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Febrile seizures
- 2. Febrile seizure D: MH RADI SINIOR REGESTRAR OF PEDIATRICS
- 3. Febrile Seizures seizures that occur: between the age of 6 and 60 m with a temperature of 38C or higher, without: CNS infection nor inflammation; metabolic imbalance, history of previous afebrile seizures.
- 4. Febrile Seizures A simple : primary generalized lasting less than 15 min, and not recurrent within a 24-hour period. A complex : more prolonged (>15 min), focal, and/or recurs within 24 hr.
- 5. Febrile Seizures . RISK FACTORS : age, < 2 y high fever, > 39 sex > in males viral infection, (HHV-6) and influenza; recent immunization, (DPT, MMR) Genetic susceptibility Iron insufficiency, and Prenatal exposure to nicotine
- 6. Febrile Seizures & risk of recurrence Febrile seizures recur in approximately 30% of those experiencing a first episode, in 50% after 2 or more episodes, and in 50% of infants <1 yr old at febrile seizure onset. Several factors affect recurrence risk
- 7. Febrile Seizures & risk of epilepsy only 2-7% proceed to develop epilepsy later in life. predictors of epilepsy after febrile seizures Simple febrile seizure 1% Neurodevelopmental abnormalities 33% Focal complex febrile seizure 29% Family history of epilepsy 18% Fever <1 hr before febrile seizure 11% Complex febrile seizure, any type 6% Recurrent febrile seizures 4%
- 8. Febrile Seizures & risk of epilepsy generalized epilepsy with febrile seizures plus (GEFS+), severe myoclonic epilepsy of infancy (SMEI, also called Dravet syndrome), and, in many patients, temporal lobe epilepsy secondary to mesial temporal sclerosis.
- 9. CLINICAL FEATURES Simple Complex Febrile status epilepticus
- 10. DIFFERENTIAL DIAGNOSIS Shaking chills Central nervous system infection Genetic epilepsies with febrile seizures
- 11. Febrile Seizures work-up diagnostic testing is unnecessary in most cases Electroencephalography (EEG) magnetic resonance imaging (MRI) lumbar puncture (LP) Other laboratories
- 12. Febrile Seizures & treatment Emergency rescue therapy Febrile status epilepticus Role of preventive therapy
- 13. THANK YOU
Editor's Notes
- 1
- INTRODUCTION — Febrile seizures are the most common neurologic disorder of infants and young children. They are an age-dependent phenomenon, occurring in 2 to 4 percent of children younger than five years of age.
- Febrile status epilepticus — Some patients present in febrile status epilepticus (FSE), ie, continuous seizures or intermittent seizures without neurologic recovery, lasting for a period of 30 minutes or longe
- with a peak incidence between 12 and 18 months The maximum height of a fever, rather than the rate of rise, may be the main determinant of risk in febrile seizures. A key variable that modulates the impact of fever is seizure threshold with an estimated male-to-female ratio of 1.6:1 HHV-6 was isolated in 35 percent of children with febrile seizures In Asia, influenza A virus is most commone isolate 20% Parainfluenza (12 percent) and adenovirus (9 percent) were also common the risk of febrile seizure is highest on the day the vaccine is administered for DPT with an absolute risk estimated at 6 to 9 per 100,000 children MMR vaccination is slightly higher(25 to 34 per 100,000) and peaks later, 8 to 14 days after vaccination
- While they eventually recur in approximately one-third of children during early childhood, they are an otherwise benign phenomenon and are associated with a risk of future epilepsy that is only slightly higher than the general population. Complex febrile seizures are a more heterogeneous group, associated with a higher risk of recurrence during early childhood and an increased likelihood of future afebrile seizures.
- Although about 15% of children with epilepsy have had febrile seizures, There are several predictors of epilepsy after febrile seizures
- Almost any type of epilepsy can be preceded by febrile seizures, and a few epilepsy syndromes typically start with febrile seizures. These are GEFS+ is usually associated with an autosomal dominant inheritance pattern the most common phenotype of GEFS+ consists of seizures with fever in early childhood that, unlike typical febrile seizures, continue beyond six years of age or are associated with afebrile tonic-clonic seizures (Dravet syndrome) is a rare genetic epilepsy that can resemble complex febrile seizures in the first year the majority are de novo rather than germline mutations. Patients with Dravet syndrome typically present in the first year of life with prolonged, often febrile, generalized clonic or hemiclonic seizures in the setting of normal cognitive and motor development prior to the onset of seizures Most patients have refractory seizures and poor neurodevelopmental outcomes
- The majority of children have their febrile seizures on the first day of illness, and in some cases, it is the first manifestation that the child is ill fever is most often at or above 39ºC The most common seizure type is generalized tonic-clonic, but atonic and tonic spells are also seen. The facial and respiratory muscles are commonly involved the postictal phase can be associated with confusion or agitation and drowsiness. Children with complex febrile seizures are often younger and more likely to have abnormal development. Important clinical clues that a seizure has ended include the presence of closed eyes and a deep breath Children with persistently open and deviated eyes may still be seizing, even if convulsive motor activity has stopped.
- Chills are common and are characterized by fine rhythmic oscillatory movements about a joint chills usually involve both sides of the body simultaneously and are not associated with loss of consciousness Provoked seizures from meningitis or encephalitis are the main concerns in a child presenting with fever and seizures as many as 40 percent, particularly younger infants, who have seizures as an initial manifestation of meningitis do not have meningeal signs, they have other symptoms and findings (eg, altered consciousness, petechial rash) that strongly suggest the correct diagnosis Children with status epilepticus and fever may be more likely to have bacterial meningitis than those with a short seizure
- The evaluation should focus on assessment and diagnosis of the underlying febrile illness and parent education about risk of recurrent febrile seizures and the low risk of future epilepsy Children presenting with prolonged or focal febrile seizures, particularly if it is the first, require a more individualized approach since the likelihood of an alternative etiology such as meningitis or an underlying structural or metabolic cause is higher Electroencephalography (EEG) and magnetic resonance imaging (MRI) in the outpatient setting may help further stratify risk of future epilepsy if an EEG is indicated, it is delayed until or repeated after >2 wk LP is unnecessary in most well-appearing children who have returned to a normal baseline after a febrile seizure the American Academy of Pediatrics (AAP) recommendations regarding the performance of LP in the setting of febrile seizures: 1 meningeal signs 2 consider if on antibiotics 3 infants between 6 and 12 months without HIB immunization A complete blood count and measurement of serum electrolytes [89], blood sugar, calcium, and urea nitrogen is of very low yield in patients with simple febrile seizures
- The majority of febrile seizures have ended spontaneously Most children with simple febrile seizures do not require hospital admission Efforts should be made to lower fever with antipyretics and a cooling blanket. febrile seizures that continue for more than five minutes should be treated. Intravenous benzodiazepines IF FEBRAIL STATUS EPILEPTICUS The most commonly used drug in this setting is fosphenytoin Prophylactic antiseizure drugs can decrease the risk of recurrent febrile seizures, but given the benign nature of most seizures, the risks of side effects generally outweigh the benefits [15,20,21]. Use of antipyretics at the first sign of fever does not prevent recurrent febrile seizures.