RCH Melb - Febrile seizure guideline

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When to confer w paeds?

- Complex febrile convulsion - Seizures unable to be controlled - Does not return to normal mental state within 1 hour - clinically unwell - Ongoing concern regarding the nature of the febrile illness.

Advice for parents:

- General info re febrile seizures, parent info sheet - F/U as appropriate for the underlying illness.

D/C requirements:

1. Return to normal neurological state following simple febrile convulsion 2. SBI r/o or adequately Mx 3. Parental education regarding febrile convulsions

Febrile status epilepticus?

= febrile convulsion lasting for longer than 30 minutes.

Febrile seizures - define

Convulsions in a child: - btwn 6mo - 6yo - in setting of acute febrile illness - w/o previous afebrile seizures - w/o significant prior neurological abnormality - no CNS infection.

Long-term issues w febrile seizures? - develop epilepsy?

If no RFs, risk of subsequent epilepsy ~1% (~population risk) RFs for future afebrile convulsions (epilepsy) inc: - FHx epilepsy - neurodevelopmental problem - atypical febrile convulsions (prolonged or focal) --> single RF: 2% risk epilepsy --> >1 RF = 10% risk epilepsy

Ix - febrile seizures?

In a simple febrile convulsion, where the focus of infection can be identified, blood tests and invasive investigations are often NOT indicated. In a child <6mo, reconsider Dx, especially the possibility of CNS infection.

Assessment

Once seizure terminated --> aim = determine cause of fever. 1. Full Hx/Ex as per febrile child 2. Additional RFs against Dx of simple febrile seizure: - previous afebrile seizures - progressive neurological conditions - signs of CNS infection

Long-term issues w febrile seizures? - recurrence?

Recurrence rate depends on: - the age of the child --> younger the child @ time of the initial convulsion, the ↑ risk a further febrile convulsion - 1 year old 50% - 2 years old 30% Long term anticonvulsants are not indicated except in rare situations with frequent recurrences. It may be appropriate to offer a review appointment with a general paediatrician, especially in the case of complex febrile convulsions.

What's a complex febrile seizure?

have 1+ of: - focal features at onset or during the seizure - last >15mins - recur w/in same febrile illness - Incomplete recovery within 1 hour.

Ix - febrile seizures? - when to consider LP

- child is < 12 months - not IUTD (esp Hib and pneumococcal) - clinically unwell - already on oral antibiotics that may mask meningitis. **If genuine CI to LP --> give AB cover for meningitis

"Afebrile febrile convulsions"?

- convulsions w. an acute infectious illness (particularly gastroenteritis) w/o documented fever - Mx is same as for simple febrile convulsions

What's a simple febrile seizure?

- generalised, tonic-clonic - lasting less than 15 minutes - do not recur within the same febrile illness - complete recovery within 1hr

Febrile seizures - demo, prog

- occur in 3% of healthy children - normally associated with simple viral infection - are benign

Acute Mx

- treat convulsion if ongoing - Reassurance is important in simple febrile convulsions - educate re anti-pyretic use


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