Difference between revisions of "Febrile seizure"

(Clinical Features)
Line 15: Line 15:
 
*Single seizure in 24hr
 
*Single seizure in 24hr
 
*Duration <15min
 
*Duration <15min
*Generalized
+
*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===
*As above, elements of one or more of the following:
+
*Any exception to above
**Can be focal or generalized OR
 
**Prolonged or multiple seizures in 24hr period OR
 
**Not returned to baseline or abnormal neuro exam
 
 
*May indicate more serious disease process
 
*May indicate more serious disease process
  
Line 30: Line 27:
  
 
==Evaluation==
 
==Evaluation==
===Work-Up===
+
*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  
  
Line 54: Line 51:
 
**[[INH ingestion]]
 
**[[INH ingestion]]
  
===Diagnosis===
 
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.
 
 
[[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
 
**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
 
  
 
==Management==
 
==Management==
Line 79: Line 65:
 
*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 [[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 00:07, 15 September 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

Simple Febrile Seizure

  • Age 6mo-5yr
  • Single seizure in 24hr
  • Duration <15min
  • Generalized with no focal features
  • Returns to neurologic baseline and has normal neuro exam after brief post-ictal period

Complex Febrile Seizure

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

Differential Diagnosis

Pediatric seizure

Pediatric fever

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.
  • Glucose in all patients

Simple febrile seizure

Complex febrile seizure

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

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