Febrile Convulsions

Question 1

What is the definition of a febrile convulsion?

Answer 1

A febrile convulsion is a convulsion, in a child between 6 months and 6 years, in the setting of an acute febrile illness, without previous afebrile seizures, without significant prior neurological abnormality and no CNS infection. They occur in 3% of children and are themselves benign.

Question 2

What are the different types of febrile convulsions?

Answer 2

Simple Febrile Convulsions
Complex Febrile Convulsions.
Febrile Status Epilepticus

Question 3

What is a simple febrile convulsion? What is a complex febrile convulsion?

Answer 3

Simple febrile convulsions are generalised, tonic-clonic seizures lasting less than 15 minutes that do not recur within the same febrile illness.

Complex febrile convulsions have one or more of the following:

• focal features at onset or during the serizure
• duration of more than 15 mins
• recurrence within the same febrile illness
• incomplete recovery within 1 hour

Febrile Status Epilepticus: febrile convulsion lasting for more than 30 mins

Question 4

What are the main points in the management of a child with a simple febrile convulsion?

Answer 4

Reassurance, especially in the setting of a simple febrile convulsion, is critical. Along with an appropriate assessment and subsequent ruling out of all serious infections and other diseases, assess the cause of the fever.

Question 5

What does paracetamol do? Does it help with febrile convulsions?

Answer 5

Paracetamol works to reduce pain and fever. It has not been shown to reduce the chance of febrile convulsions even though it does reduce the fever and the pain in infections such as AOM. Hence, parents should be advised that paracetamol, while easing the discomfort and pain and bringing down the fever doesn’t necessarily reduce the chance of a febrile convulsion.

Question 6

How do you investigate a child who has had a febrile convulsion?

Answer 6

Do not investigate a child who has had a simple febrile convulsion. Unless worried about a more serious infection or following a complex febrile seizure, no blood tests or invasive investigations are indicated.

Question 7

If the child is below 6 months, do you need to consider an alternative diagnosis? What is this alternative diagnosis and how would you go about investigating this child if there is suspicion?

Answer 7

If the child is under 6 months of age, reconsider diagnosis especially the possibility of a CNS infection (meningitis). So it may be worth conducting an LP with increased suspicion of this if immunisations are not up to date.

Question 8

What are the requirements for the discharge of a child who has had a febrile convulsion?

Answer 8

Ensure that the child has returned to a normal neurological state.
Rule out/Treat any serious bacterial illness
Educate/Reassure the parents regarding febrile convulsions and how to manage them.

Question 9

What are the risk factors which increase the chance of a child who had a febrile convulsion having another one?

Answer 9

The younger the child at the time of the initial convulsion, the greater the risk of a further febrile convulsion. (1 year old – 50%, 2 year old – 30%)

Question 10

What factors predispose an individual who had a febrile convulsion to developing epilepsy? What is the risk of a child developing epilepsy following a febrile convulsion with the various risk factors?

Answer 10

RFs – FHx of epilepsy, any neurodevelopmental problem, atypical febrile convulsions (prolonged or focal).
No RFs – 1%
1 RF – 2%
More than 1 RF – 10%