Febrile convulsion Flashcards
Most common cause of seizure in children
Febrile convulsion
Age group affected
6 months to 6 years
Clinical presentation
Short duration 1 minute - 5 minute
Generalised tonic clonic with short post ictal state
Often associated with fever and family history
No evidence of CNS infection/inflammation before or after
No history of non-febrile seizures
Are most febrile seizures simple or complex
70-80% are simple
Compare duration, seizure type, recurrence, neurological impairment
Simple are short duration (95% 15 minutes, focal onset/focal features during seizure, >1 in 24 hours, previous neurological impairment or neurological deficit after
Investigations
To find source of infection, as per febrile child guidelines
Definition
Convulsions, in a child between 6 months and 6 years of age, in the setting of an acute febrile illness, without previous afebrile seizures, significant prior neurological abnormality, and no CNS infection.
Is paracetamol used to control fever and risk of febrile convulsions
Paracetamol has NOT been shown to reduce the risk of further febrile convulsions. It may be used for pain / discomfort associated with febrile illnesses such as otitis media. The parents should understand the reasons for its use and be discouraged from using it solely to reduce their child’s fever.
Consultation with paediatrics indicated
Complex
Unable to control seizure
Child does not return to normal mental state within an hour
Child is clinically unwell
Ongoing concern regarding the nature of the febrile illness
Discharge requirements
Discharge requirements:
- Return to normal neurological state following simple febrile convulsion
- Serious bacterial infection excluded or adequately treated
- Parental education regarding febrile convulsions
Key points for parents regarding long term issues with febrile convulsion- risk of recurrence, risk of epilepsy, anticonvulsants and review appointment
Long term issues with febrile convulsions.
- Recurrence: The younger the child at the time of the initial convulsion, the greater the risk a further febrile convulsion (1 year old 50%; 2 years old 30%).
- Risk of future afebrile convulsions (epilepsy) is increased by family history of epilepsy, any neurodevelopmental problem, atypical febrile convulsions (prolonged or focal).
- ->No risk factors: risk of subsequent epilepsy approx. 1% (similar to population risk).
- ->1 risk factor: 2%.
- ->More than 1 risk factor: 10%. - Long term anticonvulsants are not indicated except in rare situations with frequent recurrences.
- It may be appropriate to offer a review appointment with a general paediatrician, especially in the case of complex febrile convulsions.
If my child has a febrile convulsion, does that mean they have epilepsy?
No. Febrile convulsions are fits or seizures that occur only with a fever. Children with epilepsy have repeated seizures without fever. Most children who experience febrile convulsion only ever have one. Some may have one or more febrile convulsions during future febrile illnesses, however, a febrile convulsion will not necessarily occur every time the child has a fever. Children who have infrequent febrile convulsions do not have an increased risk of epilepsy.
Do febrile convulsions cause brain damage?
No. No matter how dramatic and frightening febrile convulsions may look, they do not cause brain damage. Even very long convulsions lasting an hour or more almost never cause any harm.
If my child has one febrile convulsion, will it happen again?
About one in three children will have more febrile convulsions with future febrile illnesses. Even if your child has many febrile convulsions, it still does not mean they have epilepsy. Your child will outgrow the tendency to have febrile convulsions when they are about four or five years old. If your child has experienced a febrile convulsion, it is important for you to learn what to do if your child does have another.
Once the convulsion is over, does my child need special treatment?
Your child may be a bit cranky for a day or so, but this will pass. Carry on with your usual routines. Put your child to sleep at the usual time, in their own bed. Don’t worry about whether you will hear a convulsion - your child will be safe in a bed or cot. It is recommended that your child sees a doctor to find out the cause of the fever that has caused the febrile convulsion.
