Febrile Seizure

General Overview

• Convulsion in 6mo-5yo associated with fever (T>38°C)
  • Absence of CNS infection/inflammation, metabolic abnormality
  • No history of previous afebrile seizures
  • Other typical
    • Usually first day of illness
    • Can have postictal drowsiness 5-10 mins
• Simple
  • <15 mins
  • No focal features (generalized tonic-clonic or atonic/tonic)
  • Once in 24h
• Complex
  • >15 mins
  • Focal features or postictal paresis
  • >1 in 24h
• DDx
  • Shaking chills (usually fine oscillatory movements around a joint, rarely involve face/respiratory muscles)
  • CNS infections (meningitis, encephalitis)
    • Altered consciousness, petechial rash
    • Unvaccinated to Strep pneumo and H influenzae type B
  • Genetic epilepsy (rare)

History

• Seizure characteristics
  • Duration (reliability)
  • Focal features (limited to one limb, or one side of body)
  • Postictal drowsiness (>10mins)

Physical Examination

• ABC, Vitals
• LOC
• Seizure ended (closed eyes, deep breath)
  • If persistent open and deviated eyes, they may still be seizing even if motor activity stopped
• Meningeal signs
  • Stiff neck
  • Bulging fontanelle
  • Skin Rash
• Neuro
  • Focal differences in muscle tone, strength, movements

Investigations

• Lumbar puncture if
  • Meningeal signs or symptoms
  • 6-12 months of age if unvaccinated (or undetermined) Haemophilus influenzae type b or Streptococcus pneumoniae
    • <6 months as not considered a febrile seizure
  • Treated with antibiotics prior (as can mask signs/symptoms of meningitis)
  • Febrile status epilepticus (>30 mins)
  • Seizures after second day of febrile illness
• Consult pediatric neurology for complex seizure
  • Consider imaging (CT C+ or MRI) if abnormally large head, persistent abnormal neurological exam, focal features, or sign of increased ICP
  • Consider EEG if prolonged seizure or focal for prognosis

Counselling

• 1 in 25 children will have a febrile seizure
  • 1 in 3 will have another one
  • The older they are, the less likely they will have another
  • Tylenol (Acetaminophen) and Advil (Ibuprofen) for symptoms, but will not prevent seizures
• If your child has another febrile seizure
  • Stay calm
  • Place child on their side on a flat surface in a safe environment
  • Do not restrain them
  • Do not put anything in their mouth (you can wipe away vomit or saliva outside the mouth)
  • Call 9-1-1 if the seizure lasts longer than 5 minutes