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Febrile seizure


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Febrile seizure

  1. 1. Febrile seizure Dr Harshuti shah Child neurologist Rajvee hospital Helemt char rasta Ahmedabad
  2. 2. END 2012
  3. 3. All went Fake
  4. 4. Anything which is frightening is not life threatening
  5. 5. How far it is common? 2-4% of pediatric population Commonest neurological emergensy to be presented in the clinic Peak age of onset 1-3 year-i.e. 18 months
  6. 6. What is febrile seizure? As the name implies, Seizure associated with fever “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”
  7. 7. Confirmation of febrile seizure Age group:1 month- Occurrence after 6 year is uncommon Temperature is usually high>38.5*c or 100.4 F Generalised tonic-clonic But could be partial
  8. 8. How to categerise? Simple febrile seizure(60- 70%) 5 f’’ Generalised Lasts <10 min. No recurrence in 24 hours(within same illness) 3 mo-5 year No preictal/postictal aura Complex febrile seizure(30- 40%) Focal Lasts>15 min. Recur within 24 hours(within same illnes) Beyond 6 year Postictal deficit
  9. 9. FAQ
  10. 10. Will anything happen to my child? Self limiting Not brain damaging Extremely low mortality associated with febrile seizure Even least with febrile status epilepticus
  11. 11. Do I need admission? Admission 1. to identify the cause of fever 2. To know the recurrence in case of complex seizure Least chances of recurrence with simple febrile seizure
  12. 12. Why does it occur? Age specific reaction to systemic illness Breakdown of threshold associated with rate of rise of temperature Herpes-6 & Herpes -7 infections have highest rate of infection Gastroenteritis infection has lowest incidence
  13. 13. What are investigations? Total count-not much significant (There might be pleocytosis,If blood is withdrawn at the time or immediately after the onset of seizure) Electrolytes-low serum sodium after first febrile seizure is associated with the significant risk of recurrent febrile seizure
  14. 14. Whether it will happen again? Simple febrile seizure-NO Focal,afebrile,lethargic child-high chances of recurrence Neurodevelopmentally delayed/deranged child-high chance of recurrence
  15. 15. Lumber puncture Most imp. To r/o CNS infection in children Varied and vague presentation in infants Need careful evaluation by experienced doctor to avoid L>P. Imp. Points Focal seizure Persistent lethargy Child had been within 48 hours prior to onset of seizures for febrile illness Or Recurrence of seizure in 24 hours in chld <1 year Conclusively, All children<12 months old need lumber puncture
  16. 16. Do they need EEG? GAP between evidence-practice continues Consistent evidence that routine EEG does not predict febrile seizure recurrence Or subsequent epilepsy Hypnagogic spike-waves Not to be suggested if diagnosis is
  17. 17. I want CT scan/MRI X –ray skull CT scan No proven benefit Not justified based on anxiety MRI:May reveal the changes of acute inflammatory reaction on T2 weighted images but usually disappears (FEBSTAT study) Does not carry future implication
  18. 18. Whether my child will develop epilepsy? 2% chance only for development of epilepsy 4-12% following complex febrile seizures One must know…. High risk of development if epilepsy is with Focal seizures, Prolonged seizures Developmental dysfunction Neurological dysfunction Epilepsy associated with family members
  19. 19. What are the probability of having recurrent febrile seizures? If first seizure occurs before 1year of age If seizure occurred within 1 hour of onset of fever- Fever occurred after the onset of seizure Seizure occurred at low temperature<100.4 Developmentally delayed child
  20. 20. What should be done at home in acute attack Put the child on floor in open Turn head on one side Do not put any hard object nearby Remedial measures at HOME 1.intranasal spray 2. Per rectal supoositary 3. Use of per rectal inj. Diazepam/benzodiazepam DO NOT PUT ANYTHING IN MOUTH except maintaining airway.
  21. 21. Use of intranasal spray Easily operable Put the nasal spray as soon as the onset of seizure No. of spray =1/2 of the no. of weight Can be used intrabucally Can be repeated thrice at the interval of 10 min.
  22. 22. Use of rectal suppository Diazepam suppository readily available May cause drowsiness and lethargy thereafter If nothing , Inj. Diazepam (0.5mg/kg)/inj.lorazepam (0.1mg/kg)can be infused per rectally using feeding tube REDUCES DURATION OF FEBRILE SEIZURE RELIEF TO FRIGHTENED PARENT AS SENSE OF BEING IN CONTROL
  23. 23. In clinic for control of acute seizure First step, Use of intranasal spray Inj. Lorazepam 0.2 mg/kg to be given i.v. slowly Inj. Diazepam0.3mg/kg to be given I.v. slowly with the watch on respiration Rectal diazepam can be given
  24. 24. What for Prevention of recurrent attack?
  25. 25. Should I prevent the rise of temp? Seizures occurring at the height of temp. has less chance of recurrence(22%) Reduction of temp. or use of prophylactic antipyretic does not help in preventing the recurrence of febrile seizures RENDERS THE CHILD MORE COMFORTABLE
  26. 26. Recurrent febrile seizure despite of medicines given Misperception of febrile seizure Febrile myoclonus Occurs along with febrile illness During the sleep only Occurs in form of jerky movements involving either of limbs non rhythmic ,erratic Syncopal attacks Very often Always occur in upright posture Characterised by uprolling of eyeball and generalised stiffening sometimes followed by few myoclonus RIGORS Consciousness is well retained
  27. 27. Do they need AED if the febrile seizures are frequent? Regular AED is not an indication for no. of febrile seizures Regular use of prophylaxis in the high risk for recurrence of febrile seizure usually suffices
  28. 28. What medicines to be used to prevent the recurrence of febrile seizure IN INDIA, Benzodiazepine 0.1 mg/kg to be given at the time of illness/fever orally i.e. clobazam To be given at interval of 12 hours for 2 days Phenobarbitone(gardinal)4-5mg/kg/day-effective but behavioural issues and intellectual dulling Valproic acid-effective-but risk of fatal toxic hepatitis Carbamazepine and phenytoin are not effective
  29. 29. What in long run? Very good prognosis Do not develop epilepsy in most(risk2%) Risk of development of mesial temporal lobe sclerosis is only(2%) Can lead to normal life NO Effect on school performance and intelligence, academic progress
  30. 30. Inheritance Autosomal dominant Polygenic pattern Positive history of febrile seizures in first or second degree relatives increases risk 2-3 fold