FEBRILE

CONVULSIONS
 Febrile seizures are the common
cause of convulsions in younger
child.

 They occur in 2 to 4% of children younger

than five years of age(between 6 months
and 6 years)
 The majority occur between 12 and 18
months of age
 In some population it may be high as 15%
ACCEPTED CRITERIA
 A convulsion associated with an elevated
temperature more than 38c
 A child younger than 6 years of age

 No central nervous system infection or

inflammation
 No acute systemic metabolic abnormality that
may produce convulsions
 No history of previous febrile seizure
CATEGORIES
A-Simple(benign)

 The most common

 Seizures last less than 15 minutes

 No focal features

 Occur in series with a total duration less than 30

minutes
 B-complex
 Episodes last more than 15 minutes

 Focal features

 Post ictal paresis

 Series with total duration more than 30 minutes

ETIOLOGY AND PATHOGENESIS
 Not well known
 Fever induced factors(interlukin)

 Genetic susceptibility

 Fever associated neuronal activity

 Hyperthermia induced alkalosis

PREDISPOSING FACTORS
 Reduced levels of GABA in the CSF
 Increased concentration of neopetrin in the CSF

 Low iron and ferritin levels

 Genetic susceptibility

-gentic lci
- nonmendelian forms
-syndromes
 Hippocampus malformaton
CLINICAL FEATURES
A-Simple febrile:
 Generalised clonic

atonic
tonic spells
 Facial and respiratory muscles are commonly
involved
 Mostly in the first day of illness

 In 25% of cases it occurs between 38c to 39c

 It is often seen as the temperature is increasing

rapidly
 But may develop as the fever is declining
B-Complex febrile:

 Focal
 Longer than 15 minutes

 Multiple episodes within 24hours

C-Febrile status epilepticus:

 Continuous seizures
 Intermittent seizures without neurologic recovery

 Lasting for a period of 30 minutes or more

D-Recurrent febrile seizures

 30%
 Young age of onset .

 History of febrile seizures in a first degree

relative.
 Low degree of fever while in the ER.

 Brief duration between the onset of fever and the

initial seizure.
RISK FACTORS FOR RECURRENCE
OF FEBRILE SEIZURES
MAJOR
 Age <1 yr
 Duration of fever <24 hr
 Fever 38-39 C

MINOR
 Family history of febrile seizures
 Family history of epilepsy
 Complex febrile seizure
 Day care
 Male gender
 Lower serum sodium
DIFFERENTIAL DIAGNOSIS

 Shaking chills
 Metabolic disorders

 Meningitis and encephalitis

 epilepsy
TREATMENT

They always last less than 5 minutes

 Airway , respiratory status and circulation are
continuously assessed during seizure.
 Collect blood for glucose and electrolytes

 Antiepileptic drugs

 1)lorazepam

 2)additional dose

 3)fosphenytoin

 4)diazepam rectal
EXTERNAL COOLING

 External cooling may be used as an adjunct to

antipyretic therapy for children in whom you
need rapid reduction of body temperature.
 Antipyretic agents should be administered 30
minutes before external cooling.
 Antipyretic agents are necessary to reset the
thermoregulatory set point , without which
external cooling will result in an increase in heat
production.
DIAGNOSTIC EVALUATION
 Lumber puncture:
 When infants between 6 and 12 months not
immunized for haemophilus influenza
 When there are signs or symptoms of meningitis
or CNS infection
 The patient was on antibiotic before the
convulsions
 If the febrile seizure occur after the second day of
illness
 In febrile status epileptics
 Complete blood count, electrolyte , blood sugar,
urea, nitrogen are indicated for diagnosis of the
disease only.
 Neuroimaging is not indicated for simple febrile
seizures
 EEG is not warranted in the setting of simple
seizures.
FEBRILE SEIZURES WORK-UP
 Each child who presents with a febrile seizure
requires a detailed history and
 a thorough general and neurologic examination.

 These are the cornerstones of the evaluation.

 Febrile seizures often occur in the context of

otitis media,
 roseola and

 human herpesvirus 6 (HHV6) infection,

 shigella,

 or similar infections, making the evaluation more

demanding.
FEBRILE SEIZURES &LP
 Lumbar puncture is recommended in children
<12 mo of age after their first febrile seizure to
rule out meningitis.
 It is especially important to consider if the child
has received prior antibiotics that would mask
the clinical symptoms of the meningitis.
 The presence of an identified source of fever, such
as otitis media, does not eliminate the possibility
of meningitis.
 Seizures are the major sign of meningitis in 13-
15% of children presenting with this disease, and
30-35% of such children have no other meningeal
signs.
PREVENTIVE THERAPY
Based on the risk and benefits of effective
therapies, neither continuous nor intermittent
anticonvulsive therapy is recommended for
children with one or more simple febrile seizures.

Recurrent episodes of febrile seizures can create

anxiety in some parents and their children, and
as such appropriate educational support should
be provided
PATIENT INFORMATION
 Home treatment

 Place the child on their side but do not try to stop

their movement or convulsions
 Do not put any thing in the childs mouth

 Keep an eye on the time, seizures that last for

more than 5 minutes require immediate
treatment.