Febrile seizure

Revision as of 06:24, 6 July 2016 by Kyoung (talk | contribs) (add ECG consideration)


  • 50% of patients never have temp >39
  • Antipyretics do not offer significant improvements in recurrence rates of febrile seizures[1]


  • 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


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


  • Glucose in all patients
  • 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
  • Consider ECG if:
    • Family Hx of long QT, Brugada, sudden death
  • 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


Ongoing Seizure

See Seizure (peds)

Seizure Stopped



  • 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


  • Ill-appearing
  • Lethargy beyond postictal period

See Also


  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