Neuro - Febrile convulsions

Question 1

What are febrile convulsions

Answer 1

Seizures provoked by fever in otherwise normal children.

Question 2

What condition is associated with febrile convulsions

Answer 2

Roseola Infantum (caused by human herpes virus 6), can cause a maculopapular rash and febrile convulsions.

Question 3

What age do febrile convulsions occur

Answer 3

only from 6 months to 6 years

Question 4

Simple febrile vs complex febrile convulsions

Answer 4

• Simple Febrile Convulsions ⇒
  
  • Generalised, tonic-clonic seizures.
  • Last <15 minutes.
  • Only occur once during single febrile illness.
• Complex Febrile Convulsions ⇒
  
  • Focal seizures.
  • Last >15 minutes.
  • Occur multiple times during same febrile illness.

Question 5

What are the indications to admit a child with febrile convulsions

Answer 5

First febrile seizure

uncertain focus of infection

under 18 months

complex seizure features

taking antibiotics

residual focal neuro deficits

Question 6

What advice to give to parents about febrile convulsions

Answer 6

• call ambulance if seizure lasts >5 mins (and no drugs available).
  
  • Protect from injury → cushion their head, remove nearby objects, do not restrain (don’t place in recovery position).
  • Give rescue medication (PRESCRIBED BY SPECIALIST) → buccal midazolam or rectal diazepam.

Question 7

What is rescue medication for febrile convulsions

Answer 7

buccal midazolam

rectal diazepam

Question 8

What to do if rescue medication doesnt resolve febrile convulsion

Answer 8

10 mins + persisting = call ambulance and repeat the rescue therapy

Question 9

What is prognosis for febrile convulsions

Answer 9

30-40% risk of another febrile convulsion. 2.5% risk of developing epilepsy

(factors increasing risk = FH of epilepsy, complex febrile seizure (multiple within same illness or prolonged seizures, background of neurodevelopmental disorder).

Question 10

How to manage statis epilepticus

Answer 10