Febrile Seizures

&
Epilepsy
PROF. MUHAMMAD HAROON HAMID
MBBS (KE), FCPS (Pak), MRCP (Ire), FRCPCH

CHAIRMAN, DEPT. OF PAEDIATRIC MEDICINE

KING EDWARD MEDICAL UNIVERSITY, LAHORE
 Learning Objectives
• Recall definitions of fits, epilepsy and seizure disorders
• Overview of clinical features & management of Febrile fits
• Identification of common childhood epilepsy syndromes
(definition/classification)
• Management of status epilepticus
 Seizure/Convulsion
“Paroxysmal involuntary disturbance of brain function due to
abnormal excessive neuronal activity that may be manifested as an
• abnormal motor activity
• sensory disturbance
• behavioral abnormalities or
• autonomic dysfunction
• Impairment/ loss of consciousness
 DEFINITIONS

• Types:
• Focal (Partial)- simple, complex
• Generalized – tonic, clonic, tonic-clonic, myoclonic
• Febrile Seizures

• Epilepsy / Seizure disorder / Epileptic syndromes

 Epilepsy
“Recurrent seizures(convulsions) unrelated to fever
or to any acute cerebral insult.”
 Classification of Seizures
Generalized seizures:
-Tonic-clonic
-Myoclonic
-Absence
-Atonic
-Tonic
-Clonic
Partial Seizures:
a) Simple partial (Consciousness is intact)
b) Complex partial (Consciousness is lost)
Unclassified Seizures:
Neonatal
Epileptic syndromes:
FEBRILE SEIZURES
• Seizures associated with fever in the absence of detectable
CNS infection

• Characteristics:
• Age – 6 mo to 5 years (3 m – 6 yr); peak age 6-18 mo
• Temperature 38oC or higher
• No detectable CNS infection or metabolic abnormalities
• No past h/o afebrile seizures
 TYPES OF FEBRILE SEIZURES
• Simple Febrile Seizures • Complex Febrile Seizures
• Generalised, • More prolonged,
• Tonic-clonic, • Focal,
• Lasting < 5 minutes, • Recurs within 24 hours
• Early in disease,
• Not recurrent within 24
hours
 EPIDEMIOLOGY
• 2-5 % of healthy children at least 1 episode

• Not associated with increased risk of mortality with simple

febrile seizures
 Recurrence Risk

• 30% after 1 episode

• 50% after 2 or more episodes
• 50% if age < 1 year at time of 1st episode
 Risk of Epilepsy

• 1-7 % risk of developing epilepsy

• Simple FS = 1%
• Recurrent FS = 4%
• Complex FS = 6%
• Family hx of epilepsy (18%),
• Neurodevlopmental abnormalities (33%)
 Risk Factors for Recurrence of Febrile Seizures

Major Minor
• Age <1 yr • Family history of febrile seizures
• <24 hr rate : •
Recurrence
Duration of fever Family history of epilepsy
• No risk factor: 12%
• ,Complex febrile seizure
• Fever 38-39 C
• 1 risk factor: 25-50% ,
• Day care
• 2 risk factors: 50-59%;
• 3 or more: •73-100%
Male gender
• Lower serum sodium
PATHOPHYSIOLOGY
• Associated with elevation of temperature
• Exact mechanism not clear
• Genetic Predisposition
• Family Hx
• Cause – polygenic (FEB 1-10 genes on various Chromosomes)
• CLINICAL PRESENTATION
• HISTORY

• EXAMINATION
• DIFFERENTIAL DIAGNOSIS
• INVESTIGATIONS
• None needed routinely
• CBC, CRP, Urinanalysis, Cultures
• Chemistry – glucose, Ca, Ph, Mg, S/E
• CT / MRI
• Lumbar Puncture
• EEG
LUMBAR PUNCTURE
• Not routinely needed
• Should be done:
• Infants < 6 mo
• Ill looking child
• Clinical features suggestive of meningitis or encephalitis
• Optional:
• Age < 12 mo
• Immunization status –
• Pre-treated with Abx
EEG
• No required in vast majority
• Doesn’t predict recurrence
risk
• Within 2 wks may show
nonspecific slowing
• Indicated for complex FS,
Febrile Status
MANAGEMENT
• General Measures
• Control fever, correct hydration, look for source of fever – Abx ?

• Position, A B C
• Control Seizures
• Short acting anti-convulsants:
• Diazepam – 0.2 mg/kg IV, 0.5 mg/kg PR ; may repeat
• Midazolam, Clonazepam, Lorezepam
• Counselling & Reassurance
• PREVENTION OF RECURRENCE
• General Measures
• Antipyretics, sponging, care at home

• Prophylactic Anti-Convulsants
• Not routinely recommended
• Intermittent therapy – diazepam 0.33 mg/kg Q 8 H PO
• Fits lasting > 5 min, Complex Seizures
• Reduce risk but does not eliminate
• Continuous therapy – Pheno / Valproate
• High risk of epilepsy
PROGNOSIS
• Simple FS – excellent
• Recurrence
• Chances of Epilepsy
• Chances of Mortality
• Chances of Poor neurodevelopmental outcome
 THANK YOU
ANY QUESTIONS
Further Reading Material
• Nelson Textbook of Pediatrics
• Pervaiz Akber Pediatrics

For any comments / queries

• Email – profharoon@kemu.edu.pk