Febrile seizure: Difference between revisions
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== Background | ==Background== | ||
* | *Occur in 2-5% of American children before age 5<ref>https://www.ninds.nih.gov/disorders/patient-caregiver-education/fact-sheets/febrile-seizures-fact-sheet</ref> | ||
*50% of | *50% of patients never have temperature >39 | ||
* | *Febrile seizures do not increase the risk of serious bacterial illness | ||
=== | ===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 Features== | ||
*[[Seizure]] + [[fever]] | |||
== | ===Simple Febrile Seizure=== | ||
*Age 6mo-5yr, with majority occurring between 12mo-18mo | |||
*Single seizure in 24hr | |||
*Duration <15min | |||
*Generalized with no focal features | |||
*Returns to neurologic baseline and has normal neuro exam after brief post-ictal period | |||
== | ===Complex Febrile Seizure=== | ||
*Any exception to above | |||
*May indicate more serious disease process | |||
== | ==Differential Diagnosis== | ||
{{Pediatric seizure DDX}} | |||
{{Pediatric fever DDX}} | |||
*[[Seizure]] | ==Evaluation== | ||
*The key is to distinguish between simple febrile seizure secondary to minor illness vs. seizure from serious central nervous system infection, which may also present with fever and seizure. | |||
*Glucose in all patients | |||
====Simple febrile seizure==== | |||
*Neither labs nor neuroimaging are absolutely necessary | |||
*Normal [[Fever (Peds)|pediatric fever workup]] | |||
====Complex febrile seizure==== | |||
*Consider CBC, [[blood culture]], UA, urine culture, [[CSF studies]] | |||
*Consider CT if: | |||
**Persistently abnormal neuro exam (especially with focality) | |||
**Signs/symptoms of [[increased ICP]] | |||
**Patient has [[VP shunt]] | |||
*Consider [[ECG]] if: | |||
**Family history of [[long QT]], [[Brugada]], sudden death | |||
*Routine EEG not indicated | |||
**Consider only if developmental delay or for focal symptoms | |||
*Causes amenable to specific treatment | |||
**[[Hypoglycemia]] | |||
**[[Hyponatremia]] (water intoxication, dilution of formula) | |||
**[[Hypocalcemia]] | |||
**[[Hypomagnesemia]] | |||
**[[INH ingestion]] | |||
[[File:Febrile Seizure.png|thumb|Algorithm for the differentiation between simple and complex febrile seizures. Guidelines for evaluation of each.]] | |||
==Management== | |||
{{Initial management of pediatric status epilepticus}} | |||
===Seizure Stopped=== | |||
*Treat underlying infection if indicated | |||
**See [[pediatric fever of uncertain source]] | |||
==Disposition== | |||
===Discharge=== | |||
*Simple febrile seizure if patient at baseline | |||
**Follow-up in 1-2d | |||
**Around-the-clock [[acetaminophen]] may prevent seizure recurrence in the same febrile episode<ref>Murata et al. Acetaminophen and Febrile Seizure Recurrences During the Same Fever Episode. Pediatrics. November 2018, VOLUME 142 / ISSUE 5</ref> | |||
*Complex febrile seizure if patient well-appearing, work-up normal | |||
**Follow-up in 24hr | |||
===Admit=== | |||
*Ill-appearing | |||
*Lethargy beyond postictal period | |||
==See Also== | |||
*[[Seizure (peds)]] | |||
*[[Fever (Peds)]] | *[[Fever (Peds)]] | ||
== | ==References== | ||
<references/> | <references/> | ||
[[Category: | [[Category:Pediatrics]] | ||
[[Category:Neurology]] |
Latest revision as of 23:48, 11 March 2021
Background
- Occur in 2-5% of American children before age 5[1]
- 50% of patients never have temperature >39
- Febrile seizures do not increase the risk of serious bacterial illness
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 Features
Simple Febrile Seizure
- Age 6mo-5yr, with majority occurring between 12mo-18mo
- Single seizure in 24hr
- Duration <15min
- Generalized with no focal features
- Returns to neurologic baseline and has normal neuro exam after brief post-ictal period
Complex Febrile Seizure
- Any exception to above
- May indicate more serious disease process
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
- Febrile seizure
- Brain inflammation
- Increased ICP
- Seizure with VP shunt
- Hydrocephalus
- Intracranial mass
- Toxicologic
- Metabolic abnormalities: hyponatremia, hypernatremia, hypocalcemia, hypomagnesemia, hypoglycemia, hyperglycemia
- Pyridoxine responsive seizure[2]
- Eclampsia
- Posterior reversible encephalopathy syndrome
- Impact seizure (head trauma)
- Other mimics
- Psychogenic nonepileptic seizure (pseudoseizure)
- Syncope (peds)
- Breath-holding spell
- Hyperventilation syndrome
- Migraine headache
- Movement disorders
- Narcolepsy/cataplexy
- Post-hypoxic myoclonus (Status myoclonicus)
- Infantile 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
Evaluation
- The key is to distinguish between simple febrile seizure secondary to minor illness vs. seizure from serious central nervous system infection, which may also present with fever and seizure.
- Glucose in all patients
Simple febrile seizure
- Neither labs nor neuroimaging are absolutely necessary
- Normal pediatric fever workup
Complex febrile seizure
- Consider CBC, blood culture, UA, urine culture, CSF studies
- Consider CT if:
- Persistently abnormal neuro exam (especially with focality)
- Signs/symptoms of increased ICP
- Patient has VP shunt
- Consider ECG if:
- Routine EEG not indicated
- Consider only if developmental delay or for focal symptoms
- Causes amenable to specific treatment
- Hypoglycemia
- Hyponatremia (water intoxication, dilution of formula)
- Hypocalcemia
- Hypomagnesemia
- INH ingestion
Management
Initial management of pediatric status epilepticus
Timeline | General Considerations | Seizure Treatment |
0-5 minutes |
|
|
5-10 minutes |
|
|
10-15 minutes |
|
|
15-30 minutes |
|
|
>30 minutes |
|
|
^May be ineffective for toxin-induced seizures and contraindicated in cocaine toxicity
Seizure Stopped
- Treat underlying infection if indicated
Disposition
Discharge
- Simple febrile seizure if patient at baseline
- Follow-up in 1-2d
- Around-the-clock acetaminophen may prevent seizure recurrence in the same febrile episode[3]
- Complex febrile seizure if patient well-appearing, work-up normal
- Follow-up in 24hr
Admit
- Ill-appearing
- Lethargy beyond postictal period
See Also
References
- ↑ https://www.ninds.nih.gov/disorders/patient-caregiver-education/fact-sheets/febrile-seizures-fact-sheet
- ↑ Baxter P. et al. Pyridoxine‐dependent and pyridoxine‐responsive seizures. Developmental Medicine & Child Neurology 2001, 43: 416–42
- ↑ Murata et al. Acetaminophen and Febrile Seizure Recurrences During the Same Fever Episode. Pediatrics. November 2018, VOLUME 142 / ISSUE 5