Febrile convulsions, occurring in children aged 6 months to 5 years with a temperature of 38°C or higher, are classified into simple and complex seizures. These seizures are primarily caused by viral infections and involve reactions in the immune system leading to increased neuronal activity due to cytokine release. Management includes maintaining safety, assessing vital signs, and administering medications such as antipyretics and anticonvulsants.

1. FEBRILE CONVULSION
PRESENTER: UNISAA. KANU
FINAL YEAR CLINICAL PEDIATERIC
STUDENT.

2. - Introduction
- Classification
- Risk factors
- Aetiology
- Pathophysiology
- Clinical presentation
- Differential diagnoses
- Diagnoses
- Management
- Summary
Outline

3. - Febrile convulsion is also known as febrile seizures
- these are seizures that occur between the age of 6 and
60 months
- Associated temperature of 38O
C (100O
F) or higher.
- Not as a result of CNS infection or any metabolic
imbalance
- Absent of a history of prior afebrile seizures
Introduction

4. Febrile convulsion is classified into simple and complex
seizures.
Simple seizure:
- It is the most common type of febrile seizure
- They are characterize by seizure associated with fever
that is generalize.
- Usually tonic – clonic, last for <15 minutes
- It rare to reoccur within a 24 hours period
- Very short post - ictal phase
Classification

5. Complex febrile convulsion:
- These seizures associated with fever that are
characterized by more than one episodes
- It has a focal onset ( e.g. shaking limited to one limb
or one side of the body)
- Last longer than 15 minutes
- It can reoccurs more than once in 24 hours.
- Can be long and associated with deficits (Todds
palsy)

6. - Age
- High grade fever
- Infection
- Viral infection such as HHV-6 and influenza virus
- Bacterial infection and parasitic infection
- Immunization
- (DPT & MMR)
- Genetic susceptibility
- Family hx of febrile convulsion (10 -20%)
- Autosomal dominant trait
Risk factors

7. Major
- Age <1yrs
- Duration of fever <24hr
- Fever 38O
to 39O
(100.4 - 102O
F)
Minor
- Family history of febrile seizures
- Family history of epilepsy
- Complex febrile seizures
- Day care
- Male gender
- Lower serum sodium
Risk factors for recurrence of febrile
seizures

8. There are several predators of epilepsy after febrile seizures
- Simple febrile seizure 1%
- Neurodevelopmental abnormalities 33%
- Focal complex febrile seizures 29%
- Family history of epilepsy 18%
- Fever <1hr febrile seizure 11%
- Complex febrile seizure 6%
- Recurrent febrile seizures 4%
Risk factors for occurrence of subsequent
epilepsy after a febrile seizure

9.  Viral infections (most common) e.g. HHV-6, Influenza
 Bactria infections e.g. shigella, salmonella
 Vaccines: DPT (in the same day), MMR (in 8-14 days)
 Meningitis
 Cerebral malaria
 Lower and upper respiratory tract infections
 UTI
Aetiology

10. - When the body immune system exposed to a pathogen or
vaccine
- Macrophages will recognize and engulf the pathogen on the
reaction mhc2 ( major histocompatibility complex, class ii)
- Which they present it to T - cells preferably T - helper cells.
- T - cells will interact with that antigen via T - cells receptor,
also interact with mhc2 complex via cd4 positive proteins
- Once this reaction occurs it triggers the release of cytokines
such as IL-1 beta, IL-6, TNF-alpha,
- This cytokines will combat the pathogen or infection in the
localized area ultimately spilling over into circulation
resulting into elevated cytokine level.
- Cytokines will act on the hypothalamus and the NMDA-
receptor (N- methyl D- aspartate)
Pathophysiology

11.  High grade fever
 Loss of consciousness
 Jerky movements of the arms, leg, body or head
 Stiffening of the arms, leg or whole body
 Fainting
 Eye rolling
 Going pale or bluish in skin colour
 Difficulty breathing
Clinical presentation

12. - CNS infection
- Electrolyte disturbance
- Inborn error of metabolism
- Intracranial mass
- Diagnosis by hx and exclusion
Differential diagnoses

13. - Complete and proper history taking
- Complete physical examination
- Investigation
 Typical not required
Atypical
 EEG
 Toxicology screening
 Assessment of electrolyte
 CT or MRI
 Lumber puncture
Diagnoses

14. - Initial assessment
- 4S ( Safety, Stimulation, Sitting, Shout for help)
- Airway
- Breathing
- Circulation
- O2 support
Management

15. - Glucose
- D10% 5mls/kg
- Barbiturates
- Phenobarbital 15-20mg/kg LD and 5mg/kg MD
- Fosphenytoin/ phenytoin
- Phenytoin 18mg/kg LD
- Benzodiazepine
- Diazepam 0.25mg/kg
- Analgesic / Antipyretics
- Acetaminophen 15mg/kg
- Ibuprofen 10mg/kg
- Transfuse blood when necessary
- Note do not combine them together switch from one drug to
another.
Medical - Management

16. Any question

17.  Febrile seizures occurs between age 6 months to 5 years
with an associated temperature of 38^C or grater.
 Classified as simple and complex seizures.
 Most commonly caused by viral infections e.g. HHV-6,
influenza,
 It is the most common neurological disorder in infants and
young children with a peak incidence of 12-18 months.
 Release of cytokines from a trigger of pathogen can
increase the sensitivity of NMDA receptor.
 Increase in body’s temperature leading to fever increases
the basal metabolic rate of neurons increases the firing of
them.
Summary

18. THANK YOU