Febrile Seizures

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

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

Investigations

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