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Day 2a. Febrile Seizure Kuliah MHS 2012pdf
Day 2a. Febrile Seizure Kuliah MHS 2012pdf
Seizure
Definition:
a sudden temporary change in brain function
caused by an abnormal rhytmic electrical
discharge
due to the releasing of excessive electric
load from deteriorated neurons cells in the
brain
Can caused by disturbance of:
Physiological
Anatomical
Biochemical
Combination of the above component
medical emergency
Have to be managed quickly &
appropriately
Seizure
Mechanisme of Seizure
Partial secondary
generalized
Focal seizure
mechanisme
General seizure
Definition
Defined by The International League
Against Epilepsy (ILAE)
Febrile seizure:
a seizure occurring in childhood after one
month of age, associated with a febrile illness
not caused by an infection of the central
nervous system, without previous neonatal
seizures or a previous unprovoked seizure, and
not meeting criteria for other acute
symptomatic seizures
Jones T, Jacobsen SJ. Childhood Febrile Seizures: Overview
and Implications. Int. J. Med. Sci. 2007, 4 (2):110-14
Definition
Febrile Seizure is a seizure in childhood,
usually occurring associated with fever (>380C
rectal) but without evidence of intracranial
infection or define cause.
Seizure with fever in children who have
suffered a previous non-febrile seizure are
excluded.
Ismael S, KPPIK XI, 1983;
Soetomenggolo TS. Buku Ajar Neurologi Anak 1999
Natural history
Most febrile seizures occur
between 6 months and 36
months of age peaking at 18
months
The occurrence of a childs first
(initial) febrile seizures has been
associated with: first or seconddegree relative with history of
febrile and afebrile seizures
PATHOPHYISIOLOGY
Remain
unknown
It is possible that 3 feature
interact resulting in a febrile
seizure:
1. Immature brain
2. Fever
3. Genetic predisposition
Carney PR. Pediatric Practice Neurology, 2010
Immature brain
rarely occur before 1-3 mo
certain degree of myelination/
network maturation is required
for clinical expression of FS
FS rarely occur after 5-6 years
Enhanced neuronal excitability
during normal brain maturation
FS
FEVER
Fever
FEVER....
Responsible for occurrence of fever in febrile
convulsion:
respiratory tract infection
gastro enteritis
urinary tract infection
roseola infantum
post immunizations
Genetic factors
Genetic
TYPE OF FEBRILE
SEIZURE
CLASSIFICATION...
CLASSIFICATION...
INCIDENCE.....
National Collaberative Perinatal Project
Study:
74%
4% focal
8% prolonged greater than 15 minutes
16% with recurrence within 24 hours
0.4% with Todd paresis
Carney PR. Pediatric Pratice Neurology.2010
Diagnosis
Anamnesis :
21
DIAGNOSIS
The
Diferential Diagnosis
encephalopathy, encephalitis and
meningitis
Febrile shivering (peribuccal
cyanosis)
22
Differences Between
FS & Seizures due to Febrile Brain Diseases.
Febrile seizure
(FS)
Genetic predisposed to
seizure
May be strong
Type of seizure
Tonic-Clonic
Duration of seizure
None
Postictal neurologic
(Todds paralysis
Very uncommon
Conscious
Common
EEG
Niedermeyer E. Epilepsy Guide: Diagnosis and Treatment of Epileptic Seizure Disorders , 1985
CBC
Electrolyte
Blood sugar
RCP / BPA, 1991. AAP, 1999. Fukuyama Y, 1996. Baumer
J.2004.
5.
MANAGEMENT OF FS
Prevention of prolonged
seizure
2. Intermittent prophylaxis
3. Continuous prophylaxis
1.
26
% cease
spontaneousl
y
10
minutes
Seizure
duratio
n
DRUG DOSES
Table.
Onset of
Duration of
Maximal Rate
Action
action
Diazepam
1-3 minute
5-15 minute
< 2 mg/min
Midazolam
2-5 minute
30-60 minute
< 2 mg/min
Phenytoin
< 1 mg/kg/min
< 50 mg/min
Phenobarbit
< 1 mg/kg/min
al
< 100 mg/min
Freedman SB. Clin Pediatric Emergency Medicine,2003
Emergency Drugs
INTERMITTENT PROPHYLAXIS
Rectal or oral diazepam
32
CONTINOUS PROPHYLAXIS
Meta
analysis of 47 controlled
trials found that phenobarbitone
the risk of recurrence of FS
Phenobarbitone and valproate had
significantly lower risk of
recurrence than those on plasebo.
Recurrence rate of 12.8% with
valproate, 13% with phenobarbital,
and 34% in untreated controls
Wallace and Aldridge-smith 1981, Rantala et al, 1997.
Temkin 2001.
33
CONCENSUS 2005
Daily
continuous anticonvulsant
(one or more)
The presence of an abnormal neurologic (CP,
MR, Microcephaly)
History of prolonged febrile seizure (>15
min)
History of focal seizure
Consider
daily continuous
anticonvulsant
Multiple febrile seizure ( 2 or more within 24
hours)
NIH, 1980.
Ismael
S, age
1983.of
Fukuyama
Y, 1996
Seizure occur
under
the
12 months
Frequent seizures (4 or more times in 12 mo)
34
PROGNOSIS
children most children
Epilepsy : 2-4%, (3% on average)
4-6 times higher than the
incidence of epilepsy in the
general child population
Learning & behaviour disorder
(uncommon)
Diskinesia &
Incoordination(uncommon)
Mental Retardation (rarely)
Normal
Positive
family history
5.3%
Abnormal
Developme
nt 3.3%
10
%
23
%
13
%
18%
Complex
febrile seizure
4.1%
Nelson KB, Ellenberg JH: Prognosis in children with febrile
seizures.
Epilepsy following FS
The risk of later epilepsy is higher
when :
The child had been developmentally
abnormal prior to first seizure
The first seizure was long, lateralized, or
repeated during a single febrile episode.
Complex FS
A first - degree relative with epilepsy
Aicardi, 1994
The
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n
a
h
T
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o
y