Febrile seizure

Question 1

A 16 month old boy has been brought to the emergency department after having a 2 minute seizure at home. He had been unwell with a fever, runny nose and cough for the last 12 hours. On arrival in the department he is becoming more alert. He has not had a seizure before and he is otherwise developmentally normal for his age.

Answer 1

Impression
Given the patients age, duration of ‘seizure’ and recent illness with fevers, this is most likely a febrile seizure.

simple vs complex febrile seizure

OF course, would want to thoroughly assess to rule out other potential causes of this presentation;
DDx
- Primary epilepsy syndrome
- Other organic: SOL, electrolyte derangement, infective
- Syncopal episode
- Dystonia
- Chills/rigors instead of seizure

Question 2

Febrile seizure - Assessment

Answer 2

Assessment
would approach this presentation with A to E assessment
- consult paeds if complex seizure
- treat emergently with status pathway if >5mins
- identify source of infection/fever and provide targeted treatment as appropriate

Question 3

Febrile seizure - History

Answer 3

History
- PC: seizure history (before, during, after), understand semiology (focal vs generalised, absent). What was patient like after? LOC? incontinence? Definitely a fever?
- infective sx: fevers, chills, rigors, drowsy, LOC, etc.
- Trigger: is there a focus of infection? Chest/urine/skin/GIT
- Features of meningism: neck rigidity, purpuric rash
- paeds history, known epilepsy, family history, developmental screen, details of pregnancy

Question 4

Febrile seizure - Examination

Answer 4

Examination
- General appearance
- Vitals
- Neuro exam: pupils, tone, focal deficits
- systems review, looking for focal features of infection

Question 5

Febrile seizure - Investigations

Answer 5

Investigations
No investigations are indicated if it is an uncomplicated febrile seizure in <6mnths and a clear focus/source of infection.

Key investigations:
- LP for ?meningitis
- septic screen
- MRI Brain if complex seizure

Question 6

Febrile seizure - Management

Answer 6

Management
Supportive
- If simple febrile seizure, does not require admission
- Parent counselling and education on febrile seizures, however if not comfortable and bed available could be admitted for observation, depends on time of presentaiton
- Counselling: reassurance, doesn’t cause lasting harm, is common, doesn’t increase the risk of epilepsy
recurrence: younger patients are more likely to have future febrile convulsions
- Safety: don’t leave child alone swimming/in bath/in playground at heights
- Safety-netting + explain seizure first aid
- GIVE INFORMATION SHEET

?Return to baseline;
- antipyretics for fever
- targeted treatment for focus of infection if found/present