IMPORTANT CAUSE OF SEIZURE IN CHILD IMPORTANT SLIDE THING MUST KNOW TO EVERYONE

1. FEBRILE SEIZURE
DR MAHTAB
MBBS,DCH,DNB
HIMSR,NEW DELHI

2. INTRODUCTION
•SEIZURE OCCUR BETWEEN 1) 6-60 MONTH,
• 2)>_38 *C (100.4*F)
•NOT DUE TO CNS INFECTION,METABOLIC
ABNORMALITIES,NO AFEBRILE SZ IN PAST

3. SIMPLE FEBRILE SZ- GTCS,<15MIN,NO RECURRENCE WITHIN
24 HR
COMLEX FEBRILE SZ- SZ 15MIN,FOCAL,RECURRENCE WITHIN
24 HR
SIMPLE FZ PLUS --- RECURRENT WITHIN 24 HR
FEBRILE STATUS EPILEPTICUS; FZ LASTING >30MIN
*FZ GENERALLY HV SHORT POST ICTAL PHASE
RECURRENCE RATE IS 30%AFTER FIRST EPISODE 50%AFTER 2
OR MORE EPISODE OR YOUNGER CHILD <1YE WITH FZ

4. R/F FOR FEBRILE SZ ;
MAJOR : <1YR,DURATION OF FEVER <24 HR,FEVER 38-
39*C
MINOR: F/H OF FZ,EPILEPSY,COMPLEX FEBILE SZ,DAY
CARE,BOYS,HYPONATREMUIA
GENETIC FACTOR:+ F/H SOME TIME AD (feb1,feb2 single
gene or polygenic)

5. R/F FOR OCCURANCE OF SUBSEQUENT EPILEPSY
AFTER FZ
• SIMPLE FEBRILE SZ……….1%
• RECURRENT FZ…………...4%
• COMPLEX FZ(>15MIN,RECURRENT WITHIN 24 HR….6%
• FEVER <1HR BEFORE SZ…….11%
• FAMILY H/O EPILEPSY ….18%
• COMPLEX FEBRILE SZ (FOCAL)….29%
• NEURODEVELOPMENTAL ABNORMALITIES….33%
• *ANY TYPE OF EPILEPSY CAN BE PRECEDED EG GENERALISED EPILEPSY WITH
FEBRILE SZ PLUS GEFS+ ,SEVERE MYOCLONIC EPILEPSY OF INFANCY
(DRAVET SYNDROME)

6. • GEFS+ …….AD SYNDROME,EARLY CHILHOOD AND REMISSON IN
MID CHILDHOOD,CHARECTERISED BY MULTIPLE FZ+
SUBSEQUENT SEVERAL TYPE OF AFEBRILE SZ INCLUDING
GTCS,MYOCLONIC,ATONIC ETC

7. EVALUATION
FEBRILE SZ OFTEN OCCUR IN CONTEXT OF OTITIS
MEDIA,ROSEOLA,HHV6,HHV7
• HISTORY
• NEUROLOGICAL EXAMINATION
• MANAGEMENT OF ACUTE SZ
• DETERMINE R/F FOR OCCURANCE

8. COUNSIL PARENTS ABOUT RISK OF OCCURRENCE
,PROVIDE FIRST AID AND MANAGE FEVER
DETEMINE R/F FOR LATE EPILEPSY
A)LOW RISK NO THERAPY,INVESTIGATION NECESSARY
B)INTERMEDIATE AND HIGH RISK; CONSIDER
EEG,IMAGING,CONSIDER INTERMITTENT ORAL
DIAZEPAM,IN EXCEPTIONAL CASES THAT RECUR
CONTINOUS THERAPY

9. •LP
• <6M OR ILL LOOKING PT
6-12 M DEFICIT IN H.INFLUENZA AND
STREPTOCOCCUS PNEUNONIA IMMUNISATION
NON TRAUMATIC CSF RARELY SHOW
PLEOCYTOSIS AND CSF PROTEIN AND GLUCOSE
ARE USUAL NORMAL

