1. Febrile SeizuresFebrile Seizures
Febrile seizure is a seizureFebrile seizure is a seizure
accompanied by fever (> 38accompanied by fever (> 3800
C)C)
without CNS infection of definedwithout CNS infection of defined
cause in infants and children 3cause in infants and children 3
months to 6 years of agemonths to 6 years of age
[Avg. 18 – 22 months][Avg. 18 – 22 months]
Does not include seizures occurring during feverDoes not include seizures occurring during fever
in children with past H/o. afebrile seizure.in children with past H/o. afebrile seizure.
Definition:Definition:

2. Febrile SeizuresFebrile Seizures
““ a seizure occurring in childhooda seizure occurring in childhood
after 1 month of age, associated withafter 1 month of age, associated with
a febrile illness not caused by ana febrile illness not caused by an
infection of the CNS, without previousinfection of the CNS, without previous
neonatal seizures or previousneonatal seizures or previous
unprovoked seizures”unprovoked seizures”
Definition:Definition: ILAEILAE

3. Febrile SeizuresFebrile Seizures
““ an event in infancy or childhoodan event in infancy or childhood
usually occurring between threeusually occurring between three
months and five years of age,months and five years of age,
associated with fever but withoutassociated with fever but without
evidence of intracranial infection orevidence of intracranial infection or
defined cause of the seizure”defined cause of the seizure”
Definition:Definition: NIH consensus statementNIH consensus statement

4. Febrile SeizuresFebrile Seizures
• 3 -4 % of children < 5 years3 -4 % of children < 5 years
• In India – 1.8 to 10.1%In India – 1.8 to 10.1%
• More in boysMore in boys
Incidence:Incidence:

5. Febrile SeizuresFebrile Seizures
Etiology:Etiology:
• Genetic Predisposition :Genetic Predisposition :
• A strong family history in siblings andA strong family history in siblings and
parentsparents
• Linkage studies mapped FS gene toLinkage studies mapped FS gene to
chromosomechromosome 9p9p andand 8q8q13-2113-21
• Autosomal dominant pattern in someAutosomal dominant pattern in some
familiesfamilies

6. Febrile SeizuresFebrile Seizures
Risk Factors for 1Risk Factors for 1stst
EpisodeEpisode
About 50% of FS no identifiable risk factorsAbout 50% of FS no identifiable risk factors
 Positive family history
 1st
degree or relatives – 4.5 times risk
 Ante and perinatal factors
 Metarnal preeclampsia, infections, proteinuria
 Prematurity, LBW, neonatal jaundice, asphyxia,
birth injuries
 Immunizations
 Following DPT or MMR vaccinations
 Infections
 Human herpes virus 6 infection
 Miscellaneous
 Iron deficiency anemia

7. Febrile SeizuresFebrile Seizures
Infections commonly found in a child with FSInfections commonly found in a child with FS
 Acute Otitis MediaAcute Otitis Media
 UTIUTI
 URIURI
 RoseolaRoseola
 GI InfectionsGI Infections
Precipitating Factors:Precipitating Factors:
Fever of any cause can precipitate seizure inFever of any cause can precipitate seizure in
a predisposed child.a predisposed child.

8. Febrile SeizuresFebrile Seizures
Usually a generalized tonic-clonicUsually a generalized tonic-clonic
And lasts for a few seconds to 10And lasts for a few seconds to 10
minutes and is followed by a briefminutes and is followed by a brief
postictal period.postictal period.
DescriptionDescription

9. Febrile SeizuresFebrile Seizures
 SimpleSimple – 85 %– 85 %
 ComplexComplex – 15 %– 15 %
 Partial OnsetPartial Onset
 Prolonged Duration ( > 15 min.)Prolonged Duration ( > 15 min.)
 Multiple Attacks (>1 seizure in 24 hrs.)Multiple Attacks (>1 seizure in 24 hrs.)
Types :Types :

10. Febrile SeizuresFebrile Seizures
 Occur in typical age groupOccur in typical age group
 Generalized tonic clonic typeGeneralized tonic clonic type
 Last for less than 15 minLast for less than 15 min
 Single within 24 hrsSingle within 24 hrs
SimpleSimple ::

11. Febrile SeizuresFebrile Seizures
 Associated with Todd’s palsyAssociated with Todd’s palsy
 Last for more than 15 minLast for more than 15 min
 FocalFocal
 Multiple in 24hrsMultiple in 24hrs
ComplexComplex :: (about 1/3 of FSs)(about 1/3 of FSs)

12. Febrile SeizuresFebrile Seizures
 Seizure associate with fever inSeizure associate with fever in
appropriate age group,appropriate age group,
 Lasting more than 30 min orLasting more than 30 min or
 Multiple seizures lasting 30 minMultiple seizures lasting 30 min
or more without regainingor more without regaining
consciousness in betweenconsciousness in between
Febrile Status EpilepticusFebrile Status Epilepticus
About 25% of cases of SE in children areAbout 25% of cases of SE in children are
due to febrile FSdue to febrile FS

