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Febrile Convulsions
Dr.
Yousef Mohammed Quda
MSc. Pediatrics
www.facebook.com/dryousefquda
Febrile convulsions, Dr.Yousef Quda
What is seizure?
 Is defined as paroxysmal involuntary
disturbance of brain electrical activity.
 Manifested as motor, sensory, behavioral,
or autonomic dysfunction
 With or without impairment or loss of
consciousness
 If seizures manifest as motor act, it is
called convulsions.
 Single motor act = fit.
Epilepsy
Epilepsy: recurrent
seizures which are
unrelated to fever or
acute cerebral insult.
What Are the causes of
convulsive disorders?
Causes of convulsive
disorders
(A) Acute:
1-Febrile convulsions.
2-Intracranial infections: Meningitis,
encephalitis, cerebral abscess.
3-Intracranial hemorrhage: Traumatic or
non-traumatic (hemorrhagic diseases,
rupture of defective vessels or aneurysm).
Causes of convulsive
disorders
4-Toxic causes:
a-Drugs: Aminophylline, antihistamines,
phenothiazine, corticosteroids, chlorpromazine.
b- Tetanus.
c- Shigellosis, salmonellosis.
5-Anoxic cause: hypoxic-ischemic
encephalopathy
6-First epileptic fit.
Causes of convulsive
disorders
7-Metabolic:
- Hypocalcaemia - Hypomagnesemia
- Hypo & hypernatremia - Hypoglycemia
-Inborn errors of metabolism
(phenylketonuria, pyridoxine deficiency)
8-Acute cerebral edema (hypertensive
encephalopathy).
Causes of convulsive
disorders
(B) Chronic or recurrent forms:
1) Epilepsy
2) Epilepsy simulating states
3) Tetany
Febrile convulsions, Dr.Yousef Quda
Febrile Convulsions
Definition:
Convulsions in age vulnerable
children due to:
1.Rapid rise of body temperature
2.Due to extracranial causes.
Febrile Convulsions
Incidence:
- Affect 4% of children.
- Family history in about 20 % of cases
- Simple febrile seizures is inherited as
autosomal disorder.
- Recurrent in 30-50 % of cases.
Febrile Convulsions
Diagnostic criteria:
1- Age: 9 months - 5 years.
2- temperature: Usually ≥ 39ºC,
fits occur within 8-12hrs from onset
of fever.
Febrile Convulsions
Diagnostic criteria:
3- No evidence of CNS
infection (meningitis, abscess) the most
important doctor's responsibility.
4- Evidence of extracranial
infection (viral URTI, tonsillitis, otitis
media, roseola infantum infection)
Febrile Convulsions
5- Type of convulsions:
Complex
(complicated)
Typical
(simple)
- Focal seizures.
- Last > 15 min
- Recurring during
the same illness
within 24 hours
- Uncommon.
-Generalized tonic-clonic.
- Last < 15 min.
- One fit only in the same
illness.
- the commonest form.
Febrile Convulsions
6- Investigations:
- Usually not needed in children with simple
febrile convulsion.
- Complex form may need:-
- Glucose determination, serum electrolytes.
- Lumbar puncture and CSF analysis.
- Neuro-imaging (CT, MRI).
- EEG.
Febrile convulsions, Dr.Yousef Quda
Treatment
1- Fever control .
2- Benzodiazepine: diazepam (I.V. or rectal) if fit
last more than 5 minutes.
3- Treat the underlying cause  (antibiotics).
4- Parental advice about fever control.
Treatment
Diazepam:
- IV dose: 0.1-0.3 mg/kg (maximum dose is 10
mg/dose) for a maximum of 3 doses.
- Rectal dose: 0.3-0.5 mg/kg diluted in 3 ml NS,
given by syringe and a flexible tube.
- Side effects: Hypotension and respiratory arrest.
Treatment
5- Prophylactic anti-convulsants therapy (Na
valproate) may be used for cases carry risk to
develop epilepsy:
- Complex form.
- Pre existing neurologic abnormality
(delayed development milestones).
- Initial febrile seizure developed before 12 m
- Positive family history of epilepsy.
Depakine drops : 200mg/ml{0.1: 0.2ml/kg/d}
Treatment
However, Short- term or long-
term Prophylaxis is no longer
recommended as many drugs
have no effect on febrile
seizures and may decrease
cognitive function.
Treatment
6- At the onset of each febrile
illness oral diazepam (1 mg/kg
divided q8 hours )is given for
for 2-3 days to reduce risk of
recurrence in recurrent cases.
Differential diagnosis
Seizures associated with fever
1- Meningitis.
2- Viral meningeo-encephalitis.
3- Brain abscess
4- Epileptic fit precipitated by
associated fever.
Prognosis:
1.Recurrence of febrile
seizures : The risk is increased if:
-1st febrile seizure before 12 m or
-Febrile seizure occurs at < 40C.
-Complex features.
Prognosis:
- Positive family history of febrile
seizures.
2. Epilepsy: Risk is 1% in
absence of risk factors & 9% in
presence of several risk factors.
