Febrile seizures

Febrile seizures
Prof. Dr. Saad S Al Ani
Senior Pediatric Consultant
Head of Pediatric Department
Khorfakkan Hospital
Sharjah ,UAE
saadsalani@yahoo.com

A febrile seizure
Is defined as:
an event in infancy or childhood, usually
occurring between 3 months and 5 years of age,
associated with fever but without evidence of
intracranial infection or defined cause
Engel J, Jr. Report of the ILAE classification core group. Epilepsia. 2006;47:1558-1568
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Febrile seizures Prof. Dr. Saad S Al Ani
Khorfakkan Hospital
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Pediatric febrile seizures
Represent the most common childhood
seizure disorder, exist only in association
with an elevated temperature
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http://emedicine.medscape.com/article/1176205-overview

Febrile seizures groups
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Epidemiologically; febrile seizures are
grouped into 3 groups, as follows:
1.Simple febrile seizures
2.Complex febrile seizures
3.Symptomatic febrile seizures

Simple febrile seizures
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The setting is fever in a child aged 6 months to
5 years

Simple febrile seizures (cont.)
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The single seizure is generalized and lasts
less than 15 minutes

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The child is neurologically healthy and
without neurologic abnormality by
examination or by developmental history

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Fever (and seizure) is not caused by
meningitis, encephalitis, or any other
illness affecting the brain

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The seizure is either:
• Generalized clonic
or
• Generalized tonic-clonic seizure

Complex febrile seizures
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Age, neurologic status before the illness,
and fever are the same as for simple
febrile seizure

Complex febrile seizures (cont.)
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This seizure is either:
• Focal or prolonged (ie, >15 min)
or
• Multiple seizures occur in close
succession

Symptomatic febrile seizures
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Age and fever are the same as for simple
febrile seizure

Symptomatic febrile seizures(cont.)
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The child has a preexisting neurologic
abnormality or acute illness

Physical examination
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Neurologically and developmentally
healthy child
No signs of meningitis or encephalitis

Diagnosis
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No specific laboratory studies are
indicated for a simple febrile seizure.
Other laboratory tests may be indicated by
the nature of the underlying febrile illness.

Diagnosis (Cont.)
Concerning lumbar puncture :
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Strongly considered in children younger
than 12 months
( because the signs and symptoms of
bacterial meningitis may be minimal or
absent in this age group)

Diagnosis (Cont.)
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Should be considered in children aged 12-
18 months
( because clinical signs and symptoms of
bacterial meningitis may be subtle in this
age group)
Concerning lumbar puncture (Cont.) :

Diagnosis (Cont.)
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In children older than 18 months, the
decision to perform lumbar puncture rests
on the clinical suspicion of meningitis
Concerning lumbar puncture (Cont.) :

Diagnosis (Cont.)
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Neither computed tomography (CT) nor
magnetic resonance imaging (MRI) is
indicated in patients with simple febrile
seizures

Diagnosis (Cont.)
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EEG is not indicated in children with
simple febrile seizures
Vast majority of these children have a
normal EEG

Treatment
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Neither long-term nor intermittent
anticonvulsant therapy is indicated for
children who have experienced 1 or more
simple febrile seizures.

Treatment (Cont.)
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Any therapy administered after a first
simple seizure will not reduce the risk of :
– Subsequent afebrile seizure
– Recurrent afebrile seizures
(ie, epilepsy).

Treatment (Cont.)
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Rectal diazepam or intravenous, 0.2-0.5
mg/kg for patients with febrile seizures,
particularly those with febrile seizures
lasting more than 5 minutes

Treatment (Cont.)
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Midazolam, administered intranasally,
0.2 mg/kg is as safe and effective as
intravenous or rectal diazepam in the
treatment of acute pediatric seizure
emergencies.
Brooks M. Intranasal Midazolam Works for Seizure Emergencies in Kids. Medscape Medical News. Nov 5 2013.

Prognosis
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Prognosis for normal neurologic function
is excellent

Prognosis (Cont.)
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About one third of children who
experience a single simple febrile seizure
will have another

Conclusion
Children aged 3 months to 6 years may
have tonic-clonic seizures when they have
a high fever.
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http://www.epilepsy.com/learn/types-seizures/febrile-seizures

Conclusion (cont.)
More likely to occur if there is a family
history of febrile seizures.
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Conclusions (cont.)
Most children do not require daily
treatment with medication.
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Conclusions (cont.)
Among children who have their first
febrile seizure before their first birthday,
half will have at least one more.
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Conclusions (cont.)
Long-term outlook is excellent.
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Febrile seizures

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