Definition
- Occur in 2-3% of children, following respiratory, GI or urinary tract infections
- Simple: single, brief (<15minutes), generalized during fever (>38) in developmentally and neurologically normal children between 6mo and 5yr without intracranial infection or other cause
- Complex: febrile seizure that lasts longer than 15 minutes, is focal or that recurs within 24hr
Differential diagnosis
- Eplilepsy
- CNS infection
- Anoxia/stroke/bleed
- Trauma
- Intoxication
- Metabolic encephalopathy
- Neurodegenerative disorder
- Brain tumor
- Neurocutaneous syndromes
- Previous brain injury
History
- Seizure: length, description
- Previous history of seizures (febrile or afebrile) – 1/3 of children with one simple febrile seizure will have another
- Precipitating factors: height and duration of fever, length and symptoms of preceding illness, head trauma, possibility of ingestion
- Past medical history: gestation, birth, general health, growth and development
- Risk factors: Family history, slow milestones, Roseola/Shigella, DTP and measles vaccinations, males>females
- Neurological findings: H/A, vomiting, lethargy, weakness, sensory deficits, change in vision/behaviour/balance/gait
Physical exam – rule out meningitis, look for focus of infection
- Vitals, head circumference
- HEENT (meningismus)
- Neurologic (papilledema)
- Standard physical exam
Investigations
- CBCD, lytes, Ca, glucose, toxicology
- Lumbar puncture (<18 months)
- EEG (once well, will be normal if typical… must do if atypical)
- MRI
Therapy
- Not indicated as only 1/3 will proceed to have another febrile seizure – majority of which will occur within 1 year of seizure
- Increased recurrence risk if complex, family history, low fever with seizure
- If typical no long-term adverse consequences
- Rarely lead to epilepsy or recurrent non-febrile seizures later in life (1-2.4%), increased risk compared to general population
- Anticonvulsants prophylaxis (underlying neurological condition)
- Anticonvulsants:
- Diazepam PO/PR
- For parents: antipyretics, first aid instructions, when to seek help (ER)
- No cold baths as they increase core body temperature