Febrile Seizure

Question 1

What are febrile convulsions?

Answer 1

A type of seizure occurring in children with a high fever

They are not caused by epilepsy or underlying neurological pathology.

Question 2

In which age group do febrile convulsions occur?

Answer 2

Children aged 6 months to 5 years

Question 3

What are some risk factors for febrile convulsions?

Answer 3

• family history
• high fever (>40)
• viral infection
• recent immunisation
• 50% have no identified risk factor

Question 4

What characterizes simple febrile seizures?

Answer 4

• generalised tonic-clonic seizures
• last <15 minutes
• post-ictal phase <1 hour
• occur once in 24hrs

Question 5

What characterizes complex febrile seizures?

Answer 5

• partial seizures
• last >15 minutes
• post-ictal phase >1 hour
• can occur more than once in 24hrs

Question 6

What is the classic presentation for diagnosing febrile convulsions?

Answer 6

A child ~18 months old presenting with a 2-5 minute tonic clonic seizure during a high fever

Question 7

What are the methods to identify the source of fever in a child?

Answer 7

• clinical examination - ear, nose, throat, respiratory, rashes
• exclude CNS infection → red flags

Question 8

What are the red flags for CNS infection in children?

Answer 8

• neck stiffness
• photophobia
• high fever
• non-blanching rash
• irritability
• bulging fontanelle
• decreased consciousness

Question 9

What are some differential diagnoses for febrile convulsions?

Answer 9

• epilepsy
• CNS infection - meningitis, encephalitis
• intracranial space occupying lesions (tumours, intracranial haemorrhage)
• syncopal episode
• electrolyte abnormalities
• trauma (exclude NAI)

Question 10

What are the steps in the management of febrile convulsions?

Answer 10

• identify and manage underlying source of infection
• control fever with simple analgesia such as paracetamol and ibuprofen
• parental reassurance and education for further episodes

Question 11

What parental education should be provided for managing febrile convulsions?

Answer 11

• stay with the child
• put the child in a safe place (e.g. carpeted floor, pillow under head)
• place into recovery position
• don’t put anything in their mouth
• call ambulance if seizure lasts >5 minutes

Question 12

What is the prognosis for children with febrile convulsions?

Answer 12

• do not typically cause lasting damage
• one in three will have a further febrile convulsion
• risk of developing epilepsy is higher after febrile convulsions