Febrile Seizures

 Benign convulsions by any viral illness except: CNS disease,

infection or metabolic disorders. Seizures not caused by fever
or viral toxin.
 The most common seizure disorder during childhood.
 the incidence approaches 3–4% of young children.
 The peak age of onset is 14–18 mo of age. rare < 9 mo and > 5
yr of age.
 Each child with a seizure + fever  carefully examined and
investigated for the cause of the fever.
 Have an excellent prognosis but may also signify a serious
underlying acute infectious disease such as sepsis or bacterial
meningitis.
 A strong family history of febrile convulsions  genetic
predisposition.
 AD inheritance pattern is demonstrated in some families.
 d/d :
1. Febrile convulsion
2. epilepsy caused by fever

3. CNS infection

Clinical Manifestations.
 Associated with rapidly raising temperature when core
temperature = ≥39°C.

Simple complex
Pattern Generalized Partial/focal
Duration Brief<15 min Prolonged >15
min
Occurrence Once > 1 attack
in 24 hours
Neurological Normal compromised
statue
History of Negative positive
febrile
convulsion

 30–50% of children have recurrent seizures with later episodes

of fever. RISKS:
1. age <12mo
 2. lower temperature before seizure onset
3. positive family history of febrile seizures
4. complex seizure.

 Children with simple febrile seizures are at no greater risk of

later epilepsy than the general population, some factors are
associated with increased risk.
1. presence of complex seizure or atypical postictal period /
multiple SFC.
2. positive family history of epilepsy
3. initial febrile seizure before 12mo of age
4. delayed developmental milestones
5. Pre-existing neurologic disorder.
 The incidence of epilepsy is 9% when several risk factors are
present, compared with an incidence of 1% in children who
have febrile convulsions and no risk factors.
 During the acute evaluation, a physician's most important
responsibility is to determine the cause
of the fever and to rule out meningitis Note:
 <12 months at 1st attack  50% 2nd attack
and encephalitis (examine meningial  >12 months at 1st attack  30% 2nd attack
signs).  Those with 2nd attack  50% at least one
another attack.
 Convulsive status epilepticus (one
seizure lasting 30min or multiple seizures during 30min without
regaining consciousness)  CNS infection (viral or bacterial
meningitis).
 If there is possibility of meningitis, a lumbar puncture with
examination of the cerebrospinal fluid (CSF) is indicated (CSF
is normal in early meningitis).
 A lumbar puncture should be strongly considered in children
<12mo of age and considered in those 12-18mo of age.
 Seizure-induced CSF abnormalities are rare in children and all
patients with abnormal CSF after a seizure should be
thoroughly evaluated for other causes.
 viral meningoencephalitis should also be kept in mind,
especially herpes simplex.
 Viral infections of the upper respiratory tract, roseola, and acute
otitis media are most frequently the causes of febrile
convulsions.
 glucose determination, serum electrolytes and toxicology
screening should be ordered based on individual clinical
circumstances .
 EEG is not warranted after a simple febrile seizure but 
complex seizure or with other risk factors for later epilepsy.
 neuroimaging  considered with atypical features, including
focal neurologic signs or pre-existing neurologic deficits.
 No evidence that SFC cause structural damage to the brain or
induce cognitive disorders.

Treatment (No treatment = risk / benefit = negative balance)

 Routine treatment of a normal infant with simple febrile
convulsions includes
1. careful search for the cause of the fever,
2. Active measures to control the fever, antipyretics ( not

effective for FC).

3. Reassurance of the parents.

4. Prolonged anticonvulsant prophylaxis for preventing

recurrent febrile convulsions is controversial and no longer
recommended.
 Antiepileptics such as phenytoin and carbamazepine have
not effective.
 Phenobarbital effective in preventing recurrent febrile
seizures /side effect:decrease cognitive function in treated
children.
 Sodium valproate is effective in ,but:
a. Risk / benefit is negative balance for disease with
excellent prognosos w/out tt.
b. The incidence of fatal valproate-induced hepatotoxicity is
highest in children younger than 2 yr of age.
c. Other side effects: thrombocytopenia, weight gain and
drop of hair.
 Oral diazepam (assival) is an effective and safe method of
reducing the risk of recurrence of febrile seizures by 44%.
a. At the onset of febrile illness, oral diazepam, 0.3mg/kg
q8h (1mg/kg/24hr), is administered for the duration of the
illness (usually 2–3 days).
b. The side effects are usually minor, but symptoms of
lethargy, irritability, and ataxia = cover encephalitis
symptoms and golden days of its diagnosis.
c. Seizure could occur before fever = no benefit at this state.
d. Useful when parental anxiety associated with febrile
seizures is severe.