Paeds: Febrile Convulsions

Question 1

Definition

Answer 1

A febrile seizure is a seizure accompanied by a fever in the absence of intracranial infection due to bacterial meningitis or viral encephalitis.

Question 2

Epi

Answer 2

Occur in 3% of children between the ages of 6 months and 5 years

Question 3

Genetic

Answer 3

10% risk if the child has a first-degree relative with febrile seizures
19q and 19q 13-21 (don’t need to know)

Question 4

Process

Answer 4

The seizure usually occurs early in a viral infection when the temperature is rising rapidly
>39oC

Question 5

Seizure type

Answer 5

Usually brief and are generalised tonic-clonic seizures

Question 6

Future episodes

Answer 6

30-40% will have further febrile seizures
• More likely if the child is younger
• Short the duration of illness before the seizures
• The lower the temperature at the time of seizure
• Positive family history.
complex

Question 7

Prognosis

Answer 7

Simple febrile seizures do not cause brain damage; the child’s subsequent intellectual performance is the same as in children who do not experience a febrile seizure.
There is a 1-2% chance of developing epilepsy, similar to the risk for all Children.

Question 8

Types

Answer 8

Simple versus complex

Question 9

Simple

Answer 9

Both are
Secs-15 mins
Only 1/24hrs
Post ictal drowsiness (nothing else)

Question 10

Complex

Answer 10

> 15 min
More than 1 in 24hours
Post ictal seizures or movements

Question 11

Management

Answer 11

Find out the cause Rule/out meningitis/encephalitis

Question 12

Epilepsy

Answer 12

Slight increase risk however comes with a range of things like
- Other picture going on e.g. delayed dev milestones
- Fx of epilepsy
-

Question 13

Investigations

Answer 13

• Should focus on the cause of the fever, which is usually a viral illness, but a bacterial infection including meningitis should always should always be considered.
• Infection screen may be necessary
  o Blood cultures
  o Metabolic: Glucose
  o Electrolyte disturbance (Ca and MG)
  o Toxicology cause?
  o Urine culture
  o Lumbar puncture for CSF

Question 14

LP

Answer 14

♣

Question 15

Management:

Answer 15

1. Parental reassurance and information
   a. 5 mins buccal midazolam
2. Antipyretics have not been shown to prevent febrile seizures and tepid sponging is no longer recommended
3. Family should be taught the first aid management of seizures
4. If a history of prolonged seizures (>5min), rescue therapy such as rectal diazepam or buccal midazolam can be supplied.
5. Oral prophylactic anti-epileptic drugs are not used as they do not reduce the recurrence rate of seizures or the risk of epilepsy
   a. Minimal effect and adverse affects