Febrile Seizures : A Practical Approach to Freaked-Out Parents *Febrile seizures are convulsions in a child triggered by fever (>100 degrees

F). Occur without any brain or spinal cord infection or other neurologic cause - Occurs in about 3-5% otherwise healthy children aged between 6 months and 5 years -Risk factors: Rapid rise in temperature; history of febrile seizures in close relative *One Seizure Epilepsy Seizure = sudden change in neurologic activity (e.g. behavior, movement, sensation caused by excessive synchronized discharge of cortical neurons in a limited (focal) or generalized distribution of the brain Epilepsy = condition of recurrent seizures -- more common among children with early, recurrent febrile seizures, especially if there is a family history of epilepsy Classification of Febrile Seizure Simple: A short-duration (< 15-minute), generalized seizure with one seizure in a 24-hour period. High fever (> 39C) and fever onset within hours of the seizure are typical. Complex: A long-duration (> 15-minute) or focal seizure, or multiple seizures in a 24-hour period. Low-grade fever for several days before seizure onset may be present. For your H&P -Have parents describe the seizure. Good approach: Why did you suspect something was wrong? What was the child like after the episode? -Any precipitating illness? _Classify the fever onset and possible etiologies -Rule outs: hypoglycemia, breath holding spell, head trauma, toxic ingestion -Seizure mimickers - motor tics, myocloncus, Sandifers syndrome, pseudoseizures -Family history of febrile seizures 8q13-21 (FEB1) and 19q (FEB2) have been linked support for autosomal dominant, polygenic, and multifactorial inheritance -On physical exam, are they toxic appearing? Risk of Recurrence.. Risk after the first febrile seizure is about 33%, and about 9% will have three or more recurrences. Risks are: occurrence of the first febrile seizure at a young age; family history of febrile seizures; short duration of fever before the seizure; relatively low fever at the time of the initial seizure; and possibly a family history of an afebrile seizure

What tests should we perform?? --Lumbar Puncture? <12 months Do it. 12-18 months Consider it. . >18 months - Do it if meningeal symptoms are present. --Ask if the child has taken antibiotics recently ~13-16% of kids w/ meningitis seizures are the presenting sign of disease --EEG? No evidence exists that abnormal EEGs after the first febrile seizure are predictive for either the risk of recurrence of febrile seizures or the development of epilepsy --Blood glucose level?? --Neuroimaging?? **Should direct evaluations toward the diagnosis of the causes of the childrens fevers How are we going to treat it?? -Overall, anti-epileptics are not recommended when one considers their side effects weighed against the fact that a febrile seizure recurrence is likely to be of little harm to the child -Drugs reviewed by AAP: *Effective in preventing recurrence of simple febrile seizures: Phenobarbital, Priidone, Valproic Acid *Ineffective: Carbamazepine, Phenytoin *Rectal diazepam 0 Reassurance and Points to Send Home With Parents --Simple febrile seizures DO NOT: *Cause brain damage* *Usually dont recur* *Do not lead to incd risk of epilepsy* -What to do if he/she seizes again??

References:
1. UptToDate, Febrile Seizures. www.uptodate.com/contents/febrile-seizures 2. Lissauer, Tom. Illustrated textbook of paediatrics. 3. American Academy of Pediatrics (Steering Committee on Quality Improvement and Management, Subcommittee on Febrile Seizures). Clinical Practice Guideline: Febrile Seizures: Clinical Practice Guideline for the Long-term Management of the Child with Simple Febrile Seizures. . Pediatrics. 2008;121:1281-1286. 4. American Academy of Pediatrics (Provisional Committee on Quality Improvement, Subcommittee on Febrile Seizures). Practice parameter: The neurodiagnostic evaluation of the child with a first febrile seizure. Pediatrics. 1996; 97: 769-772.