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A seizure accompanied by fever ( temp > = 100.4 ° F or 38° C by any methods ) without CNS infection that occurs in infants and children 6 through 60 months of age Occurs in 2-5 % of all children ( neurologically healthy ) Most common convulsive event in children < 60 months No previous neonatal or unprovoked seizure Simple febrile seizures represent 65-90 % of febrile seizures
SIMPLE Less than 15 mins Generalised tonic-clonic No previous neurological problems Do not not recur within 24 hrs OR within the same febrile illness No post-ictal pathology COMPLEX-Duration of > 15 mins Focal onset or focal features Recurrence within 24 hrs OR within same febrile illness Febrile status epilepticus + 30 mins
Risk factors first seizure- High fever Viral infection Developmental delay Day care attendance Family history ○ 1ST degree relative who has had FS ○ a relative with epilepsy Certain vaccinations – unclear if a risk factor or not ( Barlow et al- immunization is rarely followed by a febrile seizure )
Pathophysiology-Mechanism causing FS is poorly understood Heterogeneous condition with a complicated ( yet unclear ) genetic and pathophysiological basis Rate of body temperature rise as a cause – frequently quoted theory but unsupported by evidence ie it is uncertain if Degree of fever OR Rate of rise of temp
history-Fever associated with seizure Typical features of FS’s as ○ child 6 months to 5 yrs of age ○ duration 3-6 minutes ○ generalised tonic-clonic type presenting with body stiffening twitching – face , arms , legs eye rolling jerking of arms and legs loss of consciousness Full recovery within 1 hour May occur in a child with a previous h/o FS’s Ask about – ○ family history ○ previous seizures ○ recent antibiotics use ○ immunization history
When to admit-First seizure Subsequent seizure and child not seen by paeds Diagnostic uncertainty Complex seizure Child < 18 months of age Focal neurological deficit No serious findings but currently taking antibiotics or has recently been taking them Parental anxiety/failure to cope Suspected serious cause No obvious apparent focus of infection
Rectal diazepam dose as per CKS
LINKS AND RESOURCES
PATIENT INFORMATION
NHS inform has a page which answers all questions that parents may ask https://www.nhsinform.scot/illnesses-and-conditions/brain-nerves-and-spinal-cord/febrile-seizures
NHS on febrile seizures https://www.nhs.uk/conditions/febrile-seizures/
An incredibly useful video has been produced by British Red Cross on how to manage a child who is having a febrile seizure https://www.redcross.org.uk/first-aid/learn-first-aid-for-babies-and-children/febrile-seizure
A colour coded Febrile Seizure Fact Sheet https://www.rcem.ac.uk/docs/Paediatric%20EM%20Guidance/CEM7216-Febrile-Seizure-Advice-Sheet.pdf
Nationwide children’s org – info on febrile seizures https://www.nationwidechildrens.org/conditions/febrile-seizures
Aboutkidshealth Canada information for parents https://www.aboutkidshealth.ca/article?contentid=1&language=english
National Institute of Neurological Disorders and Stroke – info on febrile seizures https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Febrile-Seizures-Fact-Sheet#3111_4
INFORMATION FOR CLINICIANS
Epilepsy society on febrile convulsions https://www.epilepsysociety.org.uk/sites/default/files/attachments/Chapter08Verity2015.pdf
American Family Physician Febrile Seizures: Risks, Evaluation and Prognosis https://www.aafp.org/afp/2012/0115/p149.html
American Academy of Paediatrics Febrile Seizures: Clinical Practice Guideline for the Long-Term Management of the Child With Simple Febrile Seizures https://pediatrics.aappublications.org/content/121/6/1281
Management of Pediatric Febrile Seizures in Int J Enviorn Res Public Health 2018 by Daniela Laino et al https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6210946/
References
- Mohammadi, Mahmoud. “Febrile seizures: four steps algorithmic clinical approach.” Iranian journal of pediatrics vol. 20,1 (2010): 5-15. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3445995/
- Management of Febrile Seizures in Children
Khawaja Tahir Mahmood, Tooba Fareed, Rabia Tabbasum 1
Department of Pharmacy, Lahore College for Women, University, Lahore, Pakistan 2
Drug Testing Laboratory, Lahore, Pakistan Khawaja Tahir Mahmood et al / J Biomed Sci and Res., Vol 3 (1), 2011,353-357 http://jbsr.pharmainfo.in/documents/vol3issue1/2011030108.pdf - Febrile Convulsions Patient UK Reviewed by Dr Adrian Bonsall | Last edited
- Febrile Seizures : Risks , Evaluation and Prognosis
- Febrile seizures. Patterson JL, Carapetian SA, Hageman JR, Kelley KR. ( Abstract ) https://www.ncbi.nlm.nih.gov/pubmed/24295158#
- Armon K Stephenson T , MacFaul R , et al An evidence and consensus based guideline for the management of a child after a seizure . Emergency Medicine Journal 2003 ; 20: 13-20
- Febrile seizure Clinical Knowledge Summaries October 2013 https://cks.nice.org.uk/febrile-seizure
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Febrile Seizures: Guideline for the Neurodiagnostic Evaluation of the Child With a Simple Febrile Seizure
- BMJ Best Practice Febrile Seizure November 2017 https://bestpractice.bmj.com/topics/en-gb/566
- ABC of One to Seven Febrile Convulsions
- BMJ Volume 306 June 1993 Febrile seizures BMJ 2015 ; 351
- Pediatric Febrile Seizures Robert J Baumann et al emedicine.medscape Nov 2017 https://emedicine.medscape.com/article/1176205-overview
- Febrile Seizures Mohamad A Mikati et al Nesons Textbook of Paediatrics
- Leung, Alexander Kc et al. “Febrile seizures: an overview.”Drugs in contextvol. 7 212536. 16 Jul. 2018, doi:10.7573/dic.212536
- Vestergaard, Mogens1; Basso, Olga2; Brink Henriksen, Tine1,3; Østergaard, John R.3; Olsen, Jørn2Risk Factors for Febrile Convulsions, Epidemiology: May 2002 – Volume 13 – Issue 3 – p 282-287