Febrile seizure

satanun charoencholvanich, MD
The most common seizure in childhood,
occurring in neurologically healthy child
between 6months to 5 years of age
without evidence of an intracranial
infection
Incidence 2-5%, boy>girl
Develop when core temperature >37.8°c
Associated with the rate of rise rather
than the absolute temperature
Strong family history of febrile seizure
 Classification of Febrile Seizure
Simple Complex
(typical) (atypical)
Febrile Seizure Febrile Seizure

Seizure type Generalize Focal

Tonic-Clonic
Duration of Seizure < 15min >15min

Recurrence within 24 no yes

hours
Neurologic exam Normal or brief Transient neurological
after seizure postictal drowsiness deficit
Todd’s paralysis
AAP Recommendation for LP in a child with
first febrile seizure (1996)
All children <12 months
LP is strongly considered
Children 12-18 months
LP should be considered (clinical signs
and symptoms of meningitis may be subtle)
Children >18 months
LP is recommended in the presence of
meningeal signs and symptoms
After the widespread immunization in the
US for H.influenzae B & S.Pneumoniae, the
incidence of bacterial meningitis is much
lower
Lumbar puncture is now an option for a
child 6-12 month whose with a simple FS if
immunization status is unknown or
incomplete and in those pretreated with
antibiotics since it can mask meningeal signs
EEG

• Family history of epilepsy

• CFS esp Focal seizures
• Neurodevelopmental abnormality
• 4 or more recurrent febrile seizure
 Acute treatment
• Seizure first aid
-Turn the patients on their side to keep
the airways open
-Don’t place anything in their mouth
-Don’t restrain the patient
• Most FS (87%) last <3 minutes
• If the seizures continue IV DZP 0.3mg/kg or
Rectal DZP 0.5 mg/kg is indicated
• Reassurance of caregivers are very importance
 Prevention of Recurrent FS
• Recurrent FS occur 30-40% after first FS
• Only 10% has more than 3 episodes of seizure
• Risk factors of recurrence after initial FS
- First FS occur before the age of 12 months
- Duration of fever<1hr before seizure onset
- FS occurred at low grade fever 38 – 38.5°C
- First-degree relative with febrile seizure

Antipyretics given at the onset of fever do not reduce

frequency of recurrent FS
Medication Effective in Prevention of
Recurrent Febrile seizure
• Intermittent use of oral diazepam
• Continuous use of Phenobarbital or
Valproic acid
but AAP does not recommend
because of potential adverse effects.
Risk factors for future epilepsy
Complex febrile seizure
Family history of epilepsy
Fever duration<1 hour before seizure onset
Neurodelopmental abnormality (e.g. cerebral
palsy, hydrocephalus)

The risk of developing epilepsy is small (1%)

and neurological development and school
progress are unaffected