Febrile Seizures

Management of seizure at home

1) Keep calm; 2) Lay child on back, turning head from side to side, to clear secretions; 3) Seek medical evaluation of fever.

Febrile Seizure

A seizure associated with a fever in a child usually between 6 months and 5 years of age.

Continuous therapy

Carbamazepine and Phentoin are ineffective Phenobarbital is effective in preventing recurrences. Adverse effects= behavioral and learning problems. Valproic Acid is effective in preventing recurrences. Adverse effects= fatal hepatotoxicity, pancreatitis (both more common in children less than 3 yrs old).

Risk Factors for Development of chronic seizure disorder in kid with febrile seizures

FH of chronic seizure disorder Initial febrile seizure < 9 months old Complex febrile seizure Developmental delay Abnormal neurological exam Risk of afebrile seizure disorder is 1% in the general population and patients with simple febrile seizures. Risk increases to 2% with one risk factor, and 10% with 2-3 risk factors

Simple Febrile Seizure

Generalized No associated neurological deficit Less than 15 minutes duration Only one within a 24 hour period

Meningitis and Seizures

In 13-16% of children with meningitis, seizures are the presenting sign of disease. In 30-35% of these children (primarily less than 18 months old), meningeal signs are lacking.

Approach to Child with Fever and First Seizure

May be due to a febrile seizure May be due to a chronic seizure disorder triggered by fever May be due to an intracranial infection, meningitis, encephalitis, brain abscess.

Fever Control

No evidence that fever control decreases the incidence of febrile seizures. In 10-30% of patients, the seizure is the first manifestation of the illness

Child intelligence

No long term intellectual or neurological dysfunction has been reported.

Intermittent therapy

Oral Diazepam: 1) Given at the time of a fever, reduces the incidence of seizures by 44%; 2) Adverse effects = lethargy, drowsiness, ataxia; 3) The adverse effects could mask evolving signs of a CNS infection, and make medical evaluation less accurate. Rectal diazapam or lorazepam: 1) Used in acute management of the seizure; 2) Parents can be taught to administer the drug: 3) effective in aborting prolonged seizures; 4) Still potential for adverse effects.

Clinical Features of Febrile Seizure

Seizure usually occurs within the first 24 hours of fever. Seizure is due to rapid change in body temperature, usually >39 C (102.2 F). Usually occurs in the presence of a clinically recognizable infection. Most common infectious triggers are viral URI, AOM, Roseola. 80% are simple febrile seizures, 20% are complex febrile seizures. Most often have generalized motor seizure. Less commonly have focal motor activity or may be only staring episode or eye rolling. Usually brief; only 8% last longer than 15 minutes.

Risk of death

Several large studies have not reported any deaths.

Parental Education

Simple febrile seizures are a benign event. No treatment has been shown to prevent the rare development of a chronic seizure disorder after a simple febrile seizure. 40% of children treated with phenobarbital have behavioral side effects (irritability, hyperactivity, disturbed sleep, learning problems)

Risk Factors for Abnormal CSF in Kids with Fever and Seizures

Suspicious findings on physical exam Complex febrile seizures Doctor visit w/i 48 hrs before the seizure Seizing upon arrival to ED Prolonged postictal state Initial seizure after 3 years old

Epilepsy development

There is a slight (<1% difference) increase in comparison to the general population.

AAP Practice Guideline for First Simple Febrile Seizure recommends

less than 12 months old LP should be strongly considered; 12-18 months LP should be considered.(for meningitis)

AAP Practice Guideline -1999

neither continuous nor intermittent anticonvulsant therapy is recommended for children with one or more simple febrile seizures

Neuroimaging

no need for skull films, CT or MRI

EEG eval

no predictive value

Blood studies

no routine serum electrolytes, calcium, phosphorus, magnesium, CBC, or blood glucose

Complex Febrile Seizure

Any one of the following Focality Greater than 15 minutes duration Neurological Deficit Multiple in a 24 hour period

Management of Seizing Child

Assess respiratory and CV status Gentle suction, or turn head from side to side to clear secretions Provide O2 Check dexrostix Fever control Begin IV