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Febrile Seizures
Definition
• Convulsion that occur at highest temperature of fever with no
evidence of intracranial pathology,metabolic derangement and other
underlying cause
• Occur between 6 months to 6 years old
• Diagnosis of exclusion
Classification
• Simple febrile fit
• 75%
• <15 minutes (often 1-2 minutes)
• Generalized tonic-clonic/tonic seizure
• Once in 24h
• Complex febrile fit
• 25%
• >15minutes
• Partial seizure
• Multiple in 24h
• Residual motor neurological deficit post ictally (Todd paralysis)
Differential diagnosis
• CNS infection : neck stiffness,photophobia,vomiting,fever
• Anoxia
• Trauma:head trauma,NAI
• Stroke and haemorrhage
• Metabolic encephalopathy
• Brain tumor
• Previous brain injury
History
• Refer epilepsy slides
• Risk factors of recurrence febrile fits
• Family history of febrile fit
• <18months old
• Low degree of fever during the 1st seizure
• Brief duration between fever and seizure
• Risk factors for subsequent epilepsy
• Family history of epilepsy
• Neurodevelopmental abnormality
• Complex febrile fit
• Brief duration between the fever and seizure
Physical examination
• Normal usually
• Important
• Vital signs
• Neurological examination
Investigations
• Depends on clinical assessment and individual case
• FBC
• RBS
• LP
• Must be done if
• Signs of intracranial infection
• Prior to antibiotic therapy
• Persistent lethargy and fully interactive 6hours after the seizure
• Strongly recommended if
• 12months old
• 1st complex febrile convuslion
• District hospital without paeditrician
• Parent having problem bringing child back
• Urinalysis
• Blood culture
• CXR
• Serum Ca and BUSE
Management
• Counsel and educate the parents
• Reassurance
• Loose child's clothing
• Left lateral position
• Wipe vomitus or secretion from the mouth
• Do not insert object into the mouth
• Do not give any fluids or drugs orally
• Comfort the child as she recovering
• Control fever
• Take off clothing
• Tepid sponging
• Antipyretic
• Syrup or rectal PCM 15mg/kg QID
• For comfort but not reducing recurrence rate
• Prophylaxis for recurrence events
• Give rectal diazepam 0.5mg/kg
Admission criteria
• 1st episode
• To exclude intracranial pathology especially infection
• Fear of recurrent fit
• To investigate and treat the cause of fever
• To allay parental anxiety (eg. Staying far from the hospital)

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Febrile Seizures Guide

  • 2. Definition • Convulsion that occur at highest temperature of fever with no evidence of intracranial pathology,metabolic derangement and other underlying cause • Occur between 6 months to 6 years old • Diagnosis of exclusion
  • 3. Classification • Simple febrile fit • 75% • <15 minutes (often 1-2 minutes) • Generalized tonic-clonic/tonic seizure • Once in 24h • Complex febrile fit • 25% • >15minutes • Partial seizure • Multiple in 24h • Residual motor neurological deficit post ictally (Todd paralysis)
  • 4. Differential diagnosis • CNS infection : neck stiffness,photophobia,vomiting,fever • Anoxia • Trauma:head trauma,NAI • Stroke and haemorrhage • Metabolic encephalopathy • Brain tumor • Previous brain injury
  • 5. History • Refer epilepsy slides • Risk factors of recurrence febrile fits • Family history of febrile fit • <18months old • Low degree of fever during the 1st seizure • Brief duration between fever and seizure • Risk factors for subsequent epilepsy • Family history of epilepsy • Neurodevelopmental abnormality • Complex febrile fit • Brief duration between the fever and seizure
  • 6. Physical examination • Normal usually • Important • Vital signs • Neurological examination
  • 7. Investigations • Depends on clinical assessment and individual case • FBC • RBS • LP • Must be done if • Signs of intracranial infection • Prior to antibiotic therapy • Persistent lethargy and fully interactive 6hours after the seizure • Strongly recommended if • 12months old • 1st complex febrile convuslion • District hospital without paeditrician • Parent having problem bringing child back • Urinalysis • Blood culture • CXR • Serum Ca and BUSE
  • 8. Management • Counsel and educate the parents • Reassurance • Loose child's clothing • Left lateral position • Wipe vomitus or secretion from the mouth • Do not insert object into the mouth • Do not give any fluids or drugs orally • Comfort the child as she recovering • Control fever • Take off clothing • Tepid sponging • Antipyretic • Syrup or rectal PCM 15mg/kg QID • For comfort but not reducing recurrence rate • Prophylaxis for recurrence events • Give rectal diazepam 0.5mg/kg
  • 9. Admission criteria • 1st episode • To exclude intracranial pathology especially infection • Fear of recurrent fit • To investigate and treat the cause of fever • To allay parental anxiety (eg. Staying far from the hospital)