Febrile seizure - Revision history

Danbot: Strip excess bold

2026-03-22T09:26:08Z

Strip excess bold

← Older revision		Revision as of 09:26, 22 March 2026
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	==Background==		==Background==
	*Seizure accompanied by ~~'''~~fever (≥100.4°F / 38°C)~~'''~~ in a child ~~'''~~6 months to 5 years~~'''~~ without CNS infection or metabolic cause		*Seizure accompanied by fever (≥100.4°F / 38°C) in a child 6 months to 5 years without CNS infection or metabolic cause
	*Occur in ~~'''~~2-5% of children~~'''~~ before age 5<ref>https://www.ninds.nih.gov/disorders/patient-caregiver-education/fact-sheets/febrile-seizures-fact-sheet</ref>		*Occur in 2-5% of children before age 5<ref>https://www.ninds.nih.gov/disorders/patient-caregiver-education/fact-sheets/febrile-seizures-fact-sheet</ref>
	*Most common seizure type in childhood		*Most common seizure type in childhood
	*High temperatures alter ion channel function, increasing neuronal excitability<ref>Mosili P, et al. The pathogenesis of fever-induced febrile seizures and its current state. ''Neurosci Insights''. 2020;15:2633105520956973. PMID 33225279</ref>		*High temperatures alter ion channel function, increasing neuronal excitability<ref>Mosili P, et al. The pathogenesis of fever-induced febrile seizures and its current state. ''Neurosci Insights''. 2020;15:2633105520956973. PMID 33225279</ref>
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	===Prognosis===		===Prognosis===
	*'''Simple febrile seizures do NOT cause brain damage, developmental delay, or increase mortality'''		*'''Simple febrile seizures do NOT cause brain damage, developmental delay, or increase mortality'''
	*Risk of epilepsy: ~~'''~~2-3%~~'''~~ (slightly higher than general population ~1%)		*Risk of epilepsy: 2-3% (slightly higher than general population ~1%)
	*Recurrence risk:		*Recurrence risk:
	**~~'''~~50%~~'''~~ if first seizure at <12 months		**50% if first seizure at <12 months
	**~~'''~~30%~~'''~~ if first seizure at >12 months		**30% if first seizure at >12 months
	*Risk factors for recurrence: younger age, family history, lower peak temperature, shorter duration of fever before seizure		*Risk factors for recurrence: younger age, family history, lower peak temperature, shorter duration of fever before seizure

	==Clinical Features==		==Clinical Features==
	===Simple Febrile Seizure===		===Simple Febrile Seizure===
	*~~'''~~Age 6 months to 5 years~~'''~~ (peak 12-18 months)		*Age 6 months to 5 years (peak 12-18 months)
	*~~'''~~Single seizure~~'''~~ within 24 hours		*Single seizure within 24 hours
	*~~'''~~Duration <15 minutes~~'''~~		*Duration <15 minutes
	*~~'''~~Generalized~~'''~~ with no focal features		*Generalized with no focal features
	*Returns to ~~'''~~neurologic baseline~~'''~~ after brief postictal period		*Returns to neurologic baseline after brief postictal period
	*~~'''~~Cannot be classified as simple~~'''~~ if: known CNS abnormalities, previous neurologic insults, or history of afebrile seizures		*Cannot be classified as simple if: known CNS abnormalities, previous neurologic insults, or history of afebrile seizures

	===Complex Febrile Seizure===		===Complex Febrile Seizure===
	*~~'''~~Any exception to the above criteria~~'''~~:		*Any exception to the above criteria:
	**Duration ~~'''~~≥15 minutes~~'''~~		**Duration ≥15 minutes
	**~~'''~~Focal features~~'''~~ (one-sided jerking, eye deviation)		**Focal features (one-sided jerking, eye deviation)
	**~~'''~~Recurrence within 24 hours~~'''~~		**Recurrence within 24 hours
	**'''Prolonged postictal state''' or failure to return to baseline		**'''Prolonged postictal state''' or failure to return to baseline
	*May indicate more serious underlying disease process		*May indicate more serious underlying disease process

	==Differential Diagnosis==		==Differential Diagnosis==
	*~~'''~~The key question: Is this a seizure WITH fever, or a CNS INFECTION causing both seizure and fever?~~'''~~		*The key question: Is this a seizure WITH fever, or a CNS INFECTION causing both seizure and fever?
	*[[Meningitis]] / [[encephalitis]] (must be excluded)		*[[Meningitis]] / [[encephalitis]] (must be excluded)
	*[[Status epilepticus]]		*[[Status epilepticus]]
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	==Evaluation==		==Evaluation==
	===Simple Febrile Seizure===		===Simple Febrile Seizure===
	*~~'''~~Neither labs nor neuroimaging are routinely necessary~~'''~~		*Neither labs nor neuroimaging are routinely necessary
	*~~'''~~Blood glucose~~'''~~ in all patients		*Blood glucose in all patients
	*Normal pediatric [[fever]] workup as clinically indicated (source identification)		*Normal pediatric [[fever]] workup as clinically indicated (source identification)
	*EEG is ~~'''~~NOT indicated~~'''~~		*EEG is NOT indicated

