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Febrile seizures

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What is febrile seizures , pediatric febrile seizures ,definition, simple febrile,complex febrile ,symptomatic febrile seizures , physical examination , causes ,types ,presentations ,diagnosis ,management, prognosis , conclusion ,summary

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Febrile seizures

  1. 1. Febrile seizures Prof. Dr. Saad S Al Ani Senior Pediatric Consultant Head of Pediatric Department Khorfakkan Hospital Sharjah ,UAE saadsalani@yahoo.com
  2. 2. A febrile seizure Is defined as: an event in infancy or childhood, usually occurring between 3 months and 5 years of age, associated with fever but without evidence of intracranial infection or defined cause Engel J, Jr. Report of the ILAE classification core group. Epilepsia. 2006;47:1558-1568 12/30/2015 Febrile seizures Prof. Dr. Saad S Al Ani Khorfakkan Hospital 2
  3. 3. Pediatric febrile seizures Represent the most common childhood seizure disorder, exist only in association with an elevated temperature 12/30/2015 Febrile seizures Prof. Dr. Saad S Al Ani Khorfakkan Hospital 3 http://emedicine.medscape.com/article/1176205-overview
  4. 4. Febrile seizures groups 12/30/2015 Febrile seizures Prof. Dr. Saad S Al Ani Khorfakkan Hospital 4 Epidemiologically; febrile seizures are grouped into 3 groups, as follows: 1.Simple febrile seizures 2.Complex febrile seizures 3.Symptomatic febrile seizures
  5. 5. Simple febrile seizures 12/30/2015 Febrile seizures Prof. Dr. Saad S Al Ani Khorfakkan Hospital 5 The setting is fever in a child aged 6 months to 5 years
  6. 6. Simple febrile seizures (cont.) 12/30/2015 Febrile seizures Prof. Dr. Saad S Al Ani Khorfakkan Hospital 6 The single seizure is generalized and lasts less than 15 minutes
  7. 7. Simple febrile seizures (cont.) 12/30/2015 Febrile seizures Prof. Dr. Saad S Al Ani Khorfakkan Hospital 7 The child is neurologically healthy and without neurologic abnormality by examination or by developmental history
  8. 8. Simple febrile seizures (cont.) 12/30/2015 Febrile seizures Prof. Dr. Saad S Al Ani Khorfakkan Hospital 8 Fever (and seizure) is not caused by meningitis, encephalitis, or any other illness affecting the brain
  9. 9. Simple febrile seizures (cont.) 12/30/2015 Febrile seizures Prof. Dr. Saad S Al Ani Khorfakkan Hospital 9 The seizure is either: • Generalized clonic or • Generalized tonic-clonic seizure
  10. 10. Complex febrile seizures 12/30/2015 Febrile seizures Prof. Dr. Saad S Al Ani Khorfakkan Hospital 10 Age, neurologic status before the illness, and fever are the same as for simple febrile seizure
  11. 11. Complex febrile seizures (cont.) 12/30/2015 Febrile seizures Prof. Dr. Saad S Al Ani Khorfakkan Hospital 11 This seizure is either: • Focal or prolonged (ie, >15 min) or • Multiple seizures occur in close succession
  12. 12. Symptomatic febrile seizures 12/30/2015 Febrile seizures Prof. Dr. Saad S Al Ani Khorfakkan Hospital 12 Age and fever are the same as for simple febrile seizure
  13. 13. Symptomatic febrile seizures(cont.) 12/30/2015 Febrile seizures Prof. Dr. Saad S Al Ani Khorfakkan Hospital 13 The child has a preexisting neurologic abnormality or acute illness
  14. 14. Physical examination 12/30/2015 Febrile seizures Prof. Dr. Saad S Al Ani Khorfakkan Hospital 14 Neurologically and developmentally healthy child No signs of meningitis or encephalitis
  15. 15. Diagnosis 12/30/2015 Febrile seizures Prof. Dr. Saad S Al Ani Khorfakkan Hospital 15 No specific laboratory studies are indicated for a simple febrile seizure. Other laboratory tests may be indicated by the nature of the underlying febrile illness.
  16. 16. Diagnosis (Cont.) Concerning lumbar puncture : 12/30/2015 Febrile seizures Prof. Dr. Saad S Al Ani Khorfakkan Hospital 16 Strongly considered in children younger than 12 months ( because the signs and symptoms of bacterial meningitis may be minimal or absent in this age group)
