Emergency room3y o child arrived by ambulance,In a room with the father ……….”my child hadbubbles coming out of the mouth this morning,and was shaking really bad ! I am scareddoctor!”“ Oh my ….. Doctor - I thought my baby girl wasdying, I did not knew what to do !!!! I just heldher while I called the ambulance, thank God theywere there in 10 min……..”“ Will my child have the brain damage now ?”
Quick assessment3 y old girl is resting comfortably onfathers arms as he is holding on to her.He is upset and nervous,Next step – start history and physicalWhat questions do we want to ask?What questions are more important ?
History and PhysicalVery important to take a very detailedhistoryQuestions that would make difference intreatment:How long did the seizures last?Were there multiple seizures lasting longerthen 15 min ?
Our PatientThat was a first episode ,Lasted for 7 minPostictal state for 1 hour afterViral cold for the past weekNever registered a fever, but “felt warm”
Febrile SeizuresNot associated with any specific illnessRelated to feverUsed to be thought:– Related to the degree of the temperature– Related to the rate of rise or decline of fever
Quoting Dr KellerNew understanding of febrile seizures :Not related to the degree of temperatureNot related to the degree of rise or declineCan happen even if the temperature is 99
Febrile Seizures2-4 % of all children6months- 5 years old,Peak incidence 18 monthsGenetic predisposition – 25%To diagnose child must be free of any pastfebrile seizures or free of identified braindisease
Febrile SeizuresSimple – last less then 15 min, manifest ingeneralized tonic- clonic activityComplex- focal or last more then 15 min,or multiple with in same illness25% are complex, 75%- simple
Febrile SeizuresLaboratory values non specificLeukocytosis could be from seizures orunderlying illnessEEG- non specificCsf – normalSometimes transient hyperglycemia
Febrile SeizuresWhat is your differential diagnosis ?
Febrile SeizuresSupport respiration – all drugs causedecrease in respiratory rateAntipyretic – acetaminophen – 10-15mg/kg per rectum or po q 4-6 hoursTreat underlying infectionReassure family – most think child will dieor have permanent brain damage .
Febrile SeizuresPrevention- not advised, due to thepossible overuse of the medications andpossible allergic reaction to medicationsAnticipatory guidance and parenteducation is absolutely a must
Febrile SeizuresWhat is important for parents to know :Inherited traitOutgrow by age of 5 if not soonerRecurrence risk -35% over childs lifetime , 25% over next 12 months
Febrile SeizuresWhen to refer:If child has neurologic deficits after seizure– refer to the pediatric neurologist.If parents frightened or insist onprophylactic treatments – refer them tospecialist to help them better understandbenign nature .