	===Complex Febrile Seizure===		===Complex Febrile Seizure===
	*~~'''~~Consider LP and CSF studies~~'''~~ if:		*Consider LP and CSF studies if:
	**~~'''~~Meningeal signs present~~'''~~		**Meningeal signs present
	**Child ~~'''~~6-12 months with incomplete immunizations~~'''~~<ref>Subcommittee on Febrile Seizures; AAP. Neurodiagnostic evaluation of the child with a simple febrile seizure. ''Pediatrics''. 2011;127(2):389-94. PMID 21285335</ref>		**Child 6-12 months with incomplete immunizations<ref>Subcommittee on Febrile Seizures; AAP. Neurodiagnostic evaluation of the child with a simple febrile seizure. ''Pediatrics''. 2011;127(2):389-94. PMID 21285335</ref>
	**Child had ~~'''~~recent antibiotic treatment~~'''~~ (may mask meningeal signs)		**Child had recent antibiotic treatment (may mask meningeal signs)
	**Clinician concern for CNS infection		**Clinician concern for CNS infection
	*~~'''~~Blood work~~'''~~: CBC, blood culture, UA, urine culture		*Blood work: CBC, blood culture, UA, urine culture
	**Consider CMP if suspect ~~'''~~hyponatremia~~'''~~ from ongoing volume loss		**Consider CMP if suspect hyponatremia from ongoing volume loss
	**Studies suggest link between iron deficiency anemia and febrile seizures<ref>Sulviani R, et al. Anemia and poor iron indices are associated with susceptibility to febrile seizures in children: systematic review and meta-analysis. ''J Child Neurol''. 2023;38(3-4):186-197.</ref>		**Studies suggest link between iron deficiency anemia and febrile seizures<ref>Sulviani R, et al. Anemia and poor iron indices are associated with susceptibility to febrile seizures in children: systematic review and meta-analysis. ''J Child Neurol''. 2023;38(3-4):186-197.</ref>
	*~~'''~~CT head~~'''~~ if:		*CT head if:
	**Persistently abnormal neuro exam (especially focal findings)		**Persistently abnormal neuro exam (especially focal findings)
	**Signs/symptoms of ~~'''~~increased ICP~~'''~~		**Signs/symptoms of increased ICP
	**VP shunt		**VP shunt
	**History of head trauma		**History of head trauma
	**Suspected neurocutaneous disorder		**Suspected neurocutaneous disorder
	*'''ECG''': consider if family history of long QT, Brugada, or sudden death		*'''ECG''': consider if family history of long QT, Brugada, or sudden death
	*~~'''~~EEG~~'''~~: NOT routinely indicated; consider only if developmental delay or focal symptoms		*EEG: NOT routinely indicated; consider only if developmental delay or focal symptoms

	===Causes Amenable to Specific Treatment===		===Causes Amenable to Specific Treatment===
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	==Management==		==Management==
	===Active Seizure===		===Active Seizure===
	*~~'''~~ABCs~~'''~~: position of safety, supplemental O2, suction		*ABCs: position of safety, supplemental O2, suction
	*~~'''~~If fever: acetaminophen 15 mg/kg rectally~~'''~~		*If fever: acetaminophen 15 mg/kg rectally
	*See '''[[Status epilepticus]]''' for seizure protocol if seizure does not self-terminate:		*See '''[[Status epilepticus]]''' for seizure protocol if seizure does not self-terminate:
	**~~'''~~Benzodiazepines first-line~~'''~~:		**Benzodiazepines first-line:
	***Lorazepam 0.1 mg/kg IV (max 4 mg) if IV access		***Lorazepam 0.1 mg/kg IV (max 4 mg) if IV access
	***Midazolam 0.2 mg/kg IM/buccal (max 10 mg) if no IV		***Midazolam 0.2 mg/kg IM/buccal (max 10 mg) if no IV
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	===Seizure Stopped===		===Seizure Stopped===
	*Treat underlying infection if indicated		*Treat underlying infection if indicated
	*See ~~'''~~[[Fever (peds)\|pediatric fever workup]]~~'''~~		*See [[Fever (peds)\|pediatric fever workup]]
	*Assess neurologic status — should return to baseline		*Assess neurologic status — should return to baseline

