1. Febrile seizure
Dr Harshuti shah
Child neurologist
Rajvee hospital
Helemt char rasta
Ahmedabad

2. END 2012

3. All went Fake

4. Anything
which
is
frightening is
not
life threatening

5. How far it is common?
2-4% of pediatric population
Commonest neurological emergensy to be
presented in the clinic
Peak age of onset 1-3 year-i.e. 18 months

6. What is febrile seizure?
As the name implies,
Seizure associated with fever
“An event in infancy or childhood usually
occurring between 3 months and 5 years
of age, associated with fever but without
evidence of intracranial infection or
defined cause”

7. Confirmation of febrile seizure
Age group:1 month-
Occurrence after 6 year is uncommon
Temperature is usually high>38.5*c or
100.4 F
Generalised tonic-clonic But could be
partial

8. How to categerise?
Simple febrile seizure(60-
70%)
5 f’’
Generalised
Lasts <10 min.
No recurrence in 24
hours(within same illness)
3 mo-5 year
No preictal/postictal aura
Complex febrile seizure(30-
40%)
Focal
Lasts>15 min.
Recur within 24
hours(within same illnes)
Beyond 6 year
Postictal deficit

11. FAQ

12. Will anything happen to my
child?
Self limiting
Not brain damaging
Extremely low mortality associated with
febrile seizure
Even least with febrile status epilepticus

13. Do I need admission?
Admission
1. to identify the cause of fever
2. To know the recurrence in case of
complex seizure
Least chances of recurrence with simple
febrile seizure

14. Why does it occur?
Age specific reaction to systemic illness
Breakdown of threshold associated with
rate of rise of temperature
Herpes-6 & Herpes -7 infections have
highest rate of infection
Gastroenteritis infection has lowest
incidence

15. What are investigations?
Total count-not much significant
(There might be pleocytosis,If blood is
withdrawn at the time or immediately after
the onset of seizure)
Electrolytes-low serum sodium after first
febrile seizure is associated with the
significant risk of recurrent febrile seizure

16. Whether it will happen again?
Simple febrile seizure-NO
Focal,afebrile,lethargic child-high chances
of recurrence
Neurodevelopmentally delayed/deranged
child-high chance of recurrence

17. Lumber puncture
Most imp. To r/o CNS infection in children
Varied and vague presentation in infants
Need careful evaluation by experienced doctor to avoid L>P.
Imp. Points
Focal seizure
Persistent lethargy
Child had been within 48 hours prior to onset of seizures for
febrile illness
Or
Recurrence of seizure in 24 hours in chld <1 year
Conclusively,
All children<12 months old need lumber puncture

18. Do they need EEG?
GAP between evidence-practice continues
Consistent evidence that routine EEG
does not predict
febrile seizure recurrence
Or
subsequent epilepsy
Hypnagogic spike-waves
Not to be suggested if diagnosis is

19. I want CT scan/MRI
X –ray skull
CT scan
No proven benefit
Not justified based on anxiety
MRI:May reveal the changes of acute
inflammatory reaction on T2 weighted
images but usually disappears (FEBSTAT
study)
Does not carry future implication

20. Whether my child will develop
epilepsy?
2% chance only for development of epilepsy
4-12% following complex febrile seizures
One must know….
High risk of development if epilepsy is with
Focal seizures,
Prolonged seizures
Developmental dysfunction
Neurological dysfunction
Epilepsy associated with family members

21. What are the probability of having
recurrent febrile seizures?
If first seizure occurs before 1year of age
If seizure occurred within 1 hour of onset
of fever-
Fever occurred after the onset of seizure
Seizure occurred at low
temperature<100.4
Developmentally delayed child

22. What should be done at home in
acute attack
Put the child on floor in open
Turn head on one side
Do not put any hard object nearby
Remedial measures at HOME
1.intranasal spray
2. Per rectal supoositary
3. Use of per rectal inj. Diazepam/benzodiazepam
DO NOT PUT ANYTHING IN MOUTH except
maintaining airway.

23. Use of intranasal spray
Easily operable
Put the nasal spray as soon as the onset
of seizure
No. of spray =1/2 of the no. of weight
Can be used intrabucally
Can be repeated thrice at the interval of 10
min.

24. Use of rectal suppository
Diazepam suppository readily available
May cause drowsiness and lethargy thereafter
If nothing ,
Inj. Diazepam (0.5mg/kg)/inj.lorazepam
(0.1mg/kg)can be infused per rectally using
feeding tube
REDUCES DURATION OF FEBRILE SEIZURE
RELIEF TO FRIGHTENED PARENT AS SENSE
OF BEING IN CONTROL

25. In clinic for control of acute
seizure
First step,
Use of intranasal spray
Inj. Lorazepam 0.2 mg/kg to be given i.v.
slowly
Inj. Diazepam0.3mg/kg to be given I.v.
slowly with the watch on respiration
Rectal diazepam can be given

26. What for Prevention of recurrent
attack?

27. Should I prevent the rise of temp?
Seizures occurring at the height of temp.
has less chance of recurrence(22%)
Reduction of temp. or use of prophylactic
antipyretic does not help in preventing the
recurrence of febrile seizures
RENDERS THE CHILD MORE
COMFORTABLE

28. Recurrent febrile seizure despite of
medicines given
Misperception of febrile seizure
Febrile myoclonus
Occurs along with febrile illness
During the sleep only
Occurs in form of jerky movements involving either of limbs
non rhythmic ,erratic
Syncopal attacks
Very often
Always occur in upright posture
Characterised by uprolling of eyeball and generalised
stiffening sometimes followed by few myoclonus
RIGORS
Consciousness is well retained

29. Do they need AED if the febrile
seizures are frequent?
Regular AED is not an indication for no. of
febrile seizures
Regular use of prophylaxis in the high risk
for recurrence of febrile seizure usually
suffices

30. What medicines to be used to
prevent the recurrence of febrile
seizure
IN INDIA,
Benzodiazepine 0.1 mg/kg to be given at the time
of illness/fever orally i.e. clobazam
To be given at interval of 12 hours for 2 days
Phenobarbitone(gardinal)4-5mg/kg/day-effective
but behavioural issues and intellectual dulling
Valproic acid-effective-but risk of