Febrile seizure: Difference between revisions
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== Background == | == Background == | ||
* | *50% of pts never have temp>39 | ||
*50% of pts | *50% of pts <12 mo will have another simple febrile seizure | ||
*30% of pts | *30% of pts >12 mo will have another simple febrile seizure | ||
=== Simple versus Complex === | === Simple versus Complex === | ||
#Simple | #Simple | ||
##Generalized tonic-clonic seizure | ##Generalized tonic-clonic seizure | ||
## | ##<15 min in duration | ||
##Age 6mo - 6yr | |||
##Age 6mo - 6yr | ##Occurs only once in 24hr period | ||
##Occurs only once in 24hr period | |||
##No focal features | ##No focal features | ||
#Complex | #Complex | ||
##Any exception to above | ##Any exception to above | ||
==DDx== | == DDx == | ||
#Meningitis | #Meningitis | ||
##More likely if status epilepticus | ##More likely if status epilepticus | ||
#Seizure due to identifiable cause (e.g. intracranial mass, trauma) | #Seizure due to identifiable cause (e.g. intracranial mass, trauma) | ||
#Epidural/subdural infection or hematoma | #Epidural/subdural infection or hematoma | ||
==Work-Up == | == Work-Up == | ||
#Glucose in all pts | #Glucose in all pts | ||
##Simple febrile seizure | ##Simple febrile seizure | ||
###No labs, neuroimaging, or EEG is necessarily necessary | ###No labs, neuroimaging, or EEG is necessarily necessary | ||
##Complex febrile seizure | ##Complex febrile seizure | ||
###Consider CBC, blood cx, UA, Ucx, CSF studies | ###Consider CBC, blood cx, UA, Ucx, CSF studies | ||
#Consider CT if: | #Consider CT if: | ||
##Persistently abnormal neuro exam (esp w/ focality) | ##Persistently abnormal neuro exam (esp w/ focality) | ||
##Signs/symptoms of increased ICP | ##Signs/symptoms of increased ICP | ||
##pt has VP shunt | ##pt has VP shunt | ||
#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 | ||
== Treatment == | == Treatment == | ||
#Treat if initial seizure persists | #Treat if initial seizure persists >5 min or for subsequent seizures | ||
##Benzodiapazines | ##Benzodiapazines | ||
###Lorazepam 0.1mg/kg | ###Lorazepam 0.1mg/kg | ||
####If persists try one additional dose (risk of resp. depression incr if | ####If persists try one additional dose (risk of resp. depression incr if >2 doses) | ||
##Fosphenytoin (15-20 mg/kg) | ##Fosphenytoin (15-20 mg/kg) | ||
###Treat if seizure persists despite benzo tx | ###Treat if seizure persists despite benzo tx | ||
###Onset of action may take as long as 30 minutes | ###Onset of action may take as long as 30 minutes | ||
###Can cause hypotension and dysrhythmias | ###Can cause hypotension and dysrhythmias | ||
##Barbituates | ##Barbituates | ||
###Consider only if benzos and phenytoin have failed | ###Consider only if benzos and phenytoin have failed | ||
###May lead to respiratory depression, especially when preceded by a benzo | ###May lead to respiratory depression, especially when preceded by a benzo | ||
##Valproic acid | ##Valproic acid | ||
###Has been shown to be effective when benzos, phenytoin, and barbituates have failed | ###Has been shown to be effective when benzos, phenytoin, and barbituates have failed | ||
###Can be used as 2nd or 3rd-line treatment | ###Can be used as 2nd or 3rd-line treatment | ||
#Treat underlying infection | #Treat underlying infection | ||
== Disposition == | == Disposition == | ||
*Discharge | *Discharge | ||
**Simple febrile seizure if pt at baseline, f/u w/in 1-2d | **Simple febrile seizure if pt at baseline, f/u w/in 1-2d | ||
**Complex febrile seizure if pt well-appearing, labs normal, f/u in 24hr | **Complex febrile seizure if pt well-appearing, labs normal, f/u in 24hr | ||
*Admit: | *Admit: | ||
**Ill-appearing | **Ill-appearing | ||
**Lethargy beyond postictal period | **Lethargy beyond postictal period | ||
== See Also == | |||
[[Seizure (Peds)]] | |||
[[Seizure (Peds)]] | |||
[[Fever (Peds)]] | [[Fever (Peds)]] | ||
== Source == | == Source == | ||
Tintinalli | Tintinalli | ||
[[Category:Peds]] | [[Category:Peds]] | ||
Revision as of 13:51, 7 July 2011
Background
- 50% of pts never have temp>39
- 50% of pts <12 mo will have another simple febrile seizure
- 30% of pts >12 mo will have another simple febrile seizure
Simple versus Complex
- Simple
- Generalized tonic-clonic seizure
- <15 min in duration
- Age 6mo - 6yr
- Occurs only once in 24hr period
- No focal features
- Complex
- Any exception to above
DDx
- Meningitis
- More likely if status epilepticus
- Seizure due to identifiable cause (e.g. intracranial mass, trauma)
- Epidural/subdural infection or hematoma
Work-Up
- Glucose in all pts
- Simple febrile seizure
- No labs, neuroimaging, or EEG is necessarily necessary
- Complex febrile seizure
- Consider CBC, blood cx, UA, Ucx, CSF studies
- Simple febrile seizure
- Consider CT if:
- Persistently abnormal neuro exam (esp w/ focality)
- Signs/symptoms of increased ICP
- pt has VP shunt
- Routine EEG not indicated
- Consider only if developmental delay or for focal symptoms
Treatment
- Treat if initial seizure persists >5 min or for subsequent seizures
- Benzodiapazines
- Lorazepam 0.1mg/kg
- If persists try one additional dose (risk of resp. depression incr if >2 doses)
- Lorazepam 0.1mg/kg
- Fosphenytoin (15-20 mg/kg)
- Treat if seizure persists despite benzo tx
- Onset of action may take as long as 30 minutes
- Can cause hypotension and dysrhythmias
- Barbituates
- Consider only if benzos and phenytoin have failed
- May lead to respiratory depression, especially when preceded by a benzo
- Valproic acid
- Has been shown to be effective when benzos, phenytoin, and barbituates have failed
- Can be used as 2nd or 3rd-line treatment
- Benzodiapazines
- Treat underlying infection
Disposition
- Discharge
- Simple febrile seizure if pt at baseline, f/u w/in 1-2d
- Complex febrile seizure if pt well-appearing, labs normal, f/u in 24hr
- Admit:
- Ill-appearing
- Lethargy beyond postictal period
See Also
Source
Tintinalli