	==Disposition==		==Disposition==
	===Discharge===		===Discharge===
	*~~'''~~Simple febrile seizure~~'''~~ if patient at baseline		*Simple febrile seizure if patient at baseline
	**Follow-up in 1-2 days		**Follow-up in 1-2 days
	**~~'''~~Around-the-clock acetaminophen~~'''~~ may prevent seizure recurrence during the same febrile episode<ref>Murata et al. Acetaminophen and febrile seizure recurrences during the same fever episode. ''Pediatrics''. 2018;142(5):e20181009. PMID 30297498</ref>		**Around-the-clock acetaminophen may prevent seizure recurrence during the same febrile episode<ref>Murata et al. Acetaminophen and febrile seizure recurrences during the same fever episode. ''Pediatrics''. 2018;142(5):e20181009. PMID 30297498</ref>
	**~~'''~~Anticipatory guidance~~'''~~: emphasize benign nature while educating on return precautions		**Anticipatory guidance: emphasize benign nature while educating on return precautions
	**~~'''~~Prophylactic AEDs are NOT indicated~~'''~~ for simple febrile seizures (AAP recommendation)		**Prophylactic AEDs are NOT indicated for simple febrile seizures (AAP recommendation)
	*~~'''~~Complex febrile seizure~~'''~~ if well-appearing, workup normal, follow-up in 24 hours		*Complex febrile seizure if well-appearing, workup normal, follow-up in 24 hours

	===Admit===		===Admit===

Danbot: Major update: AAP LP indications, recurrence risk by age, prophylactic AED not indicated, key diagnostic question (seizure with fever vs CNS infection), acetaminophen for same-episode recurrence, references with PMIDs

2026-03-21T19:59:43Z

Major update: AAP LP indications, recurrence risk by age, prophylactic AED not indicated, key diagnostic question (seizure with fever vs CNS infection), acetaminophen for same-episode recurrence, references with PMIDs

Show changes

Patricklin at 20:57, 20 March 2026

2026-03-20T20:57:30Z

← Older revision		Revision as of 20:57, 20 March 2026
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	<!--T:2-->		<!--T:2-->
			*Defined as seizure accompanied by fever (temperature ≥ 100.4°F by any method)
	*Occur in 2-5% of American children before age 5<ref>https://www.ninds.nih.gov/disorders/patient-caregiver-education/fact-sheets/febrile-seizures-fact-sheet</ref>		*Occur in 2-5% of American children before age 5<ref>https://www.ninds.nih.gov/disorders/patient-caregiver-education/fact-sheets/febrile-seizures-fact-sheet</ref>
	*~~50%~~ of ~~patients never have~~ temperature ~~>39~~		*High temperatures can alter ion channel function, increasing neuronal excitability<ref>Mosili P, Maikoo S, Mabandla MV, Qulu L. The Pathogenesis of Fever-Induced Febrile Seizures and Its Current State. Neurosci Insights. 2020 Nov 2;15:2633105520956973. doi: 10.1177/2633105520956973. PMID: 33225279; PMCID: PMC7649866.</ref>
	*Febrile seizures do not increase the risk of serious bacterial illness		**However, a high temperature is not necessarily seen in majority of febrile seizures
			*Febrile seizures do not increase the risk of serious bacterial illness<ref>Trainor JL, Hampers LC, Krug SE, Listernick R. Children with first-time simple febrile seizures are at low risk of serious bacterial illness. Acad Emerg Med. 2001 Aug;8(8):781-7. doi: 10.1111/j.1553-2712.2001.tb00207.x. PMID: 11483452.</ref>

	===Prognosis=== <!--T:3-->		===Prognosis=== <!--T:3-->

	<!--T:4-->		<!--T:4-->
	*2-3% chance of developing epilepsy (1% for general population)		*2-3% chance of developing epilepsy (slightly higher than risk of epilepsy for general population, which is 1%)
	*50% of patients <12 mo will have another simple febrile seizure		*50% of patients <12 mo will have another simple febrile seizure
	*30% of patients >12 mo will have another simple febrile seizure		*30% of patients >12 mo will have another simple febrile seizure
			*Simple febrile seizures do not increase risk of mortality or developmental delay

	==Clinical Features== <!--T:5-->		==Clinical Features== <!--T:5-->
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	<!--T:6-->		<!--T:6-->
	*[[Special:MyLanguage/Seizure\|Seizure]] + [[Special:MyLanguage/fever\|fever]]		*[[Special:MyLanguage/Seizure\|Seizure]] + [[Special:MyLanguage/fever\|fever]]