10. EEG
SFZ AND OTHERWISE NEUROLOGICAL HEALTHY PT NOT REQUIRED
REQUIRED IN ONLY WHEN EPILEPSY IS HIGHLY SUSPECTED ,EEG
SHOW GENERALISED SLOWING WITHIN 72 HR OF FSE A/W
HIPPOCAMPAL INJURY
IF INDICATED DELAY AND REPEAT >2 WK BEFORE <2WK SHOW
NON SPECIAFIC SLOWING
INDICATED IN TYPE OF EPILEPSY RATHER THAN PREDICT ITS
OCCURANCE (FZ OR EPILEPSY)
EEG HELP IN DISTINGUISH BETWEEN ONGOING SZ ACTIVITY AND
A PROLONG POSTICTAL PERIOD.SOME TIME TERMED NON
EPILEPTIC TWILIGHT STATE

11. BLOOD STUDIES
• S.ELECTROLYTES,CA++,PHOSPHORUS,MG, CBC IS NOT
ROUTINELY INDIACTED IN WORKUP OF SIMPLE FEBRILE
SZ,BLOOD GLUCOSE IS INDICATEDIN PROLONG
FASTING,PROLONG POST ICTAL OBTUNDED
• IN CLINICALLY INDICATED (DEHYDRATION)DO S.ELECTROLYTE
• LOW NA+ IS A/W HIGH RISK OF OCCURANCE WITH 24 HR

12. NEUROIMAGING
• NOT INDICATED IN SIMPLE FEBRILE SZ
• IN COMPLEX FEBRILE SZ IT IS INDIVIDUALISED
(EEG+NEUROIMAGING) IF PT NEUROLOGICALLY ABNORMAL
• 11% COMPLEX FZ IS A/W U/L HIPPOCAMPUS SWELLING --
LATER HIPPOCAMPAL ATROPHY---TEMPORAL LOBE
EPILEPSY

13. TREATMENT
• ANTIPYRETICS DECREASE COMFORT BUT DO NOT REDUCE
RECURRENCE OF FEBRILE SZ
• AED IS NOT REQUIRED GENERALLY FOR ONE OR MORE SZ
• COUSELLING IS REQUIRED (RECURRENCE OF FEBRILE SZ AND
RECURRENCE OF EPILEPSY)
• IF SZ LAST FOR MORE THAN >5 MIN GIVE ACUTE T/T BY
DIAZEPAM,MIDAZOLAM,LORAZEPAM
• RECTAL DIAZEPAM CN BE GIVEN FR RECURRENCE SZ LASTING MORE
THAN 5 MIN (ALT BUCCAL OR NASAL MIDAZOLAM CAN BE USED)

14. • IV BENZODIAZEPAM,PHENOBARBITONE,PHENYTOIN,VALPORATE MAY
NEEDED FOR FEBRILE STATUS EPILEPTICUS
• FOR ANXIOUS PARENTS INTERMITTENT ORAL DIAZEPAM (.33MG/KG
EVERY 8 HRLY DURING FEVER OR RECTAL DIAZEPAM .5 MG/KG 8
HRLY CN BE USED INTERMITTENT
• NITRAZEPAM,CLOBAZAM,CLONAZEPAM(0.1MG/KG/DAY CN BE USED
• IN CONTINOUS PROPHYLAXIS PHENOBARBITONE 4-5MG/KG/DAY IN
1-2 DIVIDED DOSE OR VALPORATE 20-30MG/KG /DAY IN 2-3
DIVIDED DOSE CAN BE GIVEN
• CONTIONOUS PROPHYLAXIS GENERALLY NOT JUSTIFIED DUE (SE,LACK
OF LONG TERM BENEFIT)
• IRON DEFICIENCY IS ASSOCITED WITH INCREASED RISK OF FEBRILE
SEIZURE

15. •THANK YOU HIMSR(NEW DELHI)