Difference between revisions of "Febrile seizure"

m (Rossdonaldson1 moved page Febrile Seizure to Febrile seizure)
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##Any exception to above
##Any exception to above
== DDx ==
==Differential Diagnosis ==
#[[Meningitis ]]
##More likely if status epilepticus
##More likely if [[status epilepticus]]
#Seizure due to identifiable cause (e.g. intracranial mass, trauma, ingestion)  
#[[Seizure]] due to identifiable cause (e.g. intracranial mass, trauma, ingestion)  
#Epidural/subdural infection or hematoma
#Epidural/subdural infection or hematoma
#Toxic Ingestion
#Toxic Ingestion

Revision as of 03:18, 6 January 2015


  • 50% of pts never have temp >39
  • 50% of pts <12 mo will have another simple febrile seizure
  • 30% of pts >12 mo will have another simple febrile seizure

Simple versus Complex

  1. Simple
    1. Generalized tonic-clonic seizure
    2. <15 min in duration
    3. Age 6mo - 6yr
    4. Occurs only once in 24hr period
    5. No focal features
  2. Complex
    1. Any exception to above

Differential Diagnosis

  1. Meningitis
    1. More likely if status epilepticus
  2. Seizure due to identifiable cause (e.g. intracranial mass, trauma, ingestion)
  3. Epidural/subdural infection or hematoma
  4. Toxic Ingestion
  5. Pyridoxine Responsive Seizure[1]


  1. Glucose in all pts
  2. Simple febrile seizure
    1. Neither labs nor neuroimaging are absolutely necessary
    2. Normal pediatric fever workup
  3. Complex febrile seizure
    1. Consider CBC, blood cx, UA, Ucx, CSF studies
  4. Consider CT if:
    1. Persistently abnormal neuro exam (esp w/ focality)
    2. Signs/symptoms of increased ICP
    3. pt has VP shunt
  5. Routine EEG not indicated
    1. Consider only if developmental delay or for focal symptoms


  1. Treat if initial seizure persists >5 min or for subsequent seizures
    1. Benzodiapazines
      1. Lorazepam 0.1mg/kg IV
      2. Diazepam 0.2 mg/kg IV or 0.5 mg/kg PR
      3. Midazolam 0.1 mg/kg IV or IM or IN
        1. If persists try one additional dose (risk of resp. depression incr if >2 doses)
    2. Fosphenytoin (15-20 mg PE/kg IV) or Phenytoin (10-20 mg/kg IV up to 1g @ 1mg/kg/min)
      1. Treat if seizure persists despite benzo tx
      2. Onset of action may take as long as 30 minutes
      3. Can cause hypotension and dysrhythmias
    3. Barbituates
      1. Phenobarbital 15-20 mg/kg IV
      2. Consider only if benzos and phenytoin have failed
      3. May lead to respiratory depression, especially when preceded by a benzo
    4. Valproic acid 10-15 mg/kg IV (20 mg/min)
      1. Has been shown to be effective when benzos, phenytoin, and barbituates have failed
      2. Can be used as 2nd or 3rd-line treatment
    5. Keppra 20 mg/kg IVP
    6. Propofol 2-3 mg/kg IVP; maintenance 0.125-0.3 mg/kg/min IV
    7. Consider Pyridoxine (vitamin B6) 1g per g of INH ingested (in D5W IV over 30 min)
    8. Consider Pyridoxine Responsive Seizure Disorder - 100mg/pyridoxine is generally effective[2]
  2. Treat underlying infection


  • Discharge
    • Simple febrile seizure if pt at baseline
      • Follow-up in 1-2d
    • Complex febrile seizure if pt well-appearing, work-up normal
      • Follow-up in 24hr
  • Admit:
    • Ill-appearing
    • Lethargy beyond postictal period

See Also


  1. Baxter P. et al. Pyridoxine‐dependent and pyridoxine‐responsive seizures. Developmental Medicine & Child Neurology 2001, 43: 416–42
  2. Pyridoxine dependent seizures a wider clinical spectrum. Archives of Disease in Childhood.1983 (58) 415-418. http://adc.bmj.com/content/58/6/415.full.pdf