	===Simple Febrile Seizure=== <!--T:7-->		===Simple Febrile Seizure=== <!--T:7-->
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	*Generalized with no focal features		*Generalized with no focal features
	*Returns to neurologic baseline and has normal neuro exam after brief post-ictal period		*Returns to neurologic baseline and has normal neuro exam after brief post-ictal period
			*Febrile seizures cannot be considered simple for any children with known CNS abnormalities, previous neurologic insults, or history of afebrile seizures

	===Complex Febrile Seizure=== <!--T:9-->		===Complex Febrile Seizure=== <!--T:9-->
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	*Any exception to above		*Any exception to above
	*May indicate more serious disease process		*May indicate more serious disease process


	==Differential Diagnosis== <!--T:11-->		==Differential Diagnosis== <!--T:11-->
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	<translate>		<translate>

			==Evaluation== <!--T:12-->

	~~==Evaluation== <!--T:12-->~~

	<!--T:13-->		<!--T:13-->
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	<!--T:15-->		<!--T:15-->
	*Neither labs nor neuroimaging are absolutely necessary		*Neither labs nor neuroimaging are absolutely necessary
	*Normal [[Special:MyLanguage/Fever (Peds)\|pediatric fever workup]]		*Normal [[Special:MyLanguage/Fever (Peds)\|pediatric fever workup]] as indicated by presentation


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	<!--T:17-->		<!--T:17-->
	*Consider CBC, [[Special:MyLanguage/blood culture\|blood culture]], UA, urine culture~~, [[Special:MyLanguage/CSF studies\|CSF studies]]~~		*Consider CBC, [[Special:MyLanguage/blood culture\|blood culture]], UA, urine culture
	**Studies have suggested a link between iron deficiency anemia and rate of febrile seizure <ref>Sulviani R, Kamarullah W, Dermawan S, et al. Anemia and poor iron indices are associated with susceptibility to febrile seizures in children: a systematic review and meta-analysis. J Child Neurol. 2023;38(3-4):186-197</ref>		**Studies have suggested a link between iron deficiency anemia and rate of febrile seizure <ref>Sulviani R, Kamarullah W, Dermawan S, et al. Anemia and poor iron indices are associated with susceptibility to febrile seizures in children: a systematic review and meta-analysis. J Child Neurol. 2023;38(3-4):186-197</ref>
			*Consider CMP if suspect hyponatremic from ongoing volume loss
			*Consider LP and [[Special:MyLanguage/CSF studies\|CSF studies]] if meningeal signs present
			**Per AAP, consider LP especially if child is between 6-12 months of age and has incomplete immunizations, or if child had recent antibiotic treatment (as meningeal signs can be masked)<ref>Subcommittee on Febrile Seizures; American Academy of Pediatrics. Neurodiagnostic evaluation of the child with a simple febrile seizure. Pediatrics. 2011 Feb;127(2):389-94. doi: 10.1542/peds.2010-3318. PMID: 21285335.</ref>
	*Consider CT if:		*Consider CT if:
	**Persistently abnormal neuro exam (especially with focality)		**Persistently abnormal neuro exam (especially with focality)
	**Signs/symptoms of [[Special:MyLanguage/increased ICP\|increased ICP]]		**Signs/symptoms of [[Special:MyLanguage/increased ICP\|increased ICP]]
	**Patient has [[Special:MyLanguage/VP shunt\|VP shunt]]		**Patient has [[Special:MyLanguage/VP shunt\|VP shunt]]
			**History of head trauma
			**Suspected neurocutaneous disorder (ex. NF, tuberous sclerosis) based on exam findings
	*Consider [[Special:MyLanguage/ECG\|ECG]] if:		*Consider [[Special:MyLanguage/ECG\|ECG]] if:
	**Family history of [[Special:MyLanguage/long QT\|long QT]], [[Special:MyLanguage/Brugada\|Brugada]], sudden death		**Family history of [[Special:MyLanguage/long QT\|long QT]], [[Special:MyLanguage/Brugada\|Brugada]], sudden death
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	<!--T:18-->		<!--T:18-->
	[[File:Febrile Seizure.png\|thumb\|Algorithm for the differentiation between simple and complex febrile seizures. Guidelines for evaluation of each.]]		[[File:Febrile Seizure.png\|thumb\|Algorithm for the differentiation between simple and complex febrile seizures. Guidelines for evaluation of each.]]


