Febrile seizures are seizures that occur in young children between the ages of 6 months and 5 years in association with a fever. They are generally associated with fevers over 100°F/38°C but have no other cause identified. Febrile seizures are classified as either simple or complex, with simple seizures lasting less than 15 minutes and not recurring within 24 hours, accounting for 85% of cases. Risk factors include age under 1 year, family history, and prior complex seizures. Evaluation involves history and exam to identify the cause of fever; bloodwork and lumbar puncture are usually not necessary. Treatment focuses on fever control with antipyretics; anticonvulsant prophylaxis may prevent recurrence in high risk cases.

1. PRESENTED BY:
J.Manohar Reddy
REG NO Y19MPH02052
DEPARTMENT OF PHARMCOLOGY
HINDU COLLEGE OF PHARMACY
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Definition
Febrile seizures are defined as seizures that occur in association
with a fever temperature of 38°C or(100°F) in children 6 months
to 5 years of age, but in whom there is no evidence of a central
nervous system infection or another definable cause of seizure,
and which are not preceded by a history of an afebrile seizure
Febrile seizures have a peak incidence at about 18 months of age,
are most common between 6 months and 5 years of age, and
onset above age 7 years is rare, although it does occur.
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Generally accepted criteria for febrile seizures include
seizures that occur in association with a fever
Febrile seizures are seizures that occurs between the age of 6
months to 5 years
Absence of central nervous system infection or inflammation
Absence of acute systemic metabolic abnormality that may
produce convulsions
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Febrile seizures are classified as
1.simple Febrile seizures 2. Complex Febrile seizures
1.Simple Febrile seizures
Simple febrile seizures are the most common type, are
characterized by seizures associated with fever that are
generalized, usually tonic-clonic, last less than 15 minutes, and
do not recur in a 24-hour period.
Simple febrile seizures account for approximately 85% of all
febrile seizures
.
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Simple febrile seizures have a life span of approximately
15minutes and are caused by a distinct infection such as a
gastrointestinal or respiratory infection
2. Complex Febrile seizures
Complex febrile seizures associated with fever that are
characterized by episodes that have a focal onset last longer (e.g.
shaking limited to one limb or one side of the body)
Complex febrile seizures have a life span of 15 to 30minutes with
more than 1 seizure occurring per episode of fever.
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EPIDEMIOLOGY
Febrile seizures are the most common type of seizure in
childhood.
They are age dependent phenomenon.
Febrile seizures are most common in children between 6
months and 3 years of age, with a peak incidence around 18
months
Boys are affected slightly more often than are girls
Approximately 30% to 40% of children experience a febrile
seizure
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ETIOLOGY AND PATHOGENESIS
The seizure threshold varies between individuals. Children prone
to febrile seizures produce more proinflammatory cytokines in
the central nervous system, such as interleukin-1, which might
induce seizures
Reduced production of interleukin-1
receptor antagonist also has been
shown to promote fever and a
tendency to develop a febrile seizure
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Risk Factors
Age.
High grade fever.
Infections.
( Viral infections such as : HHV-6 and Influenza virus )
Immunization.
( DTP & MMR )
 Genetic susceptibility.
Family History of febrile convulsion( 10-20 % )
Autosomal dominant trait .
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Risk Factors for Recurrence of Febrile Seizures
Major
Two other definite risk factors for recurrence of febrile seizures
are peak temperature and the duration of the fever prior to the
seizure.
Age < 1year
Peak temperature of 103°F (or) 38-39 °C
Duration of the fever < 24hr
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Risk Factors for Recurrence of Febrile Seizures
Minor
1.The most consistent risk factors reported are a family history of
febrile seizures and onset of first febrile seizure at < 18 months of
age
2.Family history of epilepsy
3. Complex febrile seizure
4. Daycare
5. Male gender
6. Low serum sodium at time of presentation
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Risk Factors for Subsequent Epilepsy
Sl :no Risk Factor Risk for Subsequent
Epilepsy
1 Simple febrile seizure 1%
2 Neurodevelopmental
abnormalities
33%
3 Focal Complex febrile seizures 29%
4 Family history of epilepsy 18%
5 Fever < 1 hr before febrile seizure 11%
6 Complex febrile seizures any type 6%
7 Recurrent febrile seizures 4%
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DIAGNOSTIC STUDIES
History
Physical examination
History
The type of seizure (generalized or focal) and its duration should
be described to help differentiate between simple and complex
febrile seizures.
