febrile convulsion.pptxt777777frxvkfyruxzsb

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1. FEBRILE CONVULSION PRESENTER: UNISA A. KANU FINAL YEAR CLINICAL PEDIATERIC STUDENT.

2. Introduction Classification Risk factors Aetiology Pathophysiology Clinical presentation Differential diagnoses Diagnoses Management Summary Outline

3. Febrile convulsion is also known as febrile seizures these are seizures that occur between the age of 6 and 60 months Associated temperature of 38 O C (100 O F) or higher. Not as a result of CNS infection or any metabolic imbalance Absent of a history of prior afebrile seizures Introduction

4. Febrile convulsion is classified into simple and complex seizures. Simple seizure: It is the most common type of febrile seizure They are characterize by seizure associated with fever that is generalize. Usually tonic – clonic, last for <15 minutes It rare to reoccur within a 24 hours period Very short post - ictal phase Classification

5. Complex febrile convulsion: These seizures associated with fever that are characterized by more than one episodes It has a focal onset ( e.g. shaking limited to one limb or one side of the body) L ast longer than 15 minutes It can reoccurs more than once in 24 hours. Can be long and associated with deficits ( Todds palsy)

6. Age High grade fever Infection Viral infection such as HHV-6 and influenza virus Bacterial infection and parasitic infection Immunization (DPT & MMR) Genetic susceptibility Family hx of febrile convulsion (10 -20%) Autosomal dominant trait Risk factors

7. Major Age <1yrs Duration of fever <24hr Fever 38 O to 39 O (100.4 - 102 O F) Minor Family history of febrile seizures Family history of epilepsy Complex febrile seizures Day care Male gender Lower serum sodium Risk factors for recurrence of febrile seizures

8. There are several predators of epilepsy after febrile seizures Simple febrile seizure 1% Neurodevelopmental abnormalities 33% Focal complex febrile seizures 29 % Family history of epilepsy 18% Fever <1hr febrile seizure 11% Complex febrile seizure 6% Recurrent febrile seizures 4% Risk factors for occurrence of subsequent epilepsy after a febrile seizure

9. Viral infections (most common) e.g. HHV-6, Influenza Bactria infections e.g. shigella, salmonella Vaccines: DPT (in the same day), MMR (in 8-14 days) Meningitis Cerebral malaria Lower and upper respiratory tract infections UTI Aetiology

10. When the body immune system exposed to a pathogen or vaccine Macrophages will recognize and engulf the pathogen on the reaction mhc2 ( major histocompatibility complex, class ii) Which they present it to T - cells preferably T - helper cells . T - cells will interact with that antigen via T - cells receptor, also interact with mhc2 complex via cd4 positive proteins Once this reaction occurs it triggers the release of cytokines such as IL-1 beta, IL-6, TNF-alpha, This cytokines will combat the pathogen or infection in the localized area ultimately spilling over into circulation resulting into elevated cytokine level. - Cytokines will act on the hypothalamus and the NMDA- receptor (N- methyl D- aspartate) Pathophysiology

11. High grade fever Loss of consciousness Jerky movements of the arms, leg, body or head Stiffening of the arms, leg or whole body Fainting Eye rolling Going pale or bluish in skin colour Difficulty breathing Clinical presentation

12. CNS infection Electrolyte disturbance Inborn error of metabolism Intracranial mass Diagnosis by hx and exclusion Differential diagnoses

13. Complete and proper history taking Complete physical examination Investigation Typical not required Atypical EEG Toxicology screening Assessment of electrolyte CT or MRI Lumber puncture Diagnoses

14. Initial assessment 4S ( S afety, S timulation, S itting, S hout for help) A irway B reathing C irculation O2 support Management

15. Glucose D10 % 5 mls /kg Barbiturates Phenobarbital 15-20mg/kg LD and 5mg/kg MD Fosphenytoin/ phenytoin Phenytoin 18mg/kg LD Benzodiazepine Diazepam 0.25mg/kg Analgesic / Antipyretics Acetaminophen 15mg/kg Ibuprofen 10mg/kg Transfuse blood when necessary Note do not combine them together switch from one drug to another. Medical - Management

16. Any question

17. Febrile seizures occurs between age 6 months to 5 years with an associated temperature of 38^C or grater. Classified as simple and complex seizures. Most commonly caused by viral infections e.g. HHV-6, influenza, It is the most common neurological disorder in infants and young children with a peak incidence of 12-18 months. Release of cytokines from a trigger of pathogen can increase the sensitivity of NMDA receptor. Increase in body’s temperature leading to fever increases the basal metabolic rate of neurons increases the firing of them. Summary

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