	==Management== <!--T:19-->		==Management== <!--T:19-->
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	{{Initial management of pediatric status epilepticus}}		{{Initial management of pediatric status epilepticus}}
	<translate>		<translate>


	===Seizure Stopped=== <!--T:20-->		===Seizure Stopped=== <!--T:20-->
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	*Treat underlying infection if indicated		*Treat underlying infection if indicated
	**See [[Special:MyLanguage/pediatric fever of uncertain source\|pediatric fever of uncertain source]]		**See [[Special:MyLanguage/pediatric fever of uncertain source\|pediatric fever of uncertain source]]


	==Disposition== <!--T:22-->		==Disposition== <!--T:22-->


	===Discharge=== <!--T:23-->		===Discharge=== <!--T:23-->
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	**Follow-up in 1-2d		**Follow-up in 1-2d
	**Around-the-clock [[Special:MyLanguage/acetaminophen\|acetaminophen]] may prevent seizure recurrence in the same febrile episode<ref>Murata et al. Acetaminophen and Febrile Seizure Recurrences During the Same Fever Episode. Pediatrics. November 2018, VOLUME 142 / ISSUE 5</ref>		**Around-the-clock [[Special:MyLanguage/acetaminophen\|acetaminophen]] may prevent seizure recurrence in the same febrile episode<ref>Murata et al. Acetaminophen and Febrile Seizure Recurrences During the Same Fever Episode. Pediatrics. November 2018, VOLUME 142 / ISSUE 5</ref>
			**Anticipatory guidance that emphasizes benign nature of simple febrile seizures while educating return precautions
	*Complex febrile seizure if patient well-appearing, work-up normal		*Complex febrile seizure if patient well-appearing, work-up normal
	**Follow-up in 24hr		**Follow-up in 24hr


	===Admit=== <!--T:25-->		===Admit=== <!--T:25-->

Ostermayer: Marked this version for translation

2026-01-02T12:51:24Z

Marked this version for translation

← Older revision		Revision as of 12:51, 2 January 2026
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	<translate>		<translate>

	==Background==		==Background== <!--T:1-->

			<!--T:2-->
	*Occur in 2-5% of American children before age 5<ref>https://www.ninds.nih.gov/disorders/patient-caregiver-education/fact-sheets/febrile-seizures-fact-sheet</ref>		*Occur in 2-5% of American children before age 5<ref>https://www.ninds.nih.gov/disorders/patient-caregiver-education/fact-sheets/febrile-seizures-fact-sheet</ref>
	*50% of patients never have temperature >39		*50% of patients never have temperature >39
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	===Prognosis===		===Prognosis=== <!--T:3-->

			<!--T:4-->
	*2-3% chance of developing epilepsy (1% for general population)		*2-3% chance of developing epilepsy (1% for general population)
	*50% of patients <12 mo will have another simple febrile seizure		*50% of patients <12 mo will have another simple febrile seizure
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	==Clinical Features==		==Clinical Features== <!--T:5-->

			<!--T:6-->
	*[[Special:MyLanguage/Seizure\|Seizure]] + [[Special:MyLanguage/fever\|fever]]		*[[Special:MyLanguage/Seizure\|Seizure]] + [[Special:MyLanguage/fever\|fever]]


	===Simple Febrile Seizure===		===Simple Febrile Seizure=== <!--T:7-->

			<!--T:8-->
	*Age 6mo-5yr, with majority occurring between 12mo-18mo		*Age 6mo-5yr, with majority occurring between 12mo-18mo
	*Single seizure in 24hr		*Single seizure in 24hr
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	===Complex Febrile Seizure===		===Complex Febrile Seizure=== <!--T:9-->

			<!--T:10-->
	*Any exception to above		*Any exception to above
	*May indicate more serious disease process		*May indicate more serious disease process


	==Differential Diagnosis==		==Differential Diagnosis== <!--T:11-->

	</translate>		</translate>
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	==Evaluation==		==Evaluation== <!--T:12-->

			<!--T:13-->
	*The key is to distinguish between simple febrile seizure secondary to minor illness vs. seizure from serious central nervous system infection, which may also present with fever and seizure.		*The key is to distinguish between simple febrile seizure secondary to minor illness vs. seizure from serious central nervous system infection, which may also present with fever and seizure.
	*Glucose in all patients		*Glucose in all patients


	====Simple febrile seizure====		====Simple febrile seizure==== <!--T:14-->

			<!--T:15-->
	*Neither labs nor neuroimaging are absolutely necessary		*Neither labs nor neuroimaging are absolutely necessary
	*Normal [[Special:MyLanguage/Fever (Peds)\|pediatric fever workup]]		*Normal [[Special:MyLanguage/Fever (Peds)\|pediatric fever workup]]


