Emergency room

3y o child arrived by ambulance, In a room with the father .my child had bubbles coming out of the mouth this morning, and was shaking really bad ! I am scared doctor! Oh my .. Doctor - I thought my baby girl was dying, I did not knew what to do !!!! I just held her while I called the ambulance, thank God they were there in 10 min.. Will my child have the brain damage now ?

Emergency room
What do you do next ?

Quick assessment
3 y old girl is resting comfortably on fathers arms as he is holding on to her. He is upset and nervous, Next step start history and physical What questions do we want to ask?

What questions are more important ?

History and Physical

Very important to take a very detailed history Questions that would make difference in treatment: How long did the seizures last? Were there multiple seizures lasting longer then 15 min ?

Our Patient
That was a first episode , Lasted for 7 min

Postictal state for 1 hour after

Viral cold for the past week Never registered a fever, but felt warm

Febrile Seizures
Not associated with any specific illness Related to fever Used to be thought:
Related to the degree of the temperature Related to the rate of rise or decline of fever

Quoting Dr Keller
New understanding of febrile seizures : Not related to the degree of temperature Not related to the degree of rise or decline Can happen even if the temperature is 99

Febrile Seizures
2-4 % of all children 6months- 5 years old, Peak incidence 18 months Genetic predisposition 25% To diagnose child must be free of any past febrile seizures or free of identified brain disease

Febrile Seizures
Simple last less then 15 min, manifest in generalized tonic- clonic activity Complex- focal or last more then 15 min, or multiple with in same illness

25% are complex, 75%- simple

Febrile Seizures
Laboratory values non specific Leukocytosis could be from seizures or underlying illness EEG- non specific Csf normal Sometimes transient hyperglycemia

Febrile Seizures
What is your differential diagnosis ?

Febrile Seizures
Meningitis Toxin from infection Drug reaction- anticholinergics, theophyline, salicylates, amphetamine, cocaine Metabolic disturbance- hypoglycemia, hypocalcemia

Febrile Seizures
Treatment: Simple watchful waiting, observing Complex longer then 10 min activityAntiepileptic drugs, Lorazepam- 0.05- 0.1 mg/kg Diazepam- o.2-0.4 mg/kg Phenobarbital- 20 mg/kg Phenytoin- 20 mg/kg

Febrile Seizures
Support respiration all drugs cause decrease in respiratory rate Antipyretic acetaminophen 10-15 mg/kg per rectum or po q 4-6 hours Treat underlying infection Reassure family most think child will die or have permanent brain damage .

Febrile Seizures
Complications None No epilepsy risk No brain damage No neurologic deficits No mental retardation No learning disorders

Febrile Seizures
Prevention- not advised, due to the possible overuse of the medications and possible allergic reaction to medications

Anticipatory guidance and parent education is absolutely a must

Febrile Seizures
What is important for parents to know : Inherited trait Outgrow by age of 5 if not sooner

Recurrence risk -35% over childs life time , 25% over next 12 months

Febrile Seizures
When to refer: If child has neurologic deficits after seizure refer to the pediatric neurologist. If parents frightened or insist on prophylactic treatments refer them to specialist to help them better understand benign nature .