Difference between revisions of "Febrile seizure"
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==Background== | ==Background== | ||
| − | *50% of patients never have | + | *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 |
| + | *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 | + | ==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 15: | Line 28: | ||
{{Pediatric fever DDX}} | {{Pediatric fever DDX}} | ||
| − | == | + | ==Evaluation== |
| − | ===Simple | + | *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 [[Fever (Peds)|pediatric fever workup]] | |
| − | |||
| − | |||
| − | |||
| − | === | + | ====Complex febrile seizure==== |
| − | + | *Consider CBC, [[blood culture]], UA, urine culture, [[CSF studies]] | |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
*Consider CT if: | *Consider CT if: | ||
| − | **Persistently abnormal neuro exam ( | + | **Persistently abnormal neuro exam (especially with focality) |
| − | **Signs/symptoms of increased ICP | + | **Signs/symptoms of [[increased ICP]] |
| − | ** | + | **Patient has [[VP shunt]] |
| + | *Consider [[ECG]] if: | ||
| + | **Family history of [[long QT]], [[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 | + | *Causes amenable to specific treatment |
| − | **Hypoglycemia | + | **[[Hypoglycemia]] |
| − | **Hyponatremia (water intoxication, dilution of formula) | + | **[[Hyponatremia]] (water intoxication, dilution of formula) |
| − | **Hypocalcemia | + | **[[Hypocalcemia]] |
| − | **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== | ||
| Line 58: | Line 67: | ||
*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 | ||
Latest revision as of 17:00, 18 March 2020
Contents
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
- Meningitis
- Encephalitis
- CNS abscess
- Intracranial hemorrhage
- Alcohol withdrawal
- Benzodiazepine withdrawal
- Metabolic abnormalities: hyponatremia, hypernatremia, hypocalcemia, hypomagnesemia, hypoglycemia, hyperglycemia
- Pyridoxine responsive seizure[2]
- Eclampsia
- Neurocysticercosis
- Posterior reversible encephalopathy syndrome
- Impact seizure (head trauma)
- Seizure with VP shunt
- Toxic ingestion
- Psychogenic nonepileptic seizure (pseudoseizure)
- Hydrocephalus
- Intracranial mass
- Syncope
- Breath-holding spell
- Hyperventilation syndrome
- Migraine headache
- Movement disorders
- Narcolepsy/cataplexy
- Post-hypoxic myoclonus (Status myoclonicus)
- Infatile 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