	====Complex febrile seizure====		====Complex febrile seizure==== <!--T:16-->

			<!--T:17-->
	*Consider CBC, [[Special:MyLanguage/blood culture\|blood culture]], UA, urine culture, [[Special:MyLanguage/CSF studies\|CSF studies]]		*Consider CBC, [[Special:MyLanguage/blood culture\|blood culture]], UA, urine culture, [[Special:MyLanguage/CSF studies\|CSF studies]]
	**Studies have suggested a link between iron deficiency anemia and rate of febrile seizure <ref>Sulviani R, Kamarullah W, Dermawan S, et al. Anemia and poor iron indices are associated with susceptibility to febrile seizures in children: a systematic review and meta-analysis. J Child Neurol. 2023;38(3-4):186-197</ref>		**Studies have suggested a link between iron deficiency anemia and rate of febrile seizure <ref>Sulviani R, Kamarullah W, Dermawan S, et al. Anemia and poor iron indices are associated with susceptibility to febrile seizures in children: a systematic review and meta-analysis. J Child Neurol. 2023;38(3-4):186-197</ref>
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	**[[Special:MyLanguage/INH ingestion\|INH ingestion]]		**[[Special:MyLanguage/INH ingestion\|INH ingestion]]

			<!--T:18-->
	[[File:Febrile Seizure.png\|thumb\|Algorithm for the differentiation between simple and complex febrile seizures. Guidelines for evaluation of each.]]		[[File:Febrile Seizure.png\|thumb\|Algorithm for the differentiation between simple and complex febrile seizures. Guidelines for evaluation of each.]]


	==Management==		==Management== <!--T:19-->

	</translate>		</translate>
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	===Seizure Stopped===		===Seizure Stopped=== <!--T:20-->

			<!--T:21-->
	*Treat underlying infection if indicated		*Treat underlying infection if indicated
	**See [[Special:MyLanguage/pediatric fever of uncertain source\|pediatric fever of uncertain source]]		**See [[Special:MyLanguage/pediatric fever of uncertain source\|pediatric fever of uncertain source]]


	==Disposition==		==Disposition== <!--T:22-->


	===Discharge===		===Discharge=== <!--T:23-->

			<!--T:24-->
	*Simple febrile seizure if patient at baseline		*Simple febrile seizure if patient at baseline
	**Follow-up in 1-2d		**Follow-up in 1-2d
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	===Admit===		===Admit=== <!--T:25-->

			<!--T:26-->
	*Ill-appearing		*Ill-appearing
	*Lethargy beyond postictal period		*Lethargy beyond postictal period


	==See Also==		==See Also== <!--T:27-->

			<!--T:28-->
	*[[Special:MyLanguage/Seizure (peds)\|Seizure (peds)]]		*[[Special:MyLanguage/Seizure (peds)\|Seizure (peds)]]
	*[[Special:MyLanguage/Fever (Peds)\|Fever (Peds)]]		*[[Special:MyLanguage/Fever (Peds)\|Fever (Peds)]]


	==References==		==References== <!--T:29-->

			<!--T:30-->
	<references/>		<references/>

			<!--T:31-->
	[[Category:Pediatrics]]		[[Category:Pediatrics]]
	[[Category:Neurology]]		[[Category:Neurology]]
	</translate>		</translate>

Ostermayer: Prepared the page for translation

2025-12-31T05:22:02Z

Prepared the page for translation

← Older revision		Revision as of 05:22, 31 December 2025
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			<languages/>
			<translate>

	==Background==		==Background==

	*Occur in 2-5% of American children before age 5<ref>https://www.ninds.nih.gov/disorders/patient-caregiver-education/fact-sheets/febrile-seizures-fact-sheet</ref>		*Occur in 2-5% of American children before age 5<ref>https://www.ninds.nih.gov/disorders/patient-caregiver-education/fact-sheets/febrile-seizures-fact-sheet</ref>
	*50% of patients never have temperature >39		*50% of patients never have temperature >39
	*Febrile seizures do not increase the risk of serious bacterial illness		*Febrile seizures do not increase the risk of serious bacterial illness


	===Prognosis===		===Prognosis===

	*2-3% chance of developing epilepsy (1% for general population)		*2-3% chance of developing epilepsy (1% for general population)
	*50% of patients <12 mo will have another simple febrile seizure		*50% of patients <12 mo will have another simple febrile seizure
	*30% of patients >12 mo will have another simple febrile seizure		*30% of patients >12 mo will have another simple febrile seizure


	==Clinical Features==		==Clinical Features==
	*[[Seizure]] + [[fever]]
			*[[Special:MyLanguage/Seizure\|Seizure]] + [[Special:MyLanguage/fever\|fever]]


	===Simple Febrile Seizure===		===Simple Febrile Seizure===

	*Age 6mo-5yr, with majority occurring between 12mo-18mo		*Age 6mo-5yr, with majority occurring between 12mo-18mo
	*Single seizure in 24hr		*Single seizure in 24hr
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	*Generalized with no focal features		*Generalized with no focal features
	*Returns to neurologic baseline and has normal neuro exam after brief post-ictal period		*Returns to neurologic baseline and has normal neuro exam after brief post-ictal period


