Febrile seizure: Difference between revisions
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==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 | ||
===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 | *50% of patients <12 mo will have another simple febrile seizure | ||
*30% of patients | *30% of patients >12 mo will have another simple febrile seizure | ||
==Clinical Features== | ==Clinical Features== | ||
*[[Seizure]] + [[fever]] | *[[Seizure]] + [[fever]] | ||
===Simple Febrile Seizure=== | |||
*Age 6mo-5yr, with majority occurring between 12mo-18mo | |||
*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== | ==Differential Diagnosis== | ||
| Line 17: | Line 29: | ||
==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. | |||
*Glucose in all patients | *Glucose in all patients | ||
| Line 51: | Line 52: | ||
**[[Hypomagnesemia]] | **[[Hypomagnesemia]] | ||
**[[INH ingestion]] | **[[INH ingestion]] | ||
[[File:Febrile Seizure.png|thumb|Algorithm for the differentiation between simple and complex febrile seizures. Guidelines for evaluation of each.]] | |||
==Management== | ==Management== | ||
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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 | ||
**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 | ||
===Admit=== | ===Admit=== | ||
*Ill-appearing | *Ill-appearing | ||
Revision as of 17:00, 18 March 2020
Background
- Occur in 2-5% of American children before age 5[1]
- 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, with majority occurring between 12mo-18mo
- 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
- Epileptic seizure
- First-time seizure
- Seizure with known seizure disorder
- Status epilepticus
- Temporal lobe epilepsy
- Non-compliance with or "outgrowing" AEDs
- Non-epileptic seizure
- Febrile seizure
- Brain inflammation
- Increased ICP
- Seizure with VP shunt
- Hydrocephalus
- Intracranial mass
- Toxicologic
- Metabolic abnormalities: hyponatremia, hypernatremia, hypocalcemia, hypomagnesemia, hypoglycemia, hyperglycemia
- Pyridoxine responsive seizure[2]
- Eclampsia
- Posterior reversible encephalopathy syndrome
- Impact seizure (head trauma)
- Other mimics
- Psychogenic nonepileptic seizure (pseudoseizure)
- Syncope (peds)
- Breath-holding spell
- Hyperventilation syndrome
- Migraine headache
- Movement disorders
- Narcolepsy/cataplexy
- Post-hypoxic myoclonus (Status myoclonicus)
- Infantile Spasms/West Syndrome
Pediatric fever
- Upper respiratory infection (URI)
- UTI
- Sepsis
- Meningitis
- Febrile seizure
- Pneumonia
- Acute otitis media
- Whooping cough
- Unclear source
- Kawasaki disease
- Neonatal HSV
- Specific virus
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
- Neither labs nor neuroimaging are absolutely necessary
- Normal pediatric fever workup
Complex febrile seizure
- Consider CBC, blood culture, UA, urine culture, CSF studies
- Consider CT if:
- Persistently abnormal neuro exam (especially with focality)
- Signs/symptoms of increased ICP
- Patient has VP shunt
- Consider ECG if:
- Routine EEG not indicated
- Consider only if developmental delay or for focal symptoms
- Causes amenable to specific treatment
- Hypoglycemia
- Hyponatremia (water intoxication, dilution of formula)
- Hypocalcemia
- Hypomagnesemia
- INH ingestion
Management
Ongoing Seizure
See Seizure (peds)
Seizure Stopped
- Treat underlying infection if indicated
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[3]
- Complex febrile seizure if patient well-appearing, work-up normal
- Follow-up in 24hr
Admit
- Ill-appearing
- Lethargy beyond postictal period
See Also
References
- ↑ https://www.ninds.nih.gov/disorders/patient-caregiver-education/fact-sheets/febrile-seizures-fact-sheet
- ↑ Baxter P. et al. Pyridoxine‐dependent and pyridoxine‐responsive seizures. Developmental Medicine & Child Neurology 2001, 43: 416–42
- ↑ Murata et al. Acetaminophen and Febrile Seizure Recurrences During the Same Fever Episode. Pediatrics. November 2018, VOLUME 142 / ISSUE 5