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    Febrile Seizures

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    mgonzalez_29
    Febrile seizures are the most common seizure type in childhood. They are divided into simple, complex, and symptomatic categories. Simple febrile seizures are brief and generalized, occur in children 6 months to 5 years old during a fever, and have no neurological abnormalities. Complex febrile seizures last longer than 15 minutes or are focal. Symptomatic febrile seizures occur due to an underlying illness or brain abnormality. While the cause is unknown, genetics play a role. Febrile seizures are generally benign and resolve without long-term anticonvulsant treatment.

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    Febrile Seizures

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    mgonzalez_29
    335 views4 pages
    Febrile seizures are the most common seizure type in childhood. They are divided into simple, complex, and symptomatic categories. Simple febrile seizures are brief and generalized, occur in children 6 months to 5 years old during a fever, and have no neurological abnormalities. Complex febrile seizures last longer than 15 minutes or are focal. Symptomatic febrile seizures occur due to an underlying illness or brain abnormality. While the cause is unknown, genetics play a role. Febrile seizures are generally benign and resolve without long-term anticonvulsant treatment.

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    Febrile seizures are the most common seizure type in childhood. They are divided into simple, complex, and symptomatic categories. Simple febrile seizures are brief and generalized, occur in children 6 months to 5 years old during a fever, and have no neurological abnormalities. Complex febrile seizures last longer than 15 minutes or are focal. Symptomatic febrile seizures occur due to an underlying illness or brain abnormality. While the cause is unknown, genetics play a role. Febrile seizures are generally benign and resolve without long-term anticonvulsant treatment.

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    335 views4 pages

    Febrile Seizures

    Uploaded by

    mgonzalez_29
    Febrile seizures are the most common seizure type in childhood. They are divided into simple, complex, and symptomatic categories. Simple febrile seizures are brief and generalized, occur in children 6 months to 5 years old during a fever, and have no neurological abnormalities. Complex febrile seizures last longer than 15 minutes or are focal. Symptomatic febrile seizures occur due to an underlying illness or brain abnormality. While the cause is unknown, genetics play a role. Febrile seizures are generally benign and resolve without long-term anticonvulsant treatment.

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    of 4

    Febrile Seizures

    Medscape

    Background

    Most common seizure disorder in childhood. Divided into: simple febrile seizures, complex febrile
    seizures, and symptomatic febrile seizures.

    Simple febrile seizure 70-75%

    - The setting is fever in a child aged 6 months to 5 years. Generalized < 15 minutes. But the
    postictal time may be sleepy.
    - NO other neurological abnormality.
    - Fever (and seizure) is not caused by meningitis, encephalitis, or other illness affecting the
    brain.

    Complex febrile seizure 20-25%

    - This seizure is either focal or prolonged (ie, >15 min), or multiple seizures occur in close
    succession.

    Symptomatic febrile seizure 5%

    - The child has a preexisting neurological abnormality or acute illness.

    Pathophysiology

    - Elevation of temperature. The underlying pathophysiology is unknown, but genetic


    predisposition clearly contributes to the occurrence of this disorder.1

    Frequency

    - Febrile seizures occur in 2-5% of children aged 6 months to 5 years in industrialized


    countries.

    Mortality/Morbidity

    - Previous simple febrile seizure → febrile seizures; in 1/3 of cases.


    - Children younger than 12 months at the time of their first simple febrile seizure have a
    50% probability of having a second seizure.
    - Children who have simple febrile seizures are at an increased risk for epilepsy. The rate is
    2.4%, about twice of general population.
    - Males have a slightly (but definite) higher incidence of febrile seizures.

    Clinical
    History

    - Seizure only with fever.

    - The seizure is described as either a generalized clonic or a generalized tonic-clonic seizure.

    o Signs of a focal seizure during the onset or in the postictal period (eg, initial clonic
    movements of 1 limb or of the limbs on 1 side, a weak limb postictally) would rule
    out a simple febrile seizure.

    - Simple febrile seizures often occur with the initial temperature elevation at the onset of
    illness. The seizure may be the first indication that the child is ill.

    Causes

    Simple febrile seizures are considered a genetic disorder, but neither a specific locus nor a specific
    pattern of inheritance has been described.

    Differential Diagnoses

    Acute Disseminated Encephalomyelitis Neonatal Seizures


    Acute Stroke Management Partial Epilepsies
    Anterior Circulation Stroke Posterior Cerebral Artery Stroke
    Aseptic Meningitis Seizures and Epilepsy: Overview and Classification
    Basilar Artery Thrombosis Simple Partial Seizures
    Benign Childhood Epilepsy Tonic-Clonic Seizures
    Complex Partial Seizures Viral Encephalitis
    First Seizure: Pediatric Perspective Viral Meningitis
    Meningococcal Meningitis
    Neonatal Meningitis

    Benign epilepsy syndromes.


    Brain abscess.
    Bacterial meningitis.
    Encephalitis.
    Epilepsy.

    Workup

    - No specific studies are indicated for a simple febrile seizure.


    - Physicians should focus on diagnosing the cause of fever.
    - Other laboratory tests may be indicated by the nature of the underlying febrile illness. For
    example, a child with severe diarrhea may benefit from blood studies for electrolytes.

    Imaging Studies
    Neither computed tomography (CT) nor magnetic resonance imaging (MRI) is indicated in patients
    with simple febrile seizures. EEG is not indicated in children with simple febrile seizures. Published
    studies demonstrate that the vast majority of these children have a normal EEG.

    Procedures

    - Strongly consider lumbar puncture in children younger than 12 months, because the signs
    and symptoms of bacterial meningitis may be minimal or absent in this age group.
    - Consider in children aged 12-18 months, and in > 18 months clinical judgment.

    Treatment

    On the basis of risk/benefit analysis, neither long-term nor intermittent anticonvulsant therapy is
    indicated for children who have experienced 1 or more simple febrile seizures.

    - Continuous therapy with phenobarbital or valproate they ↑ risks and adverse effects.
    - No evidence suggests that any therapy administered after a first simple seizure will reduce
    the risk of a subsequent afebrile seizure or the risk of recurrent afebrile seizures (ie,
    epilepsy).
    - < 2 years Phenobarbital because valproate is more hepatotoxic.
    - > 2 years valproate because Phenobarbital may alter neurodevelopment.
    - Oral diazepam can reduce the risk of subsequent febrile seizures. Because it is
    intermittent, this therapy probably has the fewest adverse effects. If preventing
    subsequent febrile seizures is essential, this would be the treatment of choice (IV or
    rectal). Midazolam is another option.
    - Antipyretic therapy is desirable.

    Diazepam (Diastat, Valium, Diazemuls) 0.33 mg/kg PO at onset of fever; continue q8h until child is
    afebrile.

    Can decrease number of subsequent febrile seizures when given with each febrile episode. By
    increasing activity of GABA, a major inhibitory neurotransmitter, depresses all levels of CNS,
    including limbic and reticular formation.
    A study reported in New England Journal of Medicine continued therapy until child was afebrile for
    24 h. However, this seems excessive.

    Follow-up

    Prognosis for normal neurologic function is excellent.

    - About one third of children who experience a single simple febrile seizure will have
    another.

    Patient Education

    - Inform parents that these dramatic events do not indicate future neurologic dysfunction
    or disease.
    - For excellent patient education resources, visit eMedicine's Brain and Nervous System
    Center. Also, see eMedicine's patient education articles Seizures and Fever and Seizures in
    Children.

    Miscellaneous

    Medicolegal Pitfalls

    Not recognizing bacterial meningitis or herpes simplex encephalitis and falsely diagnosing as a
    simple febrile seizure

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