Febrile seizures

It is a diagnosis of exclusion in young child 5m to 6y age with:

– Generalised Tonic Clonic, usually lasting 2 to 3 minutes

– Prescence of fever 38 or above

– Absence of meningism/ sepsis/ systemic illness

– No previous afebrile seizures

 

‘Atypical febrile seizure’ if:

– Focal seizure

– Lasting >15 minutes

– 2 or more episodes in 24 hours

History:

Describe preceeding symptoms Details of seizure

   – how did it start, any focal features?

   – sequence of motor manifestations

   – Any previous seizures?

   – Any underlying neurological or developmental disorder?

   – Any recent antibiotics?

Family history:

– febrile seizures 

– epilepsy 

– other neurological diagnosis

Examination:

– Plot head circumference

– AVPU / GCS score

– Any dysmorphism/ neurocutaneous marker?

– ENT, Skin, Systems- for focus of fever (check urine)

Signs of meningism?

Is fontanelle open?

– Full neurological examination, including

    Gait

    Co-ordination

    Cranial nerves, fundoscopy (if possible)

Management:

– Diagnose if clinically confident

– Observe for at least 4 – 6 hours

– If ill, check U&E, Ca, Mg, CRP, FBC

– Consider Lumbar Puncture, blood culture

– Education / leaflet about febrile convulsions

– Explain first aid for seizures, as recurrence in 30 – 50%

– Temperature  control, including antipyretics; but this may not prevent recurrence

– Offer buccal Midazlolam only if recurrent & prolonged febrile seizures

– Do not arrange EEG or MRI brain routinely if typical febrile seizures

Red Flags:

– Signs of meningism (not sensitive if fontanelle open)

– Prolonged post-ictal  phase

– Encephalopathy/ confusion

– Atypical febrile seizure

– Underlying neuro-developmental disorder

– Recent antibiotics (? partially treated meningitis)

– Non-blanching rash

 

Risk of developing epilepsy increased if:

– Atypical episodes

– Febrile status epileptics

– Family h/o epilepsy

– Underlying cerebral palsy, autism or other neuro-developmental disorder

Sadleir LG, Scheffer IE; Febrile seizures. BMJ. 2007 Feb 10334(7588):307-11.

 

Armon K, et al. An evidence and consensus based guideline for the management of a child after a seizure. Emerg Med J 2003 20:13-20

 

Patel AD, Vidaurre J. Complex febrile seizures: a practical guide to evaluation and treatment. J Child Neurol. 2013 Jun28(6):762-7.

 

Graves RC, et al. Febrile seizures: risks, evaluation, and prognosis. Am Fam Physician. 2012 Jan 1585(2):149-53.