Febrile Convulsions Flashcards
Febrile convulsions?
Febrile convulsions are a type of seizure that occurs in children with a high fever. They are not caused by epilepsy or other underlying neurological pathology, such as meningitis or tumours. By definition, febrile convulsions occur only in children between the ages of 6 months and 5 years.
Simple vs complex febrile convulsions?
Simple febrile convulsions are generalised, tonic clonic seizures. They last less than 15 minutes and only occur once during a single febrile illness.
Febrile convulsions can be described as complex when they consist of partial or focal seizures, last more than 15 minutes or occur multiple times during the same febrile illness.
How are febrile convulsions diagnosed?
In order the make a diagnosis of a febrile convulsion, other neurological pathology must be excluded. The differential diagnoses of a febrile convulsion are:
Epilepsy
Meningitis, encephalitis or another neurological infection such as cerebral malaria
Intracranial space occupying lesions, for example brain tumours or intracranial haemorrhage
Syncopal episode
Electrolyte abnormalities
Trauma (always think about non accidental injury)
A typical presentation is a child around 18 months of age presenting with a 2 – 5 minute tonic clonic seizure during a high fever. The fever is usually caused by an underlying viral illness or bacterial infection such as tonsillitis. Once a diagnosis of a febrile convulsion has been made, look for the underlying source of infection.
Management of febrile convulsions?
In the febrile child the first stage is to identify and manage the underlying source of infection and control the fever with simple analgesia such as paracetamol and ibuprofen. Simple febrile convulsions do not require further investigations and parents can be reassured and educated about the condition. Complex febrile convulsions may need further investigation.
Give parents advice on managing a seizure if a further episode occurs:
Stay with the child
Put the child in a safe place, for example on a carpeted floor with a pillow under their head
Place them in the recovery position and away from potential sources of injury
Don’t put anything in their mouth
Call an ambulance if the seizure lasts more than 5 minutes
The first seizure should always result in a trip to hospital for assessment, however if parents are confident in subsequent events and can safely manage the child at home then they can visit their GP at the next available opportunity.
Prognosis for febrile convulsions?
Febrile convulsions do not typically cause any lasting damage. One in three will have another febrile convulsion. The risk of developing epilepsy is:
1.8% for the general population
2-7.5% after a simple febrile convulsion
10-20% after a complex febrile convulsion
When should parents be advised to call an ambulance for febrile convulsions?
Parents should be advised to call an ambulance if a febrile convulsion lasts >5 minutes
