Febrile seizures–understanding the clinical features, management and prognosis

Question 1

Of neurologic disorders in infants and small children how common are febrile seizures?

Answer 1

They are the most common neurologic disorder occurring in 2 to 4% of children.

Question 2

What is the usual age of onset for febrile seizures?

Answer 2

6 months to 5 years of age.

Question 3

What are some of the presenting common features and necessary findings to diagnose a febrile seizure?

Answer 3

Febrile seizures commonly occur first day of illness generally occur as the temperature increases rapidly and with most fevers measured > 39 °C. There must be a documented fever at the time of seizure activity.

Question 4

What are the 3 types of febrile seizures?

Answer 4

Simple febrile seizure (80%)
Complex febrile seizure (20%)
Febrile status epilepticus (<1%)

Question 5

Describe simple febrile seizure and its duration.

Answer 5

They are generalized seizures typically lasting less than 15 minutes, with a mean duration of 3 to 4 minutes, they are typically tonic-clonic, but atonic and tonic spells can happen. The postictal phase is associated with confusion, agitation, and drowsiness but children usually return to baseline quickly. They do not recur in 24-hour.

Question 6

What are some of the common features of a generalized seizure?

Answer 6

Activity begins in both hemispheres of the brain at the same time
Movements include atonic or loss of muscle tone, tonic or muscle contractions, or tonic clonic which is rhythmic movements of tightening and loosening of the muscle tone
Loss of consciousness.

Question 7

What are the common features necessary to diagnose a complex febrile seizure and in whom do they generally occur?

Answer 7

They have a focal onset seizure that typically lasts more than 15 minutes. They they often are recurrent within a 24-hour period. They are more common in children with abnormal development. Most children develop complex febrile seizures with the first seizure.

Question 8

What are the brief descriptions of a focal seizure?

Answer 8

1. No loss of consciousness
2. Simple focal seizures AKA auras affect 1 area of the brain and include motor or jerky movements, sensory or hearing problems, hallucinations, or olfactory symptoms, autonomic or change blood pressure, heart rhythm, or bowel bladder function, and psychic or feelings of fear, anxiety, or déjà vu.
3. Complex focal seizures are often preceded by simple focal seizures AKA aura and may result in a blank stare into space or automatisms.
4. Focal seizures beginning in 1 area of the brain and can become generalized or spread to other areas at which loss of consciousness may occur.

Question 9

What is the common presenting feature of a febrile status epilepticus seizure?

Answer 9

These are continuous seizures, or intermittent seizures without neurologic recovery, lasting 30 minutes or longer. (Consider lumbar puncture to rule out meningitis)

Question 10

What are the brief description of features consistent with status epilepticus?

Answer 10

Can be convulsive (jerking motions, grunting sounds, drooling, and rapid eye movements) or nonconvulsive (appeared confused and unable to speak and behaving in an irrational way)
If the eyes are persistently open and deviated to his side then this is an ongoing focal seizure even if convulsion activity has stopped.

Question 11

What is the natural treatment and course for children with simple febrile seizures?

Answer 11

Most resolved spontaneously by the time the child was evaluated. The fevers usually treated with antipyretics, seizure precautions and positioning are given to parents.

Question 12

What should be done if a febrile seizure is lasting more than 5 minutes?

Answer 12

Treatment should be started with benzodiazepines, diazepam or lorazepam which may be given through the buccal midazolam or intranasal lorazepam, and proper monitoring should be applied.

Question 13

What is the management of a patient with febrile status epilepticus?

Answer 13

Start with emergency rescue meds including the benzodiazepines and if unsuccessful then use additional antiepileptics such as IV fosphenytoin and admit to peds ICU. An important sign that seizure has ended include closed eyes and deep breathing.

Question 14

What is the overall prognosis of simple febrile seizures?

Answer 14

They have a recurrence rate of only 30 to 35%

Question 15

How effective are antipyretics in preventing recurrent febrile seizures?

Answer 15

They do not prevent febrile seizures.

Question 16

What are the negative neurological outcomes in children with simple febrile seizure, complex febrile seizures, and febrile status epilepticus?

Answer 16

+Generally children with febrile seizures do not have neurological sequela.
Febrile seizures and febrile status epilepticus can lead to new neurologic deficits, intellectual impairment and behavioral disorders.

Question 17

What is the risk of developing epilepsy for child with simple febrile seizures?

Answer 17

There is a 1 to 2% chance of developing epilepsy which is slightly higher than the general population.

Question 18

What is the risk for developing epilepsy for a child with a complex febrile seizure, abnormal developmental history of family history of epilepsy?

Answer 18

The risk of epilepsy increases to 5 to 10% in these patients.

Question 19

Is an EEG recommended for child with simple febrile seizure?

Answer 19

No an EEG is not recommended.

Question 20

In a child with febrile status epilepticus is there an increased risk for recurrent febrile seizures and afebrile seizures or epilepsy?

Answer 20

Yes there is an increased risk