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Febrile seizures


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Slideshows on febrile seizures.. Simple and basic details available. For medical students, housemen and training doctors who wish to revise on the topic.

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Febrile seizures

  1. 1. Febrile seizures
  2. 2. Introduction  About 1 in 20 children will have at least one febrile seizure at some point.  Mostly occurs between the ages of six months and six years. The average is 18 months.  The cause is unknown, although it appears to run in some (but not all) families. Around 1 in 4 children who are affected by febrile seizures will have a family history of the condition. In half of all cases, there are no obvious causes or risk factors.
  3. 3. Definition  Having a seizure when the child’s body temperature is high i.e. 38°C or above.  Usually caused by infection, but exclude intracranial infection (bacterial meningitis/viral encephalitis)  Occur between 6 months and 6 years
  4. 4. Associated infections  Viral infections e.g. chickenpox and influenza  Otitis media  Tonsillitis  Gastroenteritis  LRTI e.g. pneumonia, bronchitis
  5. 5. Types of febrile seizures  Simple febrile seizure  The most common type of febrile seizure (~90% of cases)  Features:  Tonic clonic seizure  Does not last >15 minutes  Does not reoccur within 24 hours or during the period in which the child has an illness.
  6. 6. Body stiffness Tonic clonic seizure Loss of concious-ness Limbs twitching Urinary inconti-nence
  7. 7.  Complex febrile seizure  Less common than simple febrile seizures (~10% of cases)  Has one or more of the following features:  Seizure lasts >15 minutes  Partial or focal seizure  Seizure reoccurs within 24 hours of the first seizure or during the period in which they have an illness  The child does not fully recover from the seizure within one hour
  8. 8. Febrile seizures and epilepsy  Epilepsy: repeated seizures without fever  Children who have a history of febrile seizures have an increased risk of developing epilepsy. However, it should be stressed to the parents that the risk increase is still quite small.  Simple febrile seizures: 1 in 50 chance of developing epilepsy in later life.  Complex febrile seizures: 1 in 20 chance of developing epilepsy in later life.
  9. 9. Outlook  Almost all children make a complete recovery.  Studies on febrile seizures showed that children with a history of febrile seizures has no evidence of an increased risk of death in later childhood or adulthood.  Simple seizures  no brain damage. Subsequent intellectual performance similar as other children
  10. 10. Symptoms  Febrile seizures often occur during the first day of a fever.  Temperature: 38°C or above.  Seizures may also develop:  After a mild temperature. It may not develop at all with an extremely high temperature.  Rapid rise in temperature  Rapid drop in temperature
  11. 11. More Symptoms…  Body stiffness  Limbs twitching  Lose of conciousness  Urine incontinence ± soiling  Vomiting  Foam at the mouth  Lasting <5 minutes  Sleepiness/drowsiness after seizure ~1 hour
  12. 12. BEWARE!! Signs of dehydration Other alarming signs •Dry mouth •Sunken eyes •Lack of tears when crying •Sunken fontanelle •Seizure >5 minutes, no sign of stopping •Non-blanching rash •SOB •Focal CNS lesion/CNS abnormality •Previous h/o epilepsy •>1 attack in 24h
  13. 13. Differential Diagnosis...which we need to be aware of  Meningitis  Encephalitis  CNS lesion  Epilepsy  Trauma  Hypoglycaemia  Hypocalcaemia  Hypomagnesaemia
  14. 14. Investigations  Source of infections! Do not forget ear and throat examinations!!  FBC  BUSE, Ca2+  Glucose level  Urinalysis  CXR  ENT swab  Further investigations:  EEG  Lumbar puncture (particularly if the child is <12 months old)
  15. 15. Contraindications for LP Cardiorespiratory instability Focal neurological signs Increased ICP Coagulopathy Thrombocytopenia Local infection at LP site Procedure delays Abx administration
  16. 16. Management  Assess ABCDE  If seizure >5 min, rescue therapy  diazepam PR/ buccal midazolam  Antipyretics? Not been shown to prevent febrile seizures. But, important to reduce temperature:-  PCM  Ibuprofen  Remove unnecessary clothes or bedding Remember, NO ASPIRIN for <16 YO (REYE’S SYNDROME)
  17. 17. Further Management  Parents education  10 first aid steps when your child has a seizure: 1. Stay calm 2. Look around, assess the environment 3. Note the time 4. Stay with them. 5. Cushion their head. 6. Don’t hold them down 7. Don’t put anything in their mouth 8. Check time again. If > 5mins, call 999 9. Recovery position if seizure stops. Check airway & breathing 10. Stay with them until full recovery
  18. 18. Complications  Risk of developing epilepsy ~1.5%  Risk rises to 2.5% if the child was under 12 months old when they had their first seizures (in those who had multiple simple seizures.  Risk also increases with:  Neurological abnormalities, or a developmental delay before the onset of febrile seizures.  A family history of epilepsy.  A brief fever (<1 h) before the seizure.  Complex seizures.
  19. 19. Short case History: a clinical context  GH, 2 years old girl admitted due to fever with fits.  This is her 1st episode of fever with fits.  Seizure lasted for 1-2 minutes.  Seizure came from a rapid increase of temperature on the 1st day of fever after visiting her grandfather who is warded in HSI (due to chronic illnesses e.g. DM, HPT).  Generalised tonic-clonic seizure. Eyes rolling upwards. No tongue biting, no mouth frothing.  Just once within 24 hours. No subsequent episode.
  20. 20.  Source of infection?  Fever was NOT associated with:  Sore throat  Coughs  Shortness of breath  Changes in urinary/bowel habit  Rashes  Ear discomfort, discharge, hearing loss  Neck stiffness On examination, otitis media was found to be the cause.
  21. 21.  Family history of epilepsy. Uncle is epileptic with medication.  ICE:  Mum thinks that it may be due to the hot weather.  Mum is worried if she’ll get another febrile seizures.  Worried if she will develop epilepsy in the future.  Risk of:  Getting another seizure?  Developing epilepsy?
  22. 22.  Risk of getting another febrile fit?  30-40% will have further febrile fits.  More likely if:  The younger the child  The shorter the duration of illness before seizure  The lower the temperature at time of seizure  Positive family history
  23. 23.  Risk of developing epilepsy later?  Increased risk of 1.5%  Family history of epilepsy  Brief fever (<1h) before the seizure  Simple versus complex? Simple: 1 in 50, Complex: 1 in 20.  Risk increase by 2.5% if under 12month old when had 1st seizure.  Neurological abnormalities/Developmental delay.
  24. 24. Quiz!! 1. The followings are features of complex febrile convulsion a) Duration of seizures > 15 minutes (T , F) b) Presence of focal convulsion (T ,F) c) Recurrence of seizure within the same day (T , F) d) Children with preexisting neurological disease (T ,F) e) Age of onset before 12 months (T , F)
  25. 25. 2. The risk of recurrent febrile seizures is higher for these children except: a) young (less than 15 months) b) Have frequent fevers c) Have a parent or sibling who had febrile seizures or epilepsy d) Have a short time between the onset of fever and the seizure e) Had a high degree of fever before the seizure
  26. 26. 3. Answer true or false a) Prophylactic antiepileptic drug treatment is recommended b) Patients with early age of onset have higher risk of recurrent febrile convulsion c) Lumbar puncture is indicated in patients with even subtle clinical features suggestive of CNS infection d) Rescue therapy using PR Diazepam during seizure attack is recommended provided parents are adequately counseled
  27. 27. 4. A 2-year-old boy presents to the emergency department for evaluation following a witnessed seizure. The seizure was described as generalized, lasting less than 5 minutes with a short post-ictal period. The child has no history of seizures, no family history of seizures, and no history of head injury. His exam currently is normal, except for a red, bulging right tympanic membrane and a temperature of 39 C. What is the most appropriate management for this patient? a)Urgent CT scan of the head b) Antibiotics and antipyretics and monitored at home c) Admitted to hospital and EEG is performed d) Start on phenobarbital and sent home e)LP and Blood culture performed and start anticonvulsant in hospital
  28. 28. Frightening but harmless!! Thank you.