This document discusses febrile seizures, which are convulsions that occur during fevers in children between 6 months and 6 years old without an underlying cause. Febrile seizures are classified as either simple or complex based on duration and other factors. The differential diagnosis for a febrile seizure includes infections, anoxia, trauma, stroke, metabolic issues, brain tumors, and previous brain injuries. Risk factors for recurrence include family history, age under 18 months, brief duration between fever and seizure, and complex febrile seizures. Physical exams are usually normal but vital signs and neurological exams are important. Investigations depend on individual cases but may include blood tests, lumbar puncture, and imaging in some cases. Management involves educ

1. Febrile Seizures

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)