Febrile convulsions

Question 1

Febrile seizures - background

Answer 1

1. Definition = seizure accompanied by fever in the absence of intracranial infection due to bacterial meningitis or viral encephalitis
2. Epi = 4% of children, generally between ages of 6mo and 6y
3. Temp may be above 39 deg C, but may have become normal by the time it is measured. Seizure tends to occur during the first day of fever
4. Vast majority harmless. Not considered as epilepsy. Recurrence risk 35% over lifetime, 25% during next 12mo. 95-98% of children who have had a febrile seizure do not go on to develop epilepsy
5. Children who have febrile seizures that are lengthy, affect only part of the body, recur within 24h or have neurological abnormalities have a higher incidence of subsequent epilepsy

Question 2

Febrile seizures - classification (2)

Answer 2

1. Simple (typical) = generalised tonic-clonic activity lasting 15 mins, or multiple seizures within a day. 15% of cases

Note - convulsive seizures that occur in a child with no neurological problems, in the context of an intercurrent infection, even without a recorded fever, are normally classified as febrile

Question 3

Febrile seizures - mx

Answer 3

1. Move danger away from child. Place child on protected surface on side. Note the time
2. Call ambulance
3. If seizure lasts >5 min, use midazolam 0.2-0.3mg/kg (up to 10mg) buccally or intranasally, repeat once 15 mins later if seizure continues. Or use diazepam 0.3-0.5mg/kg (up to 10mg) rectally, repeat once 15 mins later if seizure continues
4. Consider meningitis if child shows symptoms of stiff neck, extreme lethargy >4hrs post-seizure, abundant vomiting or if they are