13. Febrile SeizuresFebrile Seizures
 Rule out meningitis.Rule out meningitis.
 Lumbar puncture ?Lumbar puncture ?
 Blood glucoseBlood glucose
 HypoglycemiaHypoglycemia
Evaluation :Evaluation :
 EEG – Not warrantedEEG – Not warranted
 Neuroimaging – not usefulNeuroimaging – not useful

14. Febrile SeizuresFebrile Seizures
Establish clear airway
Semiprone position to prevent
aspiration
 Monitor vital signs
Management :Management : Acute StageAcute Stage

15. Status EpilepsyStatus Epilepsy
 Intravenous:
 0.1 to 0.3 mg / kg
 at a rate not > 2 mg/min
 for a maximum of 3 doses repeated at 10
min.
 Rectal:
 Injectable form diluted in NS by a syringe & a
flexible tube at a dose of 0.3 – 0.5 mg/kg
 Rectal Diazepam gel : 2.5, 5, 10 mg
 Can be repeated after 10 min.
 Intravenous:
 0.1 to 0.3 mg / kg
 at a rate not > 2 mg/min
 for a maximum of 3 doses repeated at 10
min.
 Rectal:
 Injectable form diluted in NS by a syringe & a
flexible tube at a dose of 0.3 – 0.5 mg/kg
 Rectal Diazepam gel : 2.5, 5, 10 mg
 Can be repeated after 10 min.
Diazepam

16. Status EpilepsyStatus Epilepsy
Lorazepam
 Intravenous : 0.05 to 0.10 mg / kg
 Rectal : Ditto
 Sublingual : 0.05 to 0.1 mg / kg
 Intravenous : 0.05 to 0.10 mg / kg
 Rectal : Ditto
 Sublingual : 0.05 to 0.1 mg / kg

17. IntraosseousIntraosseous
RouteRoute

18. Intraosseous RouteIntraosseous Route

19. Febrile SeizuresFebrile Seizures
 Tepid spongingTepid sponging
 AntipyreticsAntipyretics
 Reassurance of parentsReassurance of parents
Management :Management :

20. Febrile SeizuresFebrile Seizures
 33% Of these 9 % have > 333% Of these 9 % have > 3
recurrencesrecurrences
 75 % of recurrences within75 % of recurrences within
1 year1 year
 90 % of recurrences within90 % of recurrences within
2 years2 years
Risk of Recurrence :Risk of Recurrence :

21. Febrile SeizuresFebrile Seizures
 Early age at seizure onsetEarly age at seizure onset
 Low temperature at theLow temperature at the
onsetonset
 Short duration of temp.Short duration of temp.
before FSbefore FS
 Positive family historyPositive family history
Factors Predisposing Recurrence :Factors Predisposing Recurrence :
•Complex FS are not a predictors of recurrenceComplex FS are not a predictors of recurrence

22. Febrile SeizuresFebrile Seizures
 9% when several risk factors +9% when several risk factors +
 1% when no risk factors1% when no risk factors
Risk of Epilepsy in children with FS:Risk of Epilepsy in children with FS:
• Risk Factors:Risk Factors:
•Atypical features of seizures or Postictal periodAtypical features of seizures or Postictal period
•Positive family h/o. epilepsyPositive family h/o. epilepsy
•Initial FS before 9 mo. Of ageInitial FS before 9 mo. Of age
•Delayed developmental mile stonesDelayed developmental mile stones
•Pre-existing neurological disorderPre-existing neurological disorder

23. Febrile SeizuresFebrile Seizures
 Prolonged anticonvulsant prophylaxisProlonged anticonvulsant prophylaxis
is no longer recommended.is no longer recommended.
Phenytoin and carbamazepine havePhenytoin and carbamazepine have
no effect on febrile convulsionsno effect on febrile convulsions
Phenobarbitone reduces the congnitivePhenobarbitone reduces the congnitive
function in childrenfunction in children
Sodium valproate – potential risk ofSodium valproate – potential risk of
hepatotoxicity in childeren < 2 yrs.hepatotoxicity in childeren < 2 yrs.
Prevention of Recurrences :Prevention of Recurrences : DontDontss

24. Febrile SeizuresFebrile Seizures
 Evaluat the causeEvaluat the cause
 Early antipyreticsEarly antipyretics
 Oral diazepam at the onsetOral diazepam at the onset
of each febrile episodeof each febrile episode
0.3 mg/kg q8h0.3 mg/kg q8h
Prevention of Recurrences :Prevention of Recurrences : DoDoss

25. - CSN Vittal- CSN Vittal