Febrile seizures Flashcards
Define febrile seizure
Seizure that occurs in association with a fever, evidence of intracranial infection ot other defined cause.
What are the seizures in febrile convulsions like?
Short lived - less than 15mins
Tonic clonic
What is the key epidemiology of febrile seizures?
Relatively common, affecting 3% oc children
6m to 5years (60months)
30% of reoccurence
What is the key aetiology of a ferbile seizure?
Abrupt rise in body temp -> often from infection
Immature brain triggers a seizure -> genetic and environmental predispositions
Most common in URTI, ear infections and childhood exanthems
What are the key risk factors for a febrile seizure?
Family history
Age 6m to 5years
High peak time
Viral infection - HHV6 or influenza
Post immunisations (rare)
Premature, iron deficiency
What are the key features of a simple febrile seizure?
Tonic clonic seizure lasting <15mins during a febrile illness
Norm full recovery within 1 hour
Does not have subsequent seizure during same illness.
What are the features of a complex febrile seizure?
> 15minsues
Partial seizure
Does not recovery completely within 1 hour
Or has another seizure within 24hrs
Higher risk of developing epilepsy later in life.
What are the key signs and symptoms of a febrile seizure?
High fever - often over 38 degrees
Tonic clonic - rhythmic jerking and loss of consciousness
Postictal drowsiness or confusion following the seizure
What are the key differentials for a febrile seizure?
Meningitis - headache, neck stiffness, altered mental status
Encephalitis - headache, altered menatal status, neuro deficits
Seizure due to electrolyte imbalances -> muscle twitching/cramps, fatigue
Epilepsy - recurrent without fever, post ictal confusion and fatigue
What are the key investigations for a febrile seizure?
Blood test to identify signs of infection
Lumbar if CNS infection is suspected
EEG if recurrent or neurological deficits
What is the acute management for a febrile convulsion?
Protocol of seizure management:
Safe environment
Recovery position once ended
Time seizure - if longer than 5 mins - call for an ambulance, terminate using benzodiazepines
What patient education is useful for febrile convulsions?
Instruction on appropriate use of antipyretics
Cautions against prophylactic use of antipyretics
Advice against sponging child to cool them down
Safety net should another seizure occur.
What are the potential complications of a febrile convulsion?
Increased anxiety of caregivers
Febrile status epilepticus -> risk hypoxia and brain injury
Epilepsy -> small increase -> particularly if complex, FH epilepsy, febrile for less than 1hr, pMH or cerebral palsy.
What is the prognosis of febrile seizures?
Very good
Up to 40% recurrence in other fever
Benign
What are the risk factors for a recurrent febrile seizure?
FH of febrile seizure
Fever <39 degrees
Febrile for less than an hour before seizure
Age <18months
Multiple seizures during same febrile illness
