Difference between revisions of "Febrile seizure"
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===Prognosis=== | ===Prognosis=== | ||
*2-3% chance of developing epilepsy (1% for general population) | *2-3% chance of developing epilepsy (1% for general population) | ||
| − | *50% of | + | *50% of patients <12 mo will have another simple febrile seizure |
| − | *30% of | + | *30% of patients >12 mo will have another simple febrile seizure |
==Clinical Presentation== | ==Clinical Presentation== | ||
| Line 27: | Line 27: | ||
===Work-Up=== | ===Work-Up=== | ||
| − | *Glucose in all | + | *Glucose in all patients |
*Simple febrile seizure | *Simple febrile seizure | ||
**Neither labs nor neuroimaging are absolutely necessary | **Neither labs nor neuroimaging are absolutely necessary | ||
Revision as of 16:50, 21 June 2016
Contents
Background
- 50% of patients never have temp >39
- Antipyretics do not offer significant improvements in recurrence rates of febrile seizures[1]
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 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 patients
- 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
- Causes amenable to specific Tx
- Hypoglycemia
- Hyponatremia (water intoxication, dilution of formula)
- Hypocalcemia
- Hypomagnesemia
- INH ingestion
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
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