Febrile seizure

Background

• 2-3% chance of developing epilepsy (1% for general population)
• 50% of pts never have temp >39
• 50% of pts <12 mo will have another simple febrile seizure
• 30% of pts >12 mo will have another simple febrile seizure

Clinical Presentation

• Seizure + fever

Differential Diagnosis

• Meningitis
  • More likely if status epilepticus
• Seizure due to identifiable cause (e.g. intracranial mass, trauma, ingestion)
• Epidural/subdural infection or hematoma
• Toxic Ingestion
• Pyridoxine Responsive Seizure

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

Treatment

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

• Seizure
• Fever (Peds)