Febrile Seizures

Question 1

What are common causes of febrile seizures?

Answer 1

• Human Herpes Simplex Virus 6 - one virus that is more commonly responsible
• Febrile convulsions are usually caused by minor viral infections, including coryzal illnesses.
• Otitis media
• Tonsillitis
• Urinary tract infection

Question 2

What are the signs and symptoms?

Answer 2

coryzal symptoms
high fever (40oC)

Question 3

What are some concerning features?

Answer 3

• <18mths old
• Amber/red features (NICE traffic light)
• Convulsion >15mins
• Focal features
• Recurred convulsion in same illness or in the last 24hrs
• Incomplete recovery 1hr after
convulsion
• No focus of infection found/Dx
uncertain
• If serious cause of fever found (e.g. pneumonia)
• Recent use or currently on Abx – need
admit
• seizure on only one side of body
• repeated seizures within same illness - can be seen with viral illness but raises concerns of other illnesses e.g. meningitis

Question 4

What investigations should be carried out?

Answer 4

Hospital assessment IF 1st episode, complex features, <18 months old, suspected causes of fever e.g. pneumonia

Admit IF 1) No focus of infection OR suspected meningitis/encephalitis/meningococcal disease

Ix = BM + urine dip + MSU
• Bloods - not routine, do IF indicated due to febrile illness (e.g. U+E in D&V)
• Neuroimaging - not routine, consider CT IF: 1) persisting focal neurology; 2) papilloedema; 3) marked
reduction in GCS; 4) prolonged >30min or not fully recovered after 2h
• Consider LP (by senior) IF: 1) <6mo or <1yo where not UTD immunisations/immunocompromised; 2) Hx of
irritability, lethargy, decreased feeding; 3) first febrile convulsion with atypical features; 4) prolonged, focal or
multiple seizures; 5) any meningitic/encephalitic clinical signs; 6) prolonged postictal phase; 7) pre-Tx with Abx
(partially masked meningitis)

C/I of LP:
• Focal neurological signs
• Clinical signs of raised ICP (Cushing’s triad = HTN,
relative bradycardia, abnormal breathing
• Drowsiness or impaired consciousness
• Clinical signs of septic shock
• Clinical signs of invasive meningococcal
disease
• Bleeding tendency
• Localised skin infection at site of LP

Question 5

What is the management for febrile seizures?

Answer 5

Mx = Most simple febrile convulsions will not need Tx; can safety net + DC

Children <3months (consultant input) IV aciclovir + IV cefotaxime + IV amoxicillin

Children 3-6months (consultant input) IV aciclovir + IV ceftriaxone

Children >6months IV aciclovir + IV ceftriaxone + oral azithromycin IF any 1 of: 1) Prolonged >30mins witnessed by health professionals; 2) Not fully
recovered in 2h; 3) Meningitic; 4) Any having LP