  17. 17. Diagnosis (Cont.) 12/30/2015 Febrile seizures Prof. Dr. Saad S Al Ani Khorfakkan Hospital 17 Should be considered in children aged 12- 18 months ( because clinical signs and symptoms of bacterial meningitis may be subtle in this age group) Concerning lumbar puncture (Cont.) :
  18. 18. Diagnosis (Cont.) 12/30/2015 Febrile seizures Prof. Dr. Saad S Al Ani Khorfakkan Hospital 18 In children older than 18 months, the decision to perform lumbar puncture rests on the clinical suspicion of meningitis Concerning lumbar puncture (Cont.) :
  19. 19. Diagnosis (Cont.) 12/30/2015 Febrile seizures Prof. Dr. Saad S Al Ani Khorfakkan Hospital 19 Neither computed tomography (CT) nor magnetic resonance imaging (MRI) is indicated in patients with simple febrile seizures
  20. 20. Diagnosis (Cont.) 12/30/2015 Febrile seizures Prof. Dr. Saad S Al Ani Khorfakkan Hospital 20 EEG is not indicated in children with simple febrile seizures Vast majority of these children have a normal EEG
  21. 21. Treatment 12/30/2015 Febrile seizures Prof. Dr. Saad S Al Ani Khorfakkan Hospital 21 Neither long-term nor intermittent anticonvulsant therapy is indicated for children who have experienced 1 or more simple febrile seizures.
  22. 22. Treatment (Cont.) 12/30/2015 Febrile seizures Prof. Dr. Saad S Al Ani Khorfakkan Hospital 22 Any therapy administered after a first simple seizure will not reduce the risk of : – Subsequent afebrile seizure – Recurrent afebrile seizures (ie, epilepsy).
  23. 23. Treatment (Cont.) 12/30/2015 Febrile seizures Prof. Dr. Saad S Al Ani Khorfakkan Hospital 23 Rectal diazepam or intravenous, 0.2-0.5 mg/kg for patients with febrile seizures, particularly those with febrile seizures lasting more than 5 minutes
  24. 24. Treatment (Cont.) 12/30/2015 Febrile seizures Prof. Dr. Saad S Al Ani Khorfakkan Hospital 24 Midazolam, administered intranasally, 0.2 mg/kg is as safe and effective as intravenous or rectal diazepam in the treatment of acute pediatric seizure emergencies. Brooks M. Intranasal Midazolam Works for Seizure Emergencies in Kids. Medscape Medical News. Nov 5 2013.
  25. 25. Prognosis 12/30/2015 Febrile seizures Prof. Dr. Saad S Al Ani Khorfakkan Hospital 25 Prognosis for normal neurologic function is excellent
  26. 26. Prognosis (Cont.) 12/30/2015 Febrile seizures Prof. Dr. Saad S Al Ani Khorfakkan Hospital 26 About one third of children who experience a single simple febrile seizure will have another
  27. 27. Conclusion Children aged 3 months to 6 years may have tonic-clonic seizures when they have a high fever. 12/30/2015 Febrile seizures Prof. Dr. Saad S Al Ani Khorfakkan Hospital 27 http://www.epilepsy.com/learn/types-seizures/febrile-seizures
  28. 28. Conclusion (cont.) More likely to occur if there is a family history of febrile seizures. 12/30/2015 Febrile seizures Prof. Dr. Saad S Al Ani Khorfakkan Hospital 28 http://www.epilepsy.com/learn/types-seizures/febrile-seizures
  29. 29. Conclusions (cont.) Most children do not require daily treatment with medication. 12/30/2015 Febrile seizures Prof. Dr. Saad S Al Ani Khorfakkan Hospital 29 http://www.epilepsy.com/learn/types-seizures/febrile-seizures
  30. 30. Conclusions (cont.) Among children who have their first febrile seizure before their first birthday, half will have at least one more. 12/30/2015 Febrile seizures Prof. Dr. Saad S Al Ani Khorfakkan Hospital 30 http://www.epilepsy.com/learn/types-seizures/febrile-seizures
  31. 31. Conclusions (cont.) Long-term outlook is excellent. 12/30/2015 Febrile seizures Prof. Dr. Saad S Al Ani Khorfakkan Hospital 31 http://www.epilepsy.com/learn/types-seizures/febrile-seizures
  32. 32. 12/30/2015 Febrile seizures Prof. Dr. Saad S Al Ani Khorfakkan Hospital 32

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