Difference between revisions of "Febrile seizure"
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== Background == | == Background == | ||
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*50% of pts never have temp >39 | *50% of pts never have temp >39 | ||
| − | * | + | *Antipyretics do not offer singificant 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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==Clinical Presentation== | ==Clinical Presentation== | ||
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**Consider only if developmental delay or for focal symptoms | **Consider only if developmental delay or for focal symptoms | ||
| − | == | + | == Management == |
===Ongoing Seizure=== | ===Ongoing Seizure=== | ||
See [[Seizure (peds)]] | See [[Seizure (peds)]] | ||
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**Ill-appearing | **Ill-appearing | ||
**Lethargy beyond postictal period | **Lethargy beyond postictal period | ||
| + | ===Prognosis=== | ||
| + | *2-3% chance of developing epilepsy (1% for general population) | ||
| + | *50% of pts <12 mo will have another simple febrile seizure | ||
| + | *30% of pts >12 mo will have another simple febrile seizure | ||
== See Also == | == See Also == | ||
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*[[Fever (Peds)]] | *[[Fever (Peds)]] | ||
| − | == | + | == References == |
<references/> | <references/> | ||
[[Category:Peds]] | [[Category:Peds]] | ||
[[Category:Neuro]] | [[Category:Neuro]] | ||
Revision as of 13:59, 13 June 2015
Contents
Background
- 50% of pts never have temp >39
- Antipyretics do not offer singificant improvements in recurrence rates of febrile seizures[1]
Clinical Presentation
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
Diagnosis
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
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
Management
Ongoing Seizure
See Seizure (peds)
Seizure Stopped
- Treat underlying infection if indicated
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
Prognosis
- 2-3% chance of developing epilepsy (1% for general population)
- 50% of pts <12 mo will have another simple febrile seizure
- 30% of pts >12 mo will have another simple febrile seizure
See Also
References
- ↑ 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.
- ↑ Baxter P. et al. Pyridoxine‐dependent and pyridoxine‐responsive seizures. Developmental Medicine & Child Neurology 2001, 43: 416–42