o most common cause of seizure in children o 3-5% of all children, M > F Criteria age 6 months - 6 years thou...
o most common cause of seizure in children
o 3-5% of all children, M > F
Criteria
- age 6 months - 6 years
- thought to be associated with initial rapid rise in temperature
- no interictal neurologic abnormalities
- no evidence of CNS infection/inflammation or acute systemic metabolic disorder
- no history of non-febrile seizures
- most common seizure type is generalized tonic-clonic; however may be any type
- risk factors include
• family history of febrile seizures (40% positive)
• high fever
• slow development of child
Simple Febrile Seizure
- duration < 15 minutes (95% < 5 minutes)
- generalized, symmetric
- does not recur in a 24 hour period
Atypical Febrile Seizure
- focal origin
- > 15 minute duration, multiple (> 1 in 24 hours)
- followed by transient neurologic deficit
Risk Factors for Recurrence
- 33% chance of recurrence
- age of onset < 1 year
• 50% chance of recurrence if < 1 year
• 28% chance of recurrence if > 1 year - risk of epilepsy is < 5%; risk factors include abnormal development of child previous to seizures, family history of afebrile seizures and a complex initial seizure
Workup
- history: determine focus of fever, description of seizure, meds, trauma history, development, family history
- exam: LOC, signs of meningitis, neurologic exam
- R/O meningitis – do LP if signs and symptoms of meningitis
- EEG not warranted unless atypical febrile seizure or abnormal neurologic findings
- investigations unnecessary except for determining focus of fever
Management
- COUNSELLING AND REASSURANCE TO PATIENT AND PARENTS
- antipyretics (e.g. acetaminophen), tepid baths, fluids for comfort (will not prevent seizure)
- prophylaxis not given except in very unusual circumstances
- if high risk for recurrent or prolonged seizures carry rectal Ativan at home
