Diferencia entre revisiones de «Febrile seizure»
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== Treatment  ==
== Treatment  ==
===Ongoing Seizure===
===Ongoing Seizure===
*Treat if initial seizure persists >5 min or for subsequent seizures
See [[Seizure (peds)]]
**[[Benzodiazepines]]
***[[Lorazepam]] 0.1mg/kg IV
***[[Diazepam]] 0.2 mg/kg IV or 0.5 mg/kg PR (choice if difficult or no access)
***[[Midazolam]] 0.1 mg/kg IV or IM or IN
****If persists try one additional dose (risk of resp. depression incr if >2 doses)
**[[Fosphenytoin]] (15-20 mg PE/kg IV) or [[Phenytoin]] (10-20 mg/kg IV up to 1g @ 1mg/kg/min)
***Treat if seizure persists despite benzo treatment
***Onset of action may take as long as 30 minutes
***Can cause [[hypotension]] and [[dysrhythmias]]
**[[Barbituates]]
***[[Phenobarbital]] 15-20 mg/kg IV
***Consider only if benzos and phenytoin have failed
***May lead to respiratory depression, especially when preceded by a benzo
**[[Valproic acid]] 10-15 mg/kg IV (20 mg/min)
***Has been shown to be effective when benzos, phenytoin, and barbituates have failed
***Can be used as 2nd or 3rd-line treatment
**[[Keppra]] 20 mg/kg IVP
**[[Propofol]] 2-3 mg/kg IVP; maintenance 0.125-0.3 mg/kg/min IV
**Consider [[Pyridoxine]] (vitamin B6) 1g per g of INH ingested  (in D5W IV over 30 min)
**Consider Pyridoxine Responsive Seizure Disorder - 100mg/pyridoxine is generally effective<ref>Pyridoxine dependent seizures a wider clinical spectrum. Archives of Disease in
Childhood.1983 (58) 415-418. http://adc.bmj.com/content/58/6/415.full.pdf</ref>
*Treat underlying infection


===Seizure Stopped===
===Seizure Stopped===
*Simple
*Treat underlying infection if indicated
**Treat fever source per normal if indicated
*Complex
**Treat source if indicated from workup


== Disposition  ==
== Disposition  ==

Revisión del 15:11 1 may 2015

Background

  • 2-3% chance of developing epilepsy (1% for general population)
  • 50% of pts never have temp >39
  • 50% of pts <12 mo will have another simple febrile seizure
  • 30% of pts >12 mo will have another simple febrile seizure

Clinical Presentation

Differential Diagnosis

  • Meningitis
  • Seizure due to identifiable cause (e.g. intracranial mass, trauma, ingestion)
  • Epidural/subdural infection or hematoma
  • Toxic Ingestion
  • Pyridoxine Responsive Seizure[1]

Diagnosis

Simple versus Complex

  • Simple
    • Generalized tonic-clonic seizure
    • <15 min in duration
    • Age 6mo - 6yr
    • Occurs only once in 24hr period
    • No focal features
  • Complex
    • Any exception to above

Work-Up

  • Glucose in all pts
  • Simple febrile seizure
  • Complex febrile seizure
    • Consider CBC, blood cx, UA, Ucx, CSF studies
  • Consider CT if:
    • Persistently abnormal neuro exam (esp w/ focality)
    • Signs/symptoms of increased ICP
    • pt has VP shunt
  • Routine EEG not indicated
    • Consider only if developmental delay or for focal symptoms

Treatment

Ongoing Seizure

See Seizure (peds)

Seizure Stopped

  • Treat underlying infection if indicated

Disposition

  • Discharge
    • Simple febrile seizure if pt at baseline
      • Follow-up in 1-2d
    • Complex febrile seizure if pt well-appearing, work-up normal
      • Follow-up in 24hr
  • Admit:
    • Ill-appearing
    • Lethargy beyond postictal period

See Also

Source

  1. ↑ Baxter P. et al. Pyridoxine‐dependent and pyridoxine‐responsive seizures. Developmental Medicine & Child Neurology 2001, 43: 416–42
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