A 2-year-old girl named Annu experienced a tonic-clonic seizure during a fever in the evening. This was her first seizure. Her panicked parents woke family members and took her to the emergency department. At the hospital, the doctor determined she had experienced a febrile seizure and reassured the parents this is a common scenario. Febrile seizures typically occur in children ages 6 months to 5 years when they have a fever but no underlying neurological issues. The doctor's plan is to observe Annu until she is alert and treat the underlying cause of her fever. The parents will be counseled on febrile seizures and how to handle future occurrences.

1. Dr Nazrul I. Barbhuiya
Registrar of Pediatrics
FAAMC, Barpeta.

2. Annu, 2yrs,who is otherwise normal ,has high
fever since evening, has a tonic clonic convulsion
at 11 pm, lasting 4 mits. This has never
happened before. Parents are panic stricken-
wake up grand parents, call next door aunty who
is experienced in child's illnesses. The child is
taken to emergency department.
Doctor relaxant… tells it is Febrile Seizure
MOST OF US FAMILIAR WITH SUCH SCNERIO.
dd………

3. Febrile convulsion
It is defined as fever with convulsion from 6
months to 60 months, without CNS infection
or metabolic abnormality, and that occur in
the absence of prior afebrile seizures.
Types of Febrile Convulsion:
1.Simple febrile seizure
 Primary generalized
 Tonic–clonic
 Lasting for a maximum of 15 min
 Not recurrent within 24-hr.
 Very short postictal state and usually return to
their baseline normal behaviour and
consciousness within minutes of the seizure.

4. 2.Complex febrile seizure
 Prolonged (>15 min)
 Focal
 Reoccurs within 24 hr.(simple febrile seizure
plus)
 2-fold long-term increase in mortality in
subsequence 2 years.
Incidence -2% to 5% of children
Simple febrile seizures do not have an
increased risk of mortality, abnormalities
of behaviour, scholastic performance,
neurocognitive function, attention.

5. Recurrence:
 30% of those experiencing first episode
 50% after 2 or more episodes
 50% of infants younger than 1 yr old at
febrile seizure onset.
Risk Factors for Recurrence of Febrile Seizures
MAJOR
 Age <1 yr.
 Duration of fever <24 hr.
 Fever 38-39°C (100.4-102.2°F)

6. MINOR FACTORS FOR RECURRENCE OF
FEBRILE SEIZURES
 Family history of febrile seizures
 Family history of epilepsy
 Complex febrile seizure
 Day care
 Male gender
 Lower serum sodium at time of
presentation

7. Relation of Febrile Seizure with Epilepsy
 Approximately 15% of children with epilepsy have
had febrile seizures.
 Only 2-7% of children who experience febrile
seizures proceed to develop epilepsy later in life.
Predictors of epilepsy after febrile seizures

8. Risk Factor Risk for Subsequent Epilepsy
After a FS
Simple febrile seizure 1%
Recurrent febrile seizures 4%
Complex febrile seizures (more
than 15 min duration or recurrent
within 24 hr)
6%
Fever <1 hr before febrile seizure 11%
Family history of epilepsy 18%
Complex febrile seizures (focal) 29%
Neurodevelopmental abnormalities 33%

9. GENETIC FACTORS
The genetic contribution to the incidence of
febrile seizures is manifested by a positive
family history for febrile seizures in many
patients.
It is inherited as an autosomal dominant trait,
and multiple single genes that cause the
disorder have been identified .However, in
most cases the disorder appears to be
polygenic. Identified single genes include FEB
1, 2, 3, 4, 5, 6, 7, 8, 9, and 10 genes on
chromosomes 8q13-q21, 19p13.3, 2q24,
5q14-q15, 6q22-24,18p11.2, 21q22, 5q34,
3p24.2-p23, and 3q26.2-q26.33

10. Epilepsy syndromes typically start
with febrile seizures..
Generalized epilepsy with febrile seizures
plus (GEFS+)
Autosomal dominant syndrome with a highly
variable
phenotype. Onset is usually in early childhood
and remission is usually in mid-childhood. It is
characterized by multiple febrile seizures and by
several subsequent types of afebrile generalized
seizures, including generalized tonic–clonic,
absence, myoclonic, atonic, or myoclonic
astatic seizures with variable degrees of severity
Severe myoclonic epilepsy of infancy
(also called Dravet syndrome)

11. EVALUATION
 A detailed history
 A thorough general and neurologic
examination.
Febrile seizures often occur in the context of otitis
media, roseola and human herpes virus (HHV) 6
infection, shigella, or similar infections, making the
evaluation more demanding. Several laboratory
studies need to be considered in evaluating the
patient with febrile seizures.

12. Lumbar Puncture
As Meningitis is the differential diagnosis
 Performed for all infants younger than 6 mo
of age
 If the child is ill appearing
 At any age if there are clinical signs or
symptoms of concern.
 A lumbar puncture is an option in a child 6-
12 mo of age who is deficient in
Haemophilus influenzae type b and
Streptococcus pneumoniae immunizations
or for whom immunization status is
unknown.

13. Blood Studies
 Serum electrolytes (sod. ,pot. ,calcium,
phosphorus, magnesium)
 Complete blood count are not routinely
recommended in the work-up of a child
with a first simple febrile seizure.
 Blood glucose should be determined in
children with prolonged postictal
obtundation or with poor oral intake
(prolonged fasting).

