therapy
Not indicated as only 1/3 will proceed to have another febrile seizure
majority
of which will occur within 1 year of seizure
Increased recurrence risk if complex, family history, low fever with seizure
If typical no long-term adverse consequences
Rarely lead to epilepsy or recurrent non-febrile seizures later in life (1-2.4%)
, increased risk compared to general population
Anticonvulsants prophylaxis (underlying neurological condition)
Anticonvulsants:
Diazepam PO/PR
For parents: antipyretics, first aid instructions, when to seek help (ER)
No cold baths as they increase core body temperature