RCH Melb - Febrile seizure guideline
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
