Difference between revisions of "Febrile seizure"

(Evaluation)
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==Background==
 
==Background==
 
*50% of patients never have temperature >39
 
*50% of patients never have temperature >39
*Antipyretics might offer significant improvements in recurrence rates of febrile seizures<ref>Murata et al. Acetaminophen and Febrile Seizure Recurrences During the Same Fever Episode. Pediatrics. November 2018, VOLUME 142 / ISSUE 5</ref> (controversial)
 
 
*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)
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==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.
+
Key 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.
 
[[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.]]
 
 
===Simple versus Complex===
 
===Simple versus Complex===
 
*Simple  
 
*Simple  
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*Simple febrile seizure if patient at baseline
 
*Simple febrile seizure if patient at baseline
 
**Follow-up in 1-2d  
 
**Follow-up in 1-2d  
**ATC acetaminophen may prevent seizure recurrence in the same febrile episode
+
**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>
 +
 
 
*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

Revision as of 17:55, 18 July 2019

Background

  • 50% of patients never have temperature >39
  • Febrile seizures do not increase the risk of serious bacterial illness

Prognosis

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

Clinical Features

Differential Diagnosis

Pediatric seizure

Pediatric fever

Evaluation

Key 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.

Algorithm for the differentiation between simple and complex febrile seizures. Guidelines for evaluation of each.

Simple versus Complex

  • Simple
    • Generalized tonic-clonic seizure
    • <15 min in duration
    • Age 6mo - 5yr
    • Occurs only once in 24hr period
    • No focal features
  • Complex
    • Any exception to above

Work-Up

  • Glucose in all patients

Simple febrile seizure

Complex febrile seizure

Management

Ongoing Seizure

See Seizure (peds)

Seizure Stopped

Disposition

Discharge

  • Simple febrile seizure if patient at baseline
    • Follow-up in 1-2d
    • Around-the-clock acetaminophen may prevent seizure recurrence in the same febrile episode[2]
  • Complex febrile seizure if patient well-appearing, work-up normal
    • Follow-up in 24hr

Admit

  • Ill-appearing
  • Lethargy beyond postictal period

See Also

References

  1. Baxter P. et al. Pyridoxine‐dependent and pyridoxine‐responsive seizures. Developmental Medicine & Child Neurology 2001, 43: 416–42
  2. Murata et al. Acetaminophen and Febrile Seizure Recurrences During the Same Fever Episode. Pediatrics. November 2018, VOLUME 142 / ISSUE 5