Febrile seizure

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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 pts <12 mo will have another simple febrile seizure
  • 30% of pts >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 - 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
  • Causes amenable to specific Tx
    • Hypoglycemia
    • Hyponatremia (water intoxication, dilution of formula)
    • Hypocalcemia
    • Hypomagnesemia
    • INH ingestion

Management

Ongoing Seizure

See Seizure (peds)

Seizure Stopped

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

  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