Febrile Convulsion

&
Epilepsy
Prof. Dr. Md. Nazrul Islam
Head of the Department of Pediatrics
Mymensingh Medical College & Hospital
 Febrile Seizure
 Seizures precipitated by fever not due to an
intracranial infection or other definable CNS cause
occurring in a genetically predisposed child.
 Most common seizure disorder in childhood.
 Incidence: 3-4% of all children.
Criteria:
1. Age & sex: 6months-5 yrs, peak 14-18 months,
males affected more.
2. Family history: Positive family history, autosomal
dominant sometimes.
 Febrile Seizure, criteria (contd.)
3. Seizure:
Onset in 24 hrs.
Type - Generalized tonic-clonic.
Duration <15 min.
Usually 1 seizure attack in each episode.
No residual weakness, only brief postictal
drowsiness.
4. Infection: 90% cases due to viral infection.
5. EEG: Usually normal.
 Atypical Febrile Seizure, criteria

1. Duration> 15 min.
2. Repeated convulsion same day.
3. Focal Seizure or focal findings in post
ictal phase.
Investigations:
1. LP indicated only if meningitis suspected.
2. Blood for TC, DC.
3. EEG, in Atypical febrile seizure.
 Febrile Seizure

Management:
1. Control convulsion by P/R Diazepam.
2. Control of fever, by antipyretic & tepid sponging.
3. Explanation & reassurance of parents.

Prophylaxis:
1. Oral Diazepam 1mg/kg/day for 2-3 days started
from onset of fever.
2. Anti pyretic.
3. Anticonvulsant prophylaxis not indicated.
 Unprovoked seizure (Epilepsy)

Seizure: Paroxysmal disturbance of brain

function that may manifested as impairment
or loss of consciousness, abnormal motor
activity, behavioral abnormalities, sensory
disturbance or autonomic dysfunction.
Epilepsy: Recurrent seizure unrelated to fever
or to an acute cerebral insult.
Incidence: 0.5-1% of population, 60% occur
in childhood
 Epileptic Seizure: Classification
1. Partial Seizure
a) Simple partial (Consciousness retained)
 Motor
 Sensory
 Autonomic
 Psychic
b) Complex partial (Consciousness impaired)
 Simple partial, followed by impaired consciousness
 Consciousness impaired at onset
c) Partial seizures with secondary generalization
 Epileptic Seizure: Classification
2. Generalized Seizure
a) Absences
 Typical
 Atypical
b) Generalized tonic-clonic
c) Tonic
d) Clonic
e) Myoclonic
f) Atonic
g) Infantile spasm

3. Unclassified Seizures
 Syndromic classification of seizure

 Infantile spasm
 Benign myoclonic epilepsy of infancy
 Lennox-Gastaut syndrome
 Febrile convulsion
 Landau Kleffner syndrome
 Juvanile myoclonic epilepsy (Janz syndrome)
 Progressive myoclonic epilepsy
 Pathophysiology
 Precise mechanism unknown.
 Deviation of normal balance between
excitation & inhibition of cerebral neuron
cause epilepsy.
 Initiated by group of neurons capable of
generating a significant burst discharge &
GABA ergic inhibitory system.
 Transmission depends on glutamenargic
synapse (Excitatory).
 Area of neural death produce hyperexcitable
synapse that cause seizure.
Partial Seizure: C/Fs

Simple Partial Seizure:

• Consciousness intact.
• Aura may be present.
• Asynchronous tonic/ clonic movement
of face, neck or extremity.
• Automatisms do not occur.
• Duration 10-20 sec.
Partial Seizure: C/Fs

 Complex Partial Seizure:

• Aura usually present.
• Altered Consciousness.
• Automatism present
• Turning of head, dystonic posture,
tonic & clonic movement of
extremity & eye blinking.
• Duration 1-2 min.
 Partial Seizure: C/Fs
Absence Seizure:
• Typical (Simple)-Cessation of motor
activity or speech.
-No aura, no postictal phase
-duration<30 sec.
• Atypical (Complex)- Myoclonic
movement of face finger & extremity.
- loss of body tone
 Generalized Seizures
 Generalized Tonic-Clonic Seizure:-
• Aura present
• Tonic phase- Skeletal muscles undergo sustained spasm
- Eyes roll back
- Biting of tongue
- Apnea with cyanosis
• Clonic phase-Rhythmic clonic contraction with relaxation
of all muscles.
- Loss of sphincter control
• Post ictal phase- Semi-comatose / in deep sleep for 30
min-2 hrs.
• O/E hyperactive reflexes, plantar is extensor.
 Generalized Seizures
 Infantile spasm
• Age 4-8 months, brief symmetrical contraction of neck,
trunk, extremities.
• 3 types- Flexor, Extensor, Mixed.
• Classified into two groups - 1. Cryptogenic
2. Symptomatic

 Myoclonic Epilepsies of childhood:

• Benign Myoclonus of infancy.
• Typical Myoclonic Epilepsy of early childhood.
• Complex Myoclonic Epilepsy.
• Juvenile Myoclonic Epilepsy.
• Progressive Myoclonic Epilepsy.
 Epileptic Seizure: Investigations

 Investigations for Initial afebrile seizure:

– Fasting blood sugar
– S. Calcium
– S. Magnesium
– S. Electrolytes
– CBC
– EEG ? CT Scan ? MRI?
 Recurrent Attack:
– EEG (Routine, Video, EEG with activation
process ).
Normal EEG does not exclude epilepsy.