Febrile seizure

Febrile seizure

1. Febrile seizure Presented by Sah , Kalpana Postgraduate intern

2. Contents Definition Classification Epidemiology Risk Factors Causes Diagnosis Treatment

3. Definition Febrile seizures are seizures that occur between the age of 6 and 60 month with a temperature of 38°C (100.4°F) or higher, that are not the result of central nervous system infection or any metabolic imbalance, and that occur in the absence of a history of prior afebrile seizures. Generally accepted criteria for febrile seizures include: A convulsion associated with an elevated temperature greater than 38°C A child older than 6 months and younger than 6 years of age Absence of central nervous system infection or inflammation Absence of acute systemic metabolic abnormality that may produce convulsions No history of previous afebrile seizures

4. Classifications Febrile seizures are further divided into two categories, simple or complex, based on clinical features : Simple febrile seizures : the most common type, are characterized by seizures associated with fever that are generalized, usually tonic- clonic , last less than 15 minutes, and do not recur in a 24-hour period. Complex febrile seizures: seizures associated with fever that are characterized by episodes that have a focal onset (e.g. shaking limited to one limb or one side of the body), last longer than 15 minutes, or occur more than once in 24 hours. Febrile Status Epilepticus : febrile seizure lasting longer than 30 min or intermittent seizure without neurologic recovery.

5. S imple F ebrile S eizure 1 generalized , last for a max of 15 min not recurren t within a 24-hour period majority of FS (85 %) C omplex F ebrile S eizure focal more prolonged ( >15 min ), recurrent within 24 hr may begin as stare or jerking on one side of the body Febrile Seizure (FS) Classification Febrile S tatus E pilepticus febrile seizure lasting >30 min.

6. Febrile seizure Between 2% and 5% of neurologically healthy infants and children experience at least 1, usually simple, febrile seizure. Simple febrile seizures do not have an increased risk of mortality Complex febrile seizures may have an approximately 2-fold long-term increase in mortality, as compared to the general population, over the subsequent 2 yr, probably secondary to coexisting pathology.

7. Epidemiology The most common neurologic disorder of infants and young children's. They are age dependent phenomenon. Occurs between the age of 6 months to 5 years Occurring in 2-4 % of children younger than 5 years. Peak incidence between 12-18 months. Male predominance with estimated male to female ratio 1.6:1

8. Epidemiology Recur in approximately 30% of those experiencing a first episode and 50 % of infants <1 year old at febrile seizure onset. Although about 15 % of children with epilepsy have had febrile seizures, only 2-7% of children who experience febrile seizures proceed to develop epilepsy later in life.

9. Genetic Factors Positive family history – the disorder is inherited as an autosomal dominant trait, and multiple single genes causing the disorder have been identified.

10. Risk Factors for Recurrence of Febrile Seizures Major Age < 1year Duration of fever < 24hr Fever 38-39 (100.4-102.2°F) Minor Family history of febrile seizure Family history of epilepsy Complex febrile seizure Daycare Male gender Low serum sodium at time of presentation

11. Risk factor Having no risk factors carries a recurrence risk of approximately 12%; 1 risk factor, 25-50%; 2 risk factors, 50-59%; 3 or more risk factors, 73-100%.

12. Causes Upper respiratory tract infection Roseola infantum (HHV-6) Gastroenteritis ( Shigella or campylobacter ) Influenza Virus Urinary tract infection

13. Work-up History Physical Examination Lumbar Puncture Electroencephalography - Prognostic Procedure Blood Studies Neuroimaging

14. Management  History: fever with actual shaking, upward rolling of eyes, and cyanosis that lasts for a couple of minutes (1 episode only).  More than 3 FS episodes may indicate another problem.

15. Treatment If the seizure lasts for longer than 5 min, acute treatment with diazepam, lorazepam , or midazolam is needed . Rectal diazepam is often prescribed to be given at the time of reoccurrence of a febrile seizure lasting longer than 5 min Alternatively, buccal or intranasal midazolam may be used and is often preferred by parents. Intravenous benzodiazepines, phenobarbital , phenytoin , or valproate may be needed in the case of febrile status epilepticus .

16. Treatment If the parents are very anxious concerning their child’s seizures, intermittent oral diazepam can be given during febrile illnesses (0.33 mg/kg every 8 hr during fever) to help reduce the risk of seizures in children known to have had febrile seizures with previous illnesses. Intermittent oral nitrazepam , clobazam , and clonazepam (0.1 mg/kg/day) have also been used.

17. Treatment Antipyretics can decrease the discomfort of the child but do not reduce the risk of having a recurrent febrile seizure, probably because the seizure often occurs as the temperature is rising or falling. Chronic antiepileptic therapy may be considered for children with a high risk for later epilepsy.

18. References Nelson TEXTBOOK of PEADIATRICS 20 th edition Nelson Essentials of Pediatrics 7 th edition

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