A 3-year-old girl was brought to the emergency room by ambulance after her father witnessed her having a seizure with foaming at the mouth while shaking. The father was scared and thought his daughter was dying. After the seizure ended, the girl was resting comfortably. It is important for the doctor to obtain a detailed history, including how long the seizure lasted and if there were multiple seizures. The girl's seizure lasted 7 minutes with a 1-hour postictal state. She had a viral cold for the past week but no registered fever. This presentation is consistent with a simple febrile seizure, which is generally benign and self-limiting in children ages 6 months to 5 years old. The family needs reassurance

1. Emergency room
3y o child arrived by ambulance,
In a room with the father ……….”my child had
bubbles coming out of the mouth this morning,
and was shaking really bad ! I am scared
doctor!”
“ Oh my ….. Doctor - I thought my baby girl was
dying, I did not knew what to do !!!! I just held
her while I called the ambulance, thank God they
were there in 10 min……..”
“ Will my child have the brain damage now ?”

2. Emergency room
What do you do next ?

3. Quick assessment
3 y old girl is resting comfortably on
fathers arms as he is holding on to her.
He is upset and nervous,
Next step – start history and physical
What questions do we want to ask?
What questions are more important ?

4. History and Physical
Very important to take a very detailed
history
Questions that would make difference in
treatment:
How long did the seizures last?
Were there multiple seizures lasting longer
then 15 min ?

5. Our Patient
That was a first episode ,
Lasted for 7 min
Postictal state for 1 hour after
Viral cold for the past week
Never registered a fever, but “felt warm”

6. Febrile Seizures
Not associated with any specific illness
Related to fever
Used to be thought:
– Related to the degree of the temperature
– Related to the rate of rise or decline of fever

7. Quoting Dr Keller
New understanding of febrile seizures :
Not related to the degree of temperature
Not related to the degree of rise or decline
Can happen even if the temperature is 99

8. Febrile Seizures
2-4 % of all children
6months- 5 years old,
Peak incidence 18 months
Genetic predisposition – 25%
To diagnose child must be free of any past
febrile seizures or free of identified brain
disease

9. Febrile Seizures
Simple – last less then 15 min, manifest in
generalized tonic- clonic activity
Complex- focal or last more then 15 min,
or multiple with in same illness
25% are complex, 75%- simple

10. Febrile Seizures
Laboratory values non specific
Leukocytosis could be from seizures or
underlying illness
EEG- non specific
Csf – normal
Sometimes transient hyperglycemia

11. Febrile Seizures
What is your differential diagnosis ?

12. Febrile Seizures
Meningitis
Toxin from infection
Drug reaction- anticholinergics,
theophyline, salicylates, amphetamine,
cocaine
Metabolic disturbance- hypoglycemia,
hypocalcemia

13. Febrile Seizures
Treatment:
Simple – watchful waiting, observing
Complex – longer then 10 min activity-
Antiepileptic drugs,
Lorazepam- 0.05- 0.1 mg/kg
Diazepam- o.2-0.4 mg/kg
Phenobarbital- 20 mg/kg
Phenytoin- 20 mg/kg

14. Febrile Seizures
Support respiration – all drugs cause
decrease in respiratory rate
Antipyretic – acetaminophen – 10-15
mg/kg per rectum or po q 4-6 hours
Treat underlying infection
Reassure family – most think child will die
or have permanent brain damage .

15. Febrile Seizures
Complications
None
No epilepsy risk
No brain damage
No neurologic deficits
No mental retardation
No learning disorders

16. Febrile Seizures
Prevention- not advised, due to the
possible overuse of the medications and
possible allergic reaction to medications
Anticipatory guidance and parent
education is absolutely a must

17. Febrile Seizures
What is important for parents to know :
Inherited trait
Outgrow by age of 5 if not sooner
Recurrence risk -35% over childs life
time , 25% over next 12 months

18. Febrile Seizures
When to refer:
If child has neurologic deficits after seizure
– refer to the pediatric neurologist.
If parents frightened or insist on
prophylactic treatments – refer them to
specialist to help them better understand
benign nature .