Febrile Convulsion

Definition

  “ An epileptic seizure occurring in childhood , after one month , associated with  a febrile illness not caused by an infection of the central nervous system , without previous neonatal seizures or a previous unprovoked seizures and not meeting criteria for other acute symptomatic seizures”.

      There are two categories ,

-          simple febrile convulsion

-           complex febrile convulsion

Cpx febrile seizers were defined as those that had one or more of the followings,

Duration more than 15min

Recurrence within 24hrs

Focal features

Simple febrile seizers were defined as those that did not have cpx features

Indications for admission to hospital after a febrile seizers.

o   First febrile seizers

o   Age <18 months

o   Incomplete recovery after one hr

o   Any likelihood CNS infection

o   A cpx febrile seizers

o   Fever has lasted more than 48 hr before onset of seizers

o   Home circumstances inadequate/excessive parental anxiety/parent’s inability to cope.

Investigation

Routine blood studies are not benefit in evaluation of child with febrile seizers.

A blood glucose estimation should be obtained if the child has a prolonged period of postictal drowsiness.

All children who convulse with fever need not have a LP how ever it should be strongly considered,

§  History of irritability, decreased feeding or lethargy.

§  If there are clinical sings of meningitis/encephalitis.

§  If the child is unduly drowsy or systemically ill.

§  If there is prolonged post ictal period or neurological deficit.

§  After cpx convulsion

A negative LP should not eliminate need for care full follow up.

EEG may help full if clinical picture suggest focal pathological changes of the brain.

Treatment

Acute management of seizers.

§  Pay attention to airway, breathing ,circulation

§  Give high flow oxygen

§  Decompress stomach

§  Measure blood glucose

§  Monitor vital sings

3.phenitoin 18mg/kg IV or IO over 20 min

 Or

 Phenobarbiton 15-20mg/kg

4. midazolam infusion 60-300microg /kg/hr

5. rapid sequence induction of anesthesia

Management of fever,

§  The fever should be treated to prompt the child’s comfort

§  An adequate fluid intake should be ensure to prevent dehydration

§  Physical method to reduced the body temperature, such as  fanning ,tepid sponging, & light clothing are often recommended

§  Paracetamole &ibuprofen are the recommended antipyretics,(max.4doses in within 24hrs.) <3months 60mg,3months-1yr 60-120mg,1-5yrs 120-250mg . dose of ibuprofen(3-4timesdaily) 1-2yrs 50mg ,3-5 yrs 100mg

§  Diclofinac sodium (rectal/oral)may also be consider for control of fever    

Prognosis

§  Risk of subsequence epilepsy after a single simple febrile seizer is about 2.5%

§  Risk of having further febrile convulsion is 30%

§  A family history of febrile seizer in a 1st degree relative is also associated with an increased risk

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