	===Complex Febrile Seizure===		===Complex Febrile Seizure===

	*Any exception to above		*Any exception to above
	*May indicate more serious disease process		*May indicate more serious disease process


	==Differential Diagnosis==		==Differential Diagnosis==

			</translate>
	{{Pediatric seizure DDX}}		{{Pediatric seizure DDX}}
			<translate>

			</translate>
	{{Pediatric fever DDX}}		{{Pediatric fever DDX}}
			<translate>


	==Evaluation==		==Evaluation==

	*The key is to distinguish between simple febrile seizure secondary to minor illness vs. seizure from serious central nervous system infection, which may also present with fever and seizure.		*The key is to distinguish between simple febrile seizure secondary to minor illness vs. seizure from serious central nervous system infection, which may also present with fever and seizure.
	*Glucose in all patients		*Glucose in all patients


	====Simple febrile seizure====		====Simple febrile seizure====

	*Neither labs nor neuroimaging are absolutely necessary		*Neither labs nor neuroimaging are absolutely necessary
	*Normal [[Fever (Peds)\|pediatric fever workup]]		*Normal [[Special:MyLanguage/Fever (Peds)\|pediatric fever workup]]


	====Complex febrile seizure====		====Complex febrile seizure====
	*Consider CBC, [[blood culture]], UA, urine culture, [[CSF studies]]
			*Consider CBC, [[Special:MyLanguage/blood culture\|blood culture]], UA, urine culture, [[Special:MyLanguage/CSF studies\|CSF studies]]
	**Studies have suggested a link between iron deficiency anemia and rate of febrile seizure <ref>Sulviani R, Kamarullah W, Dermawan S, et al. Anemia and poor iron indices are associated with susceptibility to febrile seizures in children: a systematic review and meta-analysis. J Child Neurol. 2023;38(3-4):186-197</ref>		**Studies have suggested a link between iron deficiency anemia and rate of febrile seizure <ref>Sulviani R, Kamarullah W, Dermawan S, et al. Anemia and poor iron indices are associated with susceptibility to febrile seizures in children: a systematic review and meta-analysis. J Child Neurol. 2023;38(3-4):186-197</ref>
	*Consider CT if:		*Consider CT if:
	**Persistently abnormal neuro exam (especially with focality)		**Persistently abnormal neuro exam (especially with focality)
	**Signs/symptoms of [[increased ICP]]		**Signs/symptoms of [[Special:MyLanguage/increased ICP\|increased ICP]]
	**Patient has [[VP shunt]]		**Patient has [[Special:MyLanguage/VP shunt\|VP shunt]]
	*Consider [[ECG]] if:		*Consider [[Special:MyLanguage/ECG\|ECG]] if:
	**Family history of [[long QT]], [[Brugada]], sudden death		**Family history of [[Special:MyLanguage/long QT\|long QT]], [[Special:MyLanguage/Brugada\|Brugada]], sudden death
	*Routine EEG not indicated		*Routine EEG not indicated
	**Consider only if developmental delay or for focal symptoms		**Consider only if developmental delay or for focal symptoms
	*Causes amenable to specific treatment		*Causes amenable to specific treatment
	**[[Hypoglycemia]]		**[[Special:MyLanguage/Hypoglycemia\|Hypoglycemia]]
	**[[Hyponatremia]] (water intoxication, dilution of formula)		**[[Special:MyLanguage/Hyponatremia\|Hyponatremia]] (water intoxication, dilution of formula)
	**[[Hypocalcemia]]		**[[Special:MyLanguage/Hypocalcemia\|Hypocalcemia]]
	**[[Hypomagnesemia]]		**[[Special:MyLanguage/Hypomagnesemia\|Hypomagnesemia]]
	**[[INH ingestion]]		**[[Special:MyLanguage/INH ingestion\|INH ingestion]]

	[[File:Febrile Seizure.png\|thumb\|Algorithm for the differentiation between simple and complex febrile seizures. Guidelines for evaluation of each.]]		[[File:Febrile Seizure.png\|thumb\|Algorithm for the differentiation between simple and complex febrile seizures. Guidelines for evaluation of each.]]