Focus on the history of fever, duration of fever, and potential
exposures to illness.
A history of the cause of fever (eg, viral illnesses, gastroentritis)
should be elucidated.
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Recent antibiotic use is particularly important because partially
treated meningitis must be considered.
A history of seizures, neurologic problems, developmental delay,
or other potential causes of seizure (eg, trauma, ingestion) should
be sought.
Physical examination
The underlying cause for the fever should be sought.
A careful physical examination often reveals otitis media,
pharyngitis, or a viral exanthem.
Full neurologic examination should be done.
Serial evaluations of the patient's neurologic status are essential.
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Blood Studies
A complete blood cell count and blood tests for electrolytes,
glucose, calcium, phosphorous, magnesium, creatinine, and urea
nitrogen are not helpful in the evaluation of a child with a febrile
seizure.
Lumber Puncture
A lumbar puncture also should be considered in children between
12 and 18 months of age because clinical
lumbar puncture should be considered when the patient is on
antibiotics because antibiotic treatment can mask the signs and
symptoms of meningitis.
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lumbar puncture should be considered in infants between 6 and
12 months if the immunization status for Haemophilus influenzae
type b or Streptococcus pneumoniae is deficient or undetermined.
Electroencephalogram (EEG)
Routine electroencephalography (EEG) is not warranted,
particularly in the setting of a neurologically healthy child with a
simple febrile seizure.
An EEG should be considered in children with complex febrile
seizures who have a recurrence without fever, or in children with
recurrent febrile seizures who exhibit developmental delays or
neurologic deficits
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Neuroimaging.
Neuroimaging studies such as cranial computed tomography or
magnetic resonance imaging are not routinely indicated in
children with febrile seizures
The incidence of intracranial pathology in children presenting
with complex febrile seizures also appears to be very low
MANAGEMENT
In children with febrile seizures that continue for more than five
minutes, we recommend treatment with intravenous (IV)
benzodiazepines (diazepam 0.1 to 0.2 mg/kg or lorazepam 0.05 to
0.1 mg/kg) Buccal midazolam (0.2 mg/kg, maximum 10 mg) is
an alternative when IV access is unavailable.
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The fever should be controlled with an antipyretic medication and
by removal of excessive blankets and clothing.
Although normalization of the body temperature might not
prevent further febrile seizures, the use of an antipyretic
medication might make the child more comfortable.
Whenever possible, the cause of the fever should be treated.
PREVENTION
Several studies have shown that daily administration of
phenobarbital (5 to 8 mg/kg/day for children< 2 years of age and
3 to 5 mg/kg/ day for children 2 years of age)
valproic acid (10 to 15 mg/kg/day in divided doses) is effective to
prevent febrile seizures
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Diazepam, when administered intermittently either rectally or
orally in sufficient doses (0.3 to 0.5 mg/kg, maximum 10 mg)
Adverse effects
phenobarbital valproic acid Diazepam
transient sleep
disturbances
fatal hepatotoxicity
(Baumann; Millar)
respiratory
depression
daytime drowsiness renal toxicity lethargy
fussiness thrombocytopenia drowsiness,
attention deficit pancreatitis ataxia,
hyperactivity dizziness
decreased memory slurred speech
impaired cognitive
function
bradycardia,
hypotension
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References
Febrile Seizures Alexander K.C. Leung, MBBS, FRCPC, FRCP(UK & Irel),
FRCPCH, & W. Lane M. Robson, MD, FRCPC, FRCP(Glasg)
Febrile Seizures Shlomo Shinnar MD, PhD; Tracy A. Glauser, MD
American Academy of Pediatrics, Provisional Committee on Quality
Improvement, Subcommittee on Febrile Seizures. (1996). Practice parameter:
The neurodiagnostic evaluation of the child with a first simple febrile seizure.
Pediatrics, 97, 769-775.
Commission on Epidemiology and Prognosis, International League Against
Epilepsy: Guidelines for epidemiologic studies on epilepsy. Epilepsia
1993;34:592–596.
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Thank you
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