Convulsions accompanied with hotness of the body

1. FEBRILE CONVULSIONS
Definition
 An event in infancy or childhood associated with fever
but without evidence of intracranial infection or
defined cause.

2.  Age of occurrence is 6 month to 5years.
 Prior episodes of short convulsions while febrile.
 Always associated with fever.
 Diagnosis of exclusion.
 Occurs in boys more commonly than girls.
 Usually generalised tonic clonic but can take any form.
 Chances of recurrence are higher in those whose onset
was at infancy.
 Blood smear normal.

3.  Epilepsy may develop in later life.
 Status epilepticus can occur.
 Complicated febrile seizures:
 are prolonged,
 focal or
 several episodes within the same illness
 Exclude CNS infections like meningitis.

4. Associated with
 Otitis media
 RTI
 UTI
 Measles
 Malaria
 shigellosis

5. Management
 Reduce temperature
 Clear airway
 Treat underlying disease
 Seizure lasting > 15 min give per rectal diazepam or
0.3-0.5 mg/kg body weight
 Start prophylaxic if required
 Phenobarbitone 5mg/kg once daily
 Valproate 20-30mg/kg in two divided doses

6. Managing the risks of seizures and their
treatment
 Observation
 Airway support
 Oxygen
 Bag & mask
ventilation

7. Diazepam
 Half-life, 10-20 hours, longer in newborns.
 Danger of accumulation
 Predominantly inactivated in the liver
 Can be given by iv and rectal routes
 A dose of 0.3mg/kg-iv
 A dose of 0.5mg/kg-rectal
 Diazepam given im is therefore an inappropriate
way of trying to stop a convulsion in a child. It
works much less well than the rectal route

8. Diazepam – side effects
a)Respiratory depression cause s a rise in carbon
dioxide in the blood – this causes dilation of blood
vessels in the brain and raises intracranial pressure.
In cases of meningitis, head injury, perhaps malaria
and other diseases this effect may be enough to
cause respiratory arrest.
b)Respiratory depression also can worsen delivery of
oxygen to the body.

9. Giving rectal diazepam
The most common way is to use a 1ml or
2mls syringe

10. Phenobarbitone
 Half life, ≥ 2 days
 Danger of accumulation
 Eliminated by the liver
 Can be given:
 Deep im injection
 Slow iv infusion (max 10mg/kg/min)
 iv bolus doses are contraindicated.

11. Phenobarbitone – side effects
 Respiratory depression
 ↑ pCO2, worsens acidosis and can cause an increase
in intra-cranial pressure (ICP) possibly precipitating
coning and respiratory arrest.
 ↓ pO2, worsening oxygen delivery to the tissues and
brain
 In overdose – coma and hypotension.

12. A rational approach.
Diazepam 0.3mg/kg iv, or,
0.5mg/kg pr
Diazepam 0.3mg/kg iv, or,
0.5mg/kg pr
Phenobarbitone 15mg/kg im (no
previous phenobarbitone)
1
3
2
Wait 5 minutes to see
if effective
Wait 5 minutes to see
if effective
Consider
glucose

13. Alternative therapies?
 Paraldehyde
 An effective and safe dose regimen has yet to be
established
 Can be given pr, im or iv and does not require glass
syringes in normal practice
 Phenytoin
 Must be given by slow iv infusion (20 minutes) and
cannot be given im
 No more effective than phenobarbitone but some
experience suggests can be safely used after
phenobarbitone if the seizures have not stopped.