Febrile convulsions, Dr.Yousef Quda

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Febrile convulsions, Dr.Yousef Quda

  • 1. Febrile Convulsions Dr. Yousef Mohammed Quda MSc. Pediatrics www.facebook.com/dryousefquda
  • 3. What is seizure?  Is defined as paroxysmal involuntary disturbance of brain electrical activity.  Manifested as motor, sensory, behavioral, or autonomic dysfunction  With or without impairment or loss of consciousness  If seizures manifest as motor act, it is called convulsions.  Single motor act = fit.
  • 4. Epilepsy Epilepsy: recurrent seizures which are unrelated to fever or acute cerebral insult.
  • 5. What Are the causes of convulsive disorders?
  • 6. Causes of convulsive disorders (A) Acute: 1-Febrile convulsions. 2-Intracranial infections: Meningitis, encephalitis, cerebral abscess. 3-Intracranial hemorrhage: Traumatic or non-traumatic (hemorrhagic diseases, rupture of defective vessels or aneurysm).
  • 7. Causes of convulsive disorders 4-Toxic causes: a-Drugs: Aminophylline, antihistamines, phenothiazine, corticosteroids, chlorpromazine. b- Tetanus. c- Shigellosis, salmonellosis. 5-Anoxic cause: hypoxic-ischemic encephalopathy 6-First epileptic fit.
  • 8. Causes of convulsive disorders 7-Metabolic: - Hypocalcaemia - Hypomagnesemia - Hypo & hypernatremia - Hypoglycemia -Inborn errors of metabolism (phenylketonuria, pyridoxine deficiency) 8-Acute cerebral edema (hypertensive encephalopathy).
  • 9. Causes of convulsive disorders (B) Chronic or recurrent forms: 1) Epilepsy 2) Epilepsy simulating states 3) Tetany
  • 11. Febrile Convulsions Definition: Convulsions in age vulnerable children due to: 1.Rapid rise of body temperature 2.Due to extracranial causes.
  • 12. Febrile Convulsions Incidence: - Affect 4% of children. - Family history in about 20 % of cases - Simple febrile seizures is inherited as autosomal disorder. - Recurrent in 30-50 % of cases.
  • 13. Febrile Convulsions Diagnostic criteria: 1- Age: 9 months - 5 years. 2- temperature: Usually ≥ 39ºC, fits occur within 8-12hrs from onset of fever.
  • 14. Febrile Convulsions Diagnostic criteria: 3- No evidence of CNS infection (meningitis, abscess) the most important doctor's responsibility. 4- Evidence of extracranial infection (viral URTI, tonsillitis, otitis media, roseola infantum infection)
  • 15. Febrile Convulsions 5- Type of convulsions: Complex (complicated) Typical (simple) - Focal seizures. - Last > 15 min - Recurring during the same illness within 24 hours - Uncommon. -Generalized tonic-clonic. - Last < 15 min. - One fit only in the same illness. - the commonest form.
  • 16. Febrile Convulsions 6- Investigations: - Usually not needed in children with simple febrile convulsion. - Complex form may need:- - Glucose determination, serum electrolytes. - Lumbar puncture and CSF analysis. - Neuro-imaging (CT, MRI). - EEG.
  • 18. Treatment 1- Fever control . 2- Benzodiazepine: diazepam (I.V. or rectal) if fit last more than 5 minutes. 3- Treat the underlying cause  (antibiotics). 4- Parental advice about fever control.
  • 19. Treatment Diazepam: - IV dose: 0.1-0.3 mg/kg (maximum dose is 10 mg/dose) for a maximum of 3 doses. - Rectal dose: 0.3-0.5 mg/kg diluted in 3 ml NS, given by syringe and a flexible tube. - Side effects: Hypotension and respiratory arrest.
  • 20. Treatment 5- Prophylactic anti-convulsants therapy (Na valproate) may be used for cases carry risk to develop epilepsy: - Complex form. - Pre existing neurologic abnormality (delayed development milestones). - Initial febrile seizure developed before 12 m - Positive family history of epilepsy.
  • 21. Depakine drops : 200mg/ml{0.1: 0.2ml/kg/d}
  • 22. Treatment However, Short- term or long- term Prophylaxis is no longer recommended as many drugs have no effect on febrile seizures and may decrease cognitive function.
  • 23. Treatment 6- At the onset of each febrile illness oral diazepam (1 mg/kg divided q8 hours )is given for for 2-3 days to reduce risk of recurrence in recurrent cases.
  • 24. Differential diagnosis Seizures associated with fever 1- Meningitis. 2- Viral meningeo-encephalitis. 3- Brain abscess 4- Epileptic fit precipitated by associated fever.
  • 25. Prognosis: 1.Recurrence of febrile seizures : The risk is increased if: -1st febrile seizure before 12 m or -Febrile seizure occurs at < 40C. -Complex features.
  • 26. Prognosis: - Positive family history of febrile seizures. 2. Epilepsy: Risk is 1% in absence of risk factors & 9% in presence of several risk factors.