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AAP Updates Guidelines For Evaluating Simple Febrile Seizures in Children 2011 PDF
AAP Updates Guidelines For Evaluating Simple Febrile Seizures in Children 2011 PDF
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Practice Guidelines
symptoms of the disease. Although clinical testing, it should focus on the cause of the
experience is consistent with this recommen- fever and not the cause of the seizure.
dation, extensive studies are needed. There
NEUROIMAGING
is insufficient evidence to define a duration
of antibiotic pretreatment, and the ultimate Neuroimaging should not be routinely performed
decision to perform lumbar puncture in these in children with simple febrile seizures. Quality of
patients is up to the physician. evidence: strong recommendation; overwhelming
evidence from observational studies.
ELECTROENCEPHALOGRAPHY Although neuroimaging might provide
Electroencephalography (EEG) should not be early detection of fixed structural lesions
performed in neurologically healthy children or rarely abscess or tumor, the costs and
with simple febrile seizures. Quality of evi- risks outweigh this potential benefit. Parents
dence: strong recommendation; overwhelming should be educated about these risks. The
evidence from observational studies. literature does not support the use of skull
There is no evidence that EEG in these films in children with simple febrile sei-
children is predictive of recurrence of febrile zures, and there are no data evaluating com-
seizure or of afebrile seizures (epilepsy) puted tomography or magnetic resonance
within the next two years. Only one study imaging. However, studies have shown that
showed that paroxysmal EEG was associ- computed tomography is associated with
ated with a higher rate of afebrile seizures, radiation exposure that may increase the
and there is no evidence that EEG would risk of developing cancer, and that mag-
alter outcomes. Although EEG has limited netic resonance imaging is associated with
prognostic value, parents should be told that risks related to sedation. Furthermore, data
it would not affect outcomes. on computed tomography in neurologically
healthy children with generalized epilepsy
LABORATORY TESTS have shown that clinically important intra-
The following tests should not be routinely per- cranial structural abnormalities in this pop-
formed solely for diagnosing the cause of sim- ulation are uncommon.
ple febrile seizures: complete blood count and
measurement of serum electrolyte, calcium, Conclusion
phosphorus, and magnesium levels. Quality of The evaluation of children with simple febrile
evidence: strong recommendation; overwhelm- seizures should be directed toward determin-
ing evidence from observational studies. ing the cause of the fever. Meningitis should
There is no evidence that routine blood be considered in any child with fever, and
tests are beneficial in the evaluation of simple lumbar puncture should be performed if
febrile seizures in children. Although a com- there are associated signs and symptoms.
plete blood count in children with fever may Based on physician judgment, lumbar punc-
identify those at risk of bacterial meningitis, ture may be performed in children who
the risk is the same with or without febrile have not received the recommended Hib or
seizures. Some children with febrile seizures pneumococcal vaccines and in children who
have abnormal serum electrolyte levels; how- were pretreated with antibiotics. EEG, blood
ever, appropriate patient history and physi- tests, and neuroimaging are generally not
cal examination are usually sufficient. If recommended in children with simple febrile
the decision is made to perform laboratory seizures. ■
1350 American Family Physician www.aafp.org/afp Volume 83, Number 11 ◆ June 1, 2011