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    Febrile Seizures: Benilda C. Sanchez-Gan, MD

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    Febrile seizures are seizures that occur in young children between 3 months and 6 years of age when they have a fever over 38°C but no serious underlying conditions. They are classified as simple or complex depending on features like duration, recurrence, and postictal abnormalities. While the risk of future epilepsy is low, evaluation may include lumbar puncture in young infants and treatment focuses on stopping ongoing seizures and intermittent prophylaxis with diazepam during fevers to reduce recurrence risk.

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    Febrile Seizures: Benilda C. Sanchez-Gan, MD

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    Febrile seizures are seizures that occur in young children between 3 months and 6 years of age when they have a fever over 38°C but no serious underlying conditions. They are classified as simple or complex depending on features like duration, recurrence, and postictal abnormalities. While the risk of future epilepsy is low, evaluation may include lumbar puncture in young infants and treatment focuses on stopping ongoing seizures and intermittent prophylaxis with diazepam during fevers to reduce recurrence risk.

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    FEBRILE SEIZURES

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    Febrile seizures are seizures that occur in young children between 3 months and 6 years of age when they have a fever over 38°C but no serious underlying conditions. They are classified as simple or complex depending on features like duration, recurrence, and postictal abnormalities. While the risk of future epilepsy is low, evaluation may include lumbar puncture in young infants and treatment focuses on stopping ongoing seizures and intermittent prophylaxis with diazepam during fevers to reduce recurrence risk.

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    © All Rights Reserved
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    Download as pdf or txt
    48 views17 pages

    Febrile Seizures: Benilda C. Sanchez-Gan, MD

    Uploaded by

    LM N/A
    Febrile seizures are seizures that occur in young children between 3 months and 6 years of age when they have a fever over 38°C but no serious underlying conditions. They are classified as simple or complex depending on features like duration, recurrence, and postictal abnormalities. While the risk of future epilepsy is low, evaluation may include lumbar puncture in young infants and treatment focuses on stopping ongoing seizures and intermittent prophylaxis with diazepam during fevers to reduce recurrence risk.

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    of 17

    FEBRILE SEIZURES

    Benilda C. Sanchez-Gan, MD
    Departments of Pediatrics and Neurosciences
    College of Medicine – Philippine General Hospital
    University of the Philippines Manila
    What are Febrile Seizures?

     Seizure events
    – In neurologically healthy infants and children
    – Age between 3 months to 6 years (6mos-5yrs
    in some literature)
    – With fever > 38 C
    – No intracranial infection
    – No other definable cause
    – No prior history of afebrile seizures

    Knudsen FU. Epilepsia 2000


    Incidence and Types
     Incidence
    • 2-5% of all children
     Types
    • Simple
    • Complex
    • Febrile myoclonus
    • Febrile status epilepticus
    • Febrile seizure plus
    Knudsen FU, Epilepsia 2000
    Subcommittee on febrile seizures, AAP, Pediatrics, 2011
    Simple Febrile Seizures

     Generalized seizures (tonic, clonic, tonic-


    clonic, rarely atonic)
     Duration < 15 minutes
     Not recurring within 24 hours
     No postictal abnormalities (including
    Todd’s paralysis)

    Knudsen FU. Epilepsia 2000


    Complex Febrile Seizures
     Also called complicated
     Focal features
     Prolonged duration (>15 minute)
     Recurrent within 24 hours
     Associated with postictal neurologic
    abnormalities (including Todd’s paralysis)

    Knudsen FU. Epilepsia 2000


    Febrile Myoclonus

     Seizure type is myoclonus


     Usually associated with a family
    history of febrile seizures

    Seizures in Children, A Guide to Management, 5th edition, 2014


    Febrile Status Epilepticus

     Seizure duration > 30 minutes


     Series of short seizures without
    regaining consciousness interictally
    lasting 30 minutes or longer.
     Most seizures are convulsive and
    partial or have focal features.

    Seizures in Children, A Guide to Management, 5th edition, 2014


    Febrile Seizure Plus

     Refers to syndromes associated


    with:
    – Children who have febrile or afebrile
    seizures
    – Children who remain to have persistent
    febrile seizures beyond 7years of age
    Seizures in Children, A Guide to Management, 5th edition, 2014
    Short term outcome

     Excellent

     Only adverse outcome – recurrent


    febrile seizures

    Knudsen FU. Brain and Development 1996


    Evaluation of a Child with 1st Febrile
    Seizure – Lumbar Puncture (CNSP CPG)
     CSF analysis is not the test that confirms
    the diagnosis of febrile seizure per se

     CSF analysis is the gold standard for the


    alternative diagnosis of meningitis

     AGE plays a crucial role in decision to do


    lumbar puncture
    Evaluation of a Child with 1st Febrile
    Seizure (CNSP CPG)

     Lumbar Puncture
    – Infants < 18 months – LP must be
    strongly considered
    – Age > 18 months – LP is not
    routinely warranted, but should be
    done if meningeal signs are
    present
    Evaluation of a Child with 1st
    Febrile Seizures (CNSP CPG)
     EEG
    – Not recommended as a routine after 1st febrile seizure
    – No published study which shows that EEG can predict
    future epilepsy
     Blood studies
    – Not performed routinely
    – Done depending on clinical evaluation
     Neuroimaging
    – Not recommended routinely after 1st febrile seizure
    Acute/Immediate Treatment of
    Febrile Seizures
     To stop ongoing seizure
    – Drug of choice – IV benzodiazepines
    – Alternative – Rectal diazepam
    Safe, effective, easy to use
    Rapid absorption, plasma
    levels in 2-4 minutes
    – Others - Rectal Lorazepam
    - Nasal Midazolam
    - Buccal Midazolam
    – Antipyretics – Help to make child more
    comfortable
    Acute/Immediate Treatment of
    Febrile Seizures – Use of ADE’s
    The use of continuous anticonvulsants
    is not recommended in children after
    the first simple febrile seizure.
    Although anticonvulsants can reduce
    the recurrence of febrile seizures, the
    adverse side effects of these drugs
    do not warrant their use in this
    benign disorder. – CNSP CPG
    Short term Intermittent Prophylaxis

     Intermittent Diazepam during fever


    – Can reduce recurrence by one third
    (provided doses are optimal and
    compliance is ensured)

    Knudsen FU. Arch Dis Child 1985


    Short term Intermittent Prophylaxis

     Suggested dose of diazepam


    – 0.5mg/kg given orally or rectally every 12
    hours if rectal temp. > 38.5 C
    Maximum of 4 consecutive doses to avoid
    accumulation.
    – Adverse effects:
    Lethargy, drowsiness, ataxia
    – Duration of prophylaxis
    12-18 months after last seizure

    Knudsen FU. Brain and Development 1996

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