Febrile Convulsion Flashcards
Define febrile convulsion
A seizure accompanied by fever (temperature higher than 38°C), without central nervous system infection, which occurs in infants and children aged 6 months to 5 years
What is the difference between a simple and complicated febrile convulsion
Simple = Isolated, generalised, tonic-clonic seizures lasting <15 minutes, that do not recur within 24 hours or within the same febrile illness, with complete recovery within 1 hour
Complex = One or more of the following features:
* Partial (focal) seizure (movement limited to one side of the body or one limb)
* Duration of more than 15 minutes
* Recurrence within 24h or within the same febrile illness
* Incomplete recovery within 1 hour
Define febrile status epilepticus
a febrile seizure that lasts for 30 minutes or longer, or there a series of seizures without full recovery in between that last for 30 minutes or longer
What is the aetiology of febrile convulsions
thought to be an age-dependent response of the immature brain to fever
Precipitant illness:
* Viral infection (80%)
○ Roseola infantum (sixth disease)
○ Influenza A
* Viral upper respiratory tract infections
* Otitis media
* Lower respiratory tract infection
* Urinary tract infection
* Gastroenteritis
* Post-immunisation (a febrile seizure is not a CI to further immunisation)
What are the risk factors for a febrile convulsion
Family history (sibling or parent)
Being at peak temperature
Zinc and iron deficiency
Male sex
Antenatal nicotine consumption
What are the symptoms of a febrile convulsion
6 months - 6 years old
Seizure (usually 2-3 minutes) involving a generalised tonic-clonic seizure OR twitching of the face OR rolling back of the eyes OR staring OR LOC
Fever >38
Foaming at the mouth
Difficulty breathing
Skin colour changes: pale, blue
Post-ictal drowsiness, irritability, confusion
Complete recovery within 1 hour
Complex: prolonged post-ictal period OR transient hemiparesis (Todd’s palsy)
What are the signs of febrile convulsion on examination
Normal post-itctally
Obs
Temperature after a seizure has ended (>38 is generally significant)
General
* Consciousness (AVPU, GCS)
* Dehydration: reduced skin turgor, prolonged CRT, sunken eyes, dry mucous membranes
Neurological
* Neurological deficit e.g. weakness in a hand, arm, or leg
* Normal neuro exam post-ictally
What are the differentials for a febrile seizure
Meningitis
Encephalitis
Breath holding spells
Head injury
Epilepsy
Rigors
Shivering
Syncope
What investigations should be done for febrile seizures
Investigations are not needed on initial presentation
May be needed to identify the source of infection:
Urine dip and MC&S
FBC, U&Es, CRP, blood cultures
LP, CXR< EEG
How are febrile convulsions managed
- Find the source of infection
- Cool the child down
a. Ibuprofen or paracetamol
b. Take off the layers of clothing
- Cool the child down
- First seizure → refer to first fit clinic
What would prompt urgent hospital assessment for a febrile convulsion
Suspected meningitis/encephalitis/sepsis/pneumonia
First presentation
<18 months
Complex seizure
Any focal neurological deficit
Recent ABx use
No focus of infection found
What advice should be given to parents for future febrile seizures
- Monitor seizure duration
- Protect the child from injury during the seizure:
- Cushioning their head with your hands or soft material
- Removing harmful objects away from the nearby or move the person away from immediate danger
- Do not restrain the child or put anything in their mouth.
- Consider undressing the child
- Can use a fan to cool them down
- Check the airway and place the child in the recovery position when the seizure has stopped.
- Observe the child until they have recovered.
- Examine for, and manage, any injuries
- Supportive: ibuprofen or paracetamol
What is the management for a tonic-clonic febrile convulsion lasting >5 minutes
Call emergency ambulance
Consider buccal midazolam or rectal diazepam (under specialist guidance)
Third line: IV phenytoin
What are the complications of a febrile convulsion
Parental/carer anxiety
Febrile status epilepticus (25% of SE in children, 5% of all febrile seizures)
May lead to hypoxia, brain injury, hippocampal abnormalities, temporal lobe epilepsy
Epilepsy (<10% risk), more likely if complex or FHx of epilepsy
Cognitive impairment - memory impairment for seizures >30 minutes
Increased risk of delayed language and vocabulary development
What is the prognosis for febrile convulsions
Benign with a normal cognitive outcome and normal growth and development
Usually self-limiting
One study found that 31.8% of children had recurrent seizures