14. Electroencephalogram
 EEG need not normally be performed in
Simple Febrile Seizure.
 An EEG should, therefore, generally be
restricted to special cases in which epilepsy
is highly suspected, and, generally, it
should be used to delineate the type of
epilepsy rather than to predict its
occurrence. If an EEG is indicated, it is
delayed until or repeated after more than 2
wks have passed

15. Neuroimaging
A CT or MRI is not recommended in
evaluating the child after a first simple
febrile seizure.
The work-up of children with complex
febrile seizures needs to be individualized.
Particularly if the child is neurologically
abnormal.

16. Management Strategy
Terminate the Sezure with Midazolam,
Lorazepam, Diazepam, phenobarbital,
phenytoin, or valproate may be needed in the
case of febrile status epilepticus
Observe the Child till he/she is
awake and alert
Search for the cause of the fever.
Antipyretics can decrease the discomfort of
the child but do not reduce the risk of having a
recurrent febrile seizure, probably because the
seizure often occurs as the temperature is
rising or falling

17. Parents should be counselled about recurrence of febrile
seizures and occurrence of epilepsy.
Educate them how to handle if the seizure recurs
Midazolam Nasal spray
Given emotional support
Prophylaxis :
In general, antiepileptic therapy, continuous or intermittent, is
not recommended for children with 1 or more simple febrile
seizures.
 Intermittent prophylaxis
During febrile illnesses Such therapies help to reduce (12%) but
do not eliminate the risks of recurrence. It is use where Parents
are very anxious concerning their child’s seizures,
Oral Diazepam (0.33 mg/kg every 8 hr during fever)
Rectal diazepam (0.5 mg/kg as a rectal suppository every 8 hr
Clobazam ( 0.1mg/kg)
Oral nitrazepam
Clonazepam

18.  Continuous Prophylaxis
Therapy may be considered for children with a high
risk for later epilepsy. Currently available data
indicate that the possibility of future epilepsy does
not change with or without antiepileptic therapy.
In the vast majority of cases, it is not justified to use
continuous therapy owing to the risk of side effects
and lack of demonstrated long-term benefits, even if
the recurrence rate of febrile seizures is expected to
be decreased by these drugs
Phenobarbital (4-5 mg/kg/day in 1 or 2 divided doses)
Valproate (20-30 mg/kg/day in 2 or 3 divided doses).
Iron deficiency is associated with an increased risk
of febrile seizures, and thus it should be screen and
treat.

19. Management of Febrile Seizure:
History
Exam
Manage acute febrile seizure and acute illness (first aid,
midazolam, diazepam, diagnostic tests) as needed.
Determine risk factors for recurrence and estimate risk of
recurrence of the febrile seizures
Counsel parents about risk of recurrence and how to provide first aid
and manage fever
Determine risk factors for later
epilepsy
LOW RISK
No therapy or
investigations
Are on necessary
HIGH RISK
1. Consider EEG and imaging
2. Consider intermittent oral
diazepam or, in exceptional
cases that recur, continuous
tre.

20. Theory Question
1.Define Febrile convulsion .What are the types and their characteristics?
Describe the treatment of on-going Convulsion. What are the measures to
prevent recurrence? 10
2.How will you manage on-going convulsion? Prevention of Febrile seizure.
10
3.Annu, 2yrs,who is otherwise normal ,has high fever since evening, has a
tonic clonic convulsion at 11 pm, lasting 4 mits. This has never happened
before. parents are panic stricken- wake up grand parents, call next door
aunty who is experienced in child's illnesses. The child is taken to
emergency department.
What is your pd? how will you manage and plan for discharge from hospital?

21. 1.Continuous prophylactic anticonvulsant therapy is not needed in achild
with febrile convulsion with 2014
a) Developmental delay
b) Family history of epilepsy
c) Typical simple febrile fit
d) Persistant neurological deficit.
2. % of children with simple febrile seizure developing epilepsy is 2013
a)1-2%
b)2-5%
c)5-10%
d)10-15%
3.Treatment of simple febrile seizure is 2012
a) Control of Fever
b) Rectal diazepam
c) CSF finding
d) Blood report

22. ans…. c……a…….b
4.What is correct about Febrile Seizure 2012
a)Causes developmental delay
b)Focal deficit
c) Repeated seizure in 24 hsr
d) Doer not need long term anti epileptis
5.Which of the following is not associated with increase in the risk of
epilepsy in a child with FS
a) Developmental delay
b) Compex partial seizure
c) Late age of onset
d) Family history positive for epilepsy
6.Management of typical febrile seizures include all except
a) Sponging
b) Paracetamol or ibuprofen
c) Intermitant Diazepam
d) Prophylactic phenobarbitone
Ans…….d….c……d

23. 8.True regarding FS is
a) Carbamazepine is good drug to treat it
b) Patient with F/H of FS have increase incidence of recurrence
c) Long term deficit are common
d) Usually last for short time
e) Continuous anti epileptic therapy is required
9.A 4 year male had febrile seizures, best prophylaxis is
a) Paracetamol 6 hourly
b) Paracetamol and diazepam
c) Diazepam
d) Phenobarbitone
10.The most common cause of convulsion in a 9 months old infant with
fever
a) Septicemia
b) FS
c) Hypoglycemia
d) Hypernatremia.
Ans…..b…..c….b……….

24. THANK
YOU！