Febrile convulsions

Question 1

definition

Answer 1

a simple tonic-clonic, symmetrical generalised seizure lasting <15mins (complex febrile seizures can last >15mins)
occurs as temp rises, usually in febrile illness
typically in a normally developing child, 0.5-6yo

approx 3% of children will have at least one febrile seizure

Question 2

DDx

Answer 2

if focal CNS signs or CNS abnormality, PMH of epilepsy, >15mins, >1 attack in 24h, consider:
meningo-encephalitis
CNS lesion
epilepsy
trauma
hypoglycaemia
hypocalcaemia
decreased magnesium

Question 3

examination

Answer 3

find any infection
if neck stiffness, consider meningitis
if you suspect meningitis treat immediately, do not wait for LP etc

Question 4

Rx

Answer 4

put in recovery position
if fit last longer than 5 mins - lorazepam IV, buccal midazolam or diazepam
paracetamol syrup
consider FBC, U&E, calcium, glucose, MSU, CXR, ENT swabs

Question 5

parental education

Answer 5

allay fear (child is not dying during a fit)
not usually (<3%) linked to an increased risk of epilepsy
in the 50% who will have recurrences, advise care givers to give anti-pyretics early in febrile illness
if convulsions last longer than 10mins, treat as status epilepticus

Question 6

further prevention

Answer 6

poor evidence to support measures to prevent febrile seizures
prompt anti-pyretics, but this will not necessarily avois another seizure
keep buccal midazolam to hand if needed

Question 7

prognosis

Answer 7

in typical febrile convulsions there is no progress to epilepsy
risk is much higher if pre-existing CNS abnormality (50%), epilepsy in a first degree relative or complex febrile seizures