Febrile seizure

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Background

  • Fever + seizure activity
  • affects children 6 months to 6 years of age
  • Can be categorized into simple and complex
  • Simple
  • <10-15 min in duration
  • generalized
  • once in 24hrs
  • nl neuro exam (give 30min postictal period; 1hr if improving)
  • no sig trauma
  • no h/o neuro pro
  • Complex
  • Any exception to above
  • Runs in families (2-4x higher)
  • Associated with viral infection (roseola, herpes), and recent vaccinations
  • Can recur with subsequent febrile illnesses
  • Risk of recurrence:

<1yr = 50%

1-3yr = 25%

>3yr = 12%

  • risk factors for recurrence include:
  • age <15 mo at onset
  • h/o epilepsy or febrile sz in fam
  • many episodes of sz
  • initial complex febrile sz


Diagnosis/Work-Up

  • PreHospital
  • ABC's
  • consider trauma, toxidromes, infc/ petechiae
  • accucheck
  • if sz >5 min tx with IM, IV, IN Versed
  • PALS
  • ED Eval
  • consider trauma or toxic cause
  • classifly as simple or comple
  • search for devel delay, fam hx,
  • physical exam should find focus of fever
  • routine lab tests other than blood glucose not needed unless searching for cause of fever (UA, CBC, CXR, etc)
  • LP if:
  • age <12 mo per AAP however usually pt with meningitis appear ill- fussy, poor feeding, focal sz, sz in ED, prior visit to PMD, slow post ictal resolution
  • Pmd visit w/ in 48 hrs
  • Sz in ED
  • Focal sz
  • Abnormal neuro/ phys exam
  • Irritable, poor feeding
  • Complex features
  • Slow post ictal clearance
  • Pretx with abx (consider partially tx meningitis if already on abx)
  • CT
  • CT if status, complex, VP shunt, trauma
  • EEG not needed- only if devel delay, neuro change or focal s


DDx

  • epidural/subdural infection or hematoma
  • meningitis
  • sepsis
  • status
  • seizure


Treatment

  • if patient has seizure activity manage with benzodiazepines and anticonvulsants if needed
  • Simple Febrile Seizure: no specific treatment needed for the seizure, treat underlying infection, antipyretics,


Disposition

  • Home: may dispo home if simple febrile seizure and patient back at baseline with follow up in 1-2 days
  • Admit: Complex febrile seizures, unstable clinical status, lethargy beyond postictal period, uncertain home situation


See Also

Seizure (Peds)

Fever (Peds)


Source

Adapted from Gausche, Mistry, Donaldson, Pani

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