	==Management==		==Management==

			</translate>
	{{Initial management of pediatric status epilepticus}}		{{Initial management of pediatric status epilepticus}}
			<translate>


	===Seizure Stopped===		===Seizure Stopped===

	*Treat underlying infection if indicated		*Treat underlying infection if indicated
	**See [[pediatric fever of uncertain source]]		**See [[Special:MyLanguage/pediatric fever of uncertain source\|pediatric fever of uncertain source]]


	==Disposition==		==Disposition==


	===Discharge===		===Discharge===

	*Simple febrile seizure if patient at baseline		*Simple febrile seizure if patient at baseline
	**Follow-up in 1-2d		**Follow-up in 1-2d
	**Around-the-clock [[acetaminophen]] may prevent seizure recurrence in the same febrile episode<ref>Murata et al. Acetaminophen and Febrile Seizure Recurrences During the Same Fever Episode. Pediatrics. November 2018, VOLUME 142 / ISSUE 5</ref>		**Around-the-clock [[Special:MyLanguage/acetaminophen\|acetaminophen]] may prevent seizure recurrence in the same febrile episode<ref>Murata et al. Acetaminophen and Febrile Seizure Recurrences During the Same Fever Episode. Pediatrics. November 2018, VOLUME 142 / ISSUE 5</ref>
	*Complex febrile seizure if patient well-appearing, work-up normal		*Complex febrile seizure if patient well-appearing, work-up normal
	**Follow-up in 24hr		**Follow-up in 24hr


	===Admit===		===Admit===

	*Ill-appearing		*Ill-appearing
	*Lethargy beyond postictal period		*Lethargy beyond postictal period


	==See Also==		==See Also==
	*[[Seizure (peds)]]
	*[[Fever (Peds)]]		*[[Special:MyLanguage/Seizure (peds)\|Seizure (peds)]]
			*[[Special:MyLanguage/Fever (Peds)\|Fever (Peds)]]


	==References==		==References==

	<references/>		<references/>

	[[Category:Pediatrics]]		[[Category:Pediatrics]]
	[[Category:Neurology]]		[[Category:Neurology]]
			</translate>

Zbuchwald: /* Complex febrile seizure */

2025-12-15T06:36:10Z

Complex febrile seizure

← Older revision		Revision as of 06:36, 15 December 2025
Line 38:		Line 38:
	====Complex febrile seizure====		====Complex febrile seizure====
	*Consider CBC, [[blood culture]], UA, urine culture, [[CSF studies]]		*Consider CBC, [[blood culture]], UA, urine culture, [[CSF studies]]
			**Studies have suggested a link between iron deficiency anemia and rate of febrile seizure <ref>Sulviani R, Kamarullah W, Dermawan S, et al. Anemia and poor iron indices are associated with susceptibility to febrile seizures in children: a systematic review and meta-analysis. J Child Neurol. 2023;38(3-4):186-197</ref>
	*Consider CT if:		*Consider CT if:
	**Persistently abnormal neuro exam (especially with focality)		**Persistently abnormal neuro exam (especially with focality)

Rossdonaldson1: /* Management */

2021-03-11T23:48:18Z

Management

← Older revision		Revision as of 23:48, 11 March 2021
Line 56:		Line 56:

	==Management==		==Management==
	~~===Ongoing Seizure===~~		{{Initial management of pediatric status epilepticus}}
	~~See [[Seizure (peds)]]~~

	===Seizure Stopped===		===Seizure Stopped===

Rossdonaldson1: /* See Also */

2021-03-11T21:23:12Z

NadavNahumi: /* Simple Febrile Seizure */

2020-03-18T17:00:56Z

Simple Febrile Seizure

← Older revision		Revision as of 17:00, 18 March 2020
Line 13:		Line 13:

	===Simple Febrile Seizure===		===Simple Febrile Seizure===
	*Age 6mo-5yr		*Age 6mo-5yr, with majority occurring between 12mo-18mo
	*Single seizure in 24hr		*Single seizure in 24hr
	*Duration <15min		*Duration <15min
	*Generalized with no focal features		*Generalized with no focal features
	*Returns to neurologic baseline and has normal neuro exam after brief post-ictal period		*Returns to neurologic baseline and has normal neuro exam after brief post-ictal period

	===Complex Febrile Seizure===		===Complex Febrile Seizure===
	*Any exception to above		*Any exception to above

NadavNahumi: /* Background */

2020-03-18T16:57:04Z

Background

← Older revision		Revision as of 16:57, 18 March 2020
Line 1:		Line 1:
	==Background==		==Background==
			*Occur in 2-5% of American children before age 5<ref>https://www.ninds.nih.gov/disorders/patient-caregiver-education/fact-sheets/febrile-seizures-fact-sheet</ref>
	*50% of patients never have temperature >39		*50% of patients never have temperature >39
	*Febrile seizures do not increase the risk of serious bacterial illness		*Febrile seizures do not increase the risk of serious bacterial illness

← Older revision		Revision as of 21:23, 11 March 2021
Line 76:		Line 76:

	==See Also==		==See Also==
	*[[Seizure]]		*[[Seizure (peds)]]
	*[[Fever (Peds)]]		*[[Fever (Peds)]]