Febrile seizures

What increases risk of seizure recurrence?

- A first febrile seizure before the age of 18 months - Family history of febrile seizures or epilepsy - Seizure preceded by fever of short duration (less than 1 hour) or with a temperature of less than 40°C - A partial seizure - Multiple seizures during the same febrile episode

What % have recurrence?

About 30% to 40% (1 in 3)

Characteristic features of a febrile seizure

Age 6 months to 5 years. Duration of seizure usually no longer than 3-6 minutes. Seizure is usually generalised tonic-clonic Complete recovery of consciousness within 1 hour. Fever around the time of the seizure. History of previous febrile seizure.

Complex febrile seizure

Complex febrile seizures have one or more of the following features: a partial (focal) onset or focal features during the seizure; duration of more than 15 minutes; incomplete recovery within 1 hour; recurrence within 24 hours, or within the same febrile illness

DDx

Meningitis and encephalitis; conditions that may be confused with seizures e.g. rigors, syncope, and apnoea; and other causes of afebrile seizures e.g. epilepsy, hypoglycaemia, or brain injury.

Does reducing fever prevent seizure recurrence?

No. Advise parents about managing fever, but explain that reducing fever does not prevent recurrence.

What should be given to a child who is fitting for more than 5 minutes?

Rectal diazepam (repeated once after 5 minutes if necessary) or buccal midazolam should be given

Simple febrile seizure

Simple febrile seizures are isolated, generalised, tonic-clonic seizures lasting less than 15 minutes, that do not recur within 24 hours or within the same febrile illness, in the absence of previous neurologic problems.

How do febrile seizures affect intellect, educational performance etc.

There is no increased risk of intellectual delay, school difficulties, or behavioural problems in children who have had febrile seizures

How should temperature be measured in children 4 weeks to 5 years old?

With:- - Electronic thermometer in the axilla - Chemical dot thermometer in the axilla - Infra-red tympanic thermometer

How should temperature be measured in infants under 4 weeks?

with an electronic thermometer in the axilla