Difference between revisions of "Febrile seizure"

(Differential Diagnosis)
Line 1: Line 1:
 
== Background  ==
 
== Background  ==
*2-3% chance of developing epilepsy (1% for general population)
 
 
*50% of pts never have temp >39
 
*50% of pts never have temp >39
*50% of pts <12 mo will have another simple febrile seizure
+
*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>
*30% of pts &gt;12 mo will have another simple febrile seizure
 
  
 
==Clinical Presentation==
 
==Clinical Presentation==
Line 38: Line 36:
 
**Consider only if developmental delay or for focal symptoms
 
**Consider only if developmental delay or for focal symptoms
  
== Treatment  ==
+
== Management ==
 
===Ongoing Seizure===
 
===Ongoing Seizure===
 
See [[Seizure (peds)]]
 
See [[Seizure (peds)]]
Line 54: Line 52:
 
**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 &lt;12 mo will have another simple febrile seizure
 +
*30% of pts &gt;12 mo will have another simple febrile seizure
  
 
== See Also  ==
 
== See Also  ==
Line 59: Line 61:
 
*[[Fever (Peds)]]
 
*[[Fever (Peds)]]
  
== Source  ==
+
== References ==
 
<references/>
 
<references/>
  
 
[[Category:Peds]]
 
[[Category:Peds]]
 
[[Category:Neuro]]
 
[[Category:Neuro]]

Revision as of 13:59, 13 June 2015

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

Pediatric fever

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
  • 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
  • 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

  1. 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.
  2. Baxter P. et al. Pyridoxine‐dependent and pyridoxine‐responsive seizures. Developmental Medicine & Child Neurology 2001, 43: 416–42