Febrile seizure: Difference between revisions
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=== Simple versus Complex === | === Simple versus Complex === | ||
*Simple | |||
**Generalized tonic-clonic seizure | |||
**<15 min in duration | |||
**Age 6mo - 6yr | |||
**Occurs only once in 24hr period | |||
**No focal features | |||
*Complex | |||
**Any exception to above | |||
==Differential Diagnosis == | ==Differential Diagnosis == | ||
*[[Meningitis ]] | |||
**More likely if [[status epilepticus]] | |||
*[[Seizure]] due to identifiable cause (e.g. intracranial mass, trauma, ingestion) | |||
*Epidural/subdural infection or hematoma | |||
*Toxic Ingestion | |||
*Pyridoxine Responsive Seizure<ref>Baxter P. et al. Pyridoxine‐dependent and pyridoxine‐responsive seizures. Developmental Medicine & Child Neurology 2001, 43: 416–42</ref> | |||
== Work-Up == | == Work-Up == | ||
*Glucose in all pts | |||
*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: | |||
**Persistently abnormal neuro exam (esp w/ focality) | |||
**Signs/symptoms of increased ICP | |||
**pt has VP shunt | |||
*Routine EEG not indicated | |||
**Consider only if developmental delay or for focal symptoms | |||
== Treatment == | == Treatment == | ||
*Treat if initial seizure persists >5 min or for subsequent seizures | |||
**[[Benzodiazepines]] | |||
***[[Lorazepam]] 0.1mg/kg IV | |||
***[[Diazepam]] 0.2 mg/kg IV or 0.5 mg/kg PR (choice if difficult or no access) | |||
***[[Midazolam]] 0.1 mg/kg IV or IM or IN | |||
****If persists try one additional dose (risk of resp. depression incr if >2 doses) | |||
**[[Fosphenytoin]] (15-20 mg PE/kg IV) or [[Phenytoin]] (10-20 mg/kg IV up to 1g @ 1mg/kg/min) | |||
***Treat if seizure persists despite benzo treatment | |||
***Onset of action may take as long as 30 minutes | |||
***Can cause [[hypotension]] and [[dysrhythmias]] | |||
**[[Barbituates]] | |||
***[[Phenobarbital]] 15-20 mg/kg IV | |||
***Consider only if benzos and phenytoin have failed | |||
***May lead to respiratory depression, especially when preceded by a benzo | |||
**[[Valproic acid]] 10-15 mg/kg IV (20 mg/min) | |||
***Has been shown to be effective when benzos, phenytoin, and barbituates have failed | |||
***Can be used as 2nd or 3rd-line treatment | |||
**[[Keppra]] 20 mg/kg IVP | |||
**[[Propofol]] 2-3 mg/kg IVP; maintenance 0.125-0.3 mg/kg/min IV | |||
**Consider [[Pyridoxine]] (vitamin B6) 1g per g of INH ingested (in D5W IV over 30 min) | |||
**Consider Pyridoxine Responsive Seizure Disorder - 100mg/pyridoxine is generally effective<ref>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</ref> | Childhood.1983 (58) 415-418. http://adc.bmj.com/content/58/6/415.full.pdf</ref> | ||
*Treat underlying infection | |||
== Disposition == | == Disposition == | ||
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== See Also == | == See Also == | ||
*[[Seizure]] | *[[Seizure]] | ||
*[[Fever (Peds)]] | *[[Fever (Peds)]] | ||
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<references/> | <references/> | ||
[[Category:Peds]][[Category:Neuro]] | [[Category:Peds]] | ||
[[Category:Neuro]] |
Revision as of 14:53, 1 May 2015
Background
- 2-3% chance of developing epilepsy (1% for general population)
- 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
- Simple
- Generalized tonic-clonic seizure
- <15 min in duration
- Age 6mo - 6yr
- Occurs only once in 24hr period
- No focal features
- Complex
- Any exception to above
Differential Diagnosis
- Meningitis
- More likely if status epilepticus
- Seizure due to identifiable cause (e.g. intracranial mass, trauma, ingestion)
- Epidural/subdural infection or hematoma
- Toxic Ingestion
- Pyridoxine Responsive Seizure[1]
Work-Up
- Glucose in all pts
- Simple febrile seizure
- Neither labs nor neuroimaging are absolutely necessary
- Normal pediatric fever workup
- Complex febrile seizure
- Consider CBC, blood cx, UA, Ucx, CSF studies
- Consider CT if:
- Persistently abnormal neuro exam (esp w/ focality)
- Signs/symptoms of increased ICP
- pt has VP shunt
- Routine EEG not indicated
- Consider only if developmental delay or for focal symptoms
Treatment
- Treat if initial seizure persists >5 min or for subsequent seizures
- Benzodiazepines
- Fosphenytoin (15-20 mg PE/kg IV) or Phenytoin (10-20 mg/kg IV up to 1g @ 1mg/kg/min)
- Treat if seizure persists despite benzo treatment
- Onset of action may take as long as 30 minutes
- Can cause hypotension and dysrhythmias
- Barbituates
- Phenobarbital 15-20 mg/kg IV
- Consider only if benzos and phenytoin have failed
- May lead to respiratory depression, especially when preceded by a benzo
- Valproic acid 10-15 mg/kg IV (20 mg/min)
- Has been shown to be effective when benzos, phenytoin, and barbituates have failed
- Can be used as 2nd or 3rd-line treatment
- Keppra 20 mg/kg IVP
- Propofol 2-3 mg/kg IVP; maintenance 0.125-0.3 mg/kg/min IV
- Consider Pyridoxine (vitamin B6) 1g per g of INH ingested (in D5W IV over 30 min)
- Consider Pyridoxine Responsive Seizure Disorder - 100mg/pyridoxine is generally effective[2]
- Treat underlying infection
Disposition
- 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
- Simple febrile seizure if pt at baseline
- Admit:
- Ill-appearing
- Lethargy beyond postictal period
See Also
Source
- ↑ Baxter P. et al. Pyridoxine‐dependent and pyridoxine‐responsive seizures. Developmental Medicine & Child Neurology 2001, 43: 416–42
- ↑ 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