Difference between revisions of "Febrile seizure"

(add ECG consideration)
(Work-Up)
Line 28: Line 28:
 
===Work-Up===
 
===Work-Up===
 
*Glucose in all patients  
 
*Glucose in all patients  
*Simple febrile seizure  
+
 
**Neither labs nor neuroimaging are absolutely necessary
+
====Simple febrile seizure====
**Normal [[Fever (Peds)|pediatric fever workup]]
+
*Neither labs nor neuroimaging are absolutely necessary
*Complex febrile seizure  
+
*Normal [[Fever (Peds)|pediatric fever workup]]
**Consider CBC, blood cx, UA, Ucx, CSF studies
+
 
 +
====Complex febrile seizure====
 +
*Consider CBC, [[blood culture]], UA, Ucx, [[CSF studies]]
 
*Consider CT if:  
 
*Consider CT if:  
**Persistently abnormal neuro exam (esp w/ focality)  
+
**Persistently abnormal neuro exam (especially with focality)  
**Signs/symptoms of increased ICP  
+
**Signs/symptoms of [[increased ICP]]
**Pt has VP shunt
+
**Patient has [[VP shunt]]
*Consider ECG if:
+
*Consider [[ECG]] if:
**Family Hx of long QT, Brugada, sudden death
+
**Family history of [[long QT]], [[Brugada]], sudden death
 
*Routine EEG not indicated  
 
*Routine EEG not indicated  
 
**Consider only if developmental delay or for focal symptoms
 
**Consider only if developmental delay or for focal symptoms
*Causes amenable to specific Tx
+
*Causes amenable to specific treatment
**Hypoglycemia
+
**[[Hypoglycemia]]
**Hyponatremia (water intoxication, dilution of formula)
+
**[[Hyponatremia]] (water intoxication, dilution of formula)
**Hypocalcemia
+
**[[Hypocalcemia]]
**Hypomagnesemia
+
**[[Hypomagnesemia]]
**INH ingestion
+
**[[INH ingestion]]
  
 
==Management==
 
==Management==

Revision as of 15:23, 6 July 2016

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

Pediatric fever

Diagnosis

Simple versus Complex

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

Work-Up

  • Glucose in all patients

Simple febrile seizure

Complex febrile seizure

Management

Ongoing Seizure

See Seizure (peds)

Seizure Stopped

Disposition

Discharge

  • Simple febrile seizure if patient at baseline
    • Follow-up in 1-2d
  • Complex febrile seizure if patient well-appearing, work-up normal
    • Follow-up in 24hr

Admit

  • Ill-appearing
  • Lethargy beyond postictal period

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