Difference between revisions of "Febrile seizure"

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(Simple Febrile Seizure)
 
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==Background==
 
==Background==
*50% of patients never have temp >39
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*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>
*Antipyretics do not offer significant improvements in recurrence rates of febrile seizures<ref>Rosenbloom E, et al. Do antipyretics prevent the recurrence of febrile seizures in children? A systemic review of randomized controlled trials and meta-analysis. Eur J Paediatr Neurol. 2013; 17:585-588.</ref>
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*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 &lt;12 mo will have another simple febrile seizure  
+
*50% of patients <12 mo will have another simple febrile seizure  
*30% of patients &gt;12 mo will have another simple febrile seizure
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*30% of patients >12 mo will have another simple febrile seizure
  
==Clinical Presentation==
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==Clinical Features==
 
*[[Seizure]] + [[fever]]
 
*[[Seizure]] + [[fever]]
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 +
===Simple Febrile Seizure===
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*Age 6mo-5yr, with majority occurring between 12mo-18mo
 +
*Single seizure in 24hr
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*Duration <15min
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*Generalized with no focal features
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*Returns to neurologic baseline and has normal neuro exam after brief post-ictal period
 +
 +
===Complex Febrile Seizure===
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*Any exception to above
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*May indicate more serious disease process
  
 
==Differential Diagnosis==
 
==Differential Diagnosis==
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{{Pediatric fever DDX}}
 
{{Pediatric fever DDX}}
  
==Diagnosis==
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==Evaluation==
===Simple versus Complex===
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*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.
*Simple
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*Glucose in all patients
**Generalized tonic-clonic seizure
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**<15 min in duration
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====Simple febrile seizure====
**Age 6mo - 5yr
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*Neither labs nor neuroimaging are absolutely necessary
**Occurs only once in 24hr period
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*Normal [[Fever (Peds)|pediatric fever workup]]
**No focal features
 
*Complex
 
**Any exception to above
 
  
===Work-Up===
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====Complex febrile seizure====
*Glucose in all patients
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*Consider CBC, [[blood culture]], UA, urine culture, [[CSF studies]]
*Simple febrile seizure
 
**Neither labs nor neuroimaging are absolutely necessary
 
**Normal [[Fever (Peds)|pediatric fever workup]]
 
*Complex febrile seizure  
 
**Consider CBC, blood cx, UA, Ucx, CSF studies
 
 
*Consider CT if:  
 
*Consider CT if:  
**Persistently abnormal neuro exam (esp w/ focality)  
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**Persistently abnormal neuro exam (especially with focality)  
**Signs/symptoms of increased ICP  
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**Signs/symptoms of [[increased ICP]]
**Pt has VP shunt
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**Patient has [[VP shunt]]
*Consider ECG if:
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*Consider [[ECG]] if:
**Family Hx of long QT, Brugada, sudden death
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**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 Tx
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*Causes amenable to specific treatment
**Hypoglycemia
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**[[Hypoglycemia]]
**Hyponatremia (water intoxication, dilution of formula)
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**[[Hyponatremia]] (water intoxication, dilution of formula)
**Hypocalcemia
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**[[Hypocalcemia]]
**Hypomagnesemia
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**[[Hypomagnesemia]]
**INH ingestion
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**[[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  

Latest 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

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[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

  1. https://www.ninds.nih.gov/disorders/patient-caregiver-education/fact-sheets/febrile-seizures-fact-sheet
  2. Baxter P. et al. Pyridoxine‐dependent and pyridoxine‐responsive seizures. Developmental Medicine & Child Neurology 2001, 43: 416–42
  3. Murata et al. Acetaminophen and Febrile Seizure Recurrences During the Same Fever Episode. Pediatrics. November 2018, VOLUME 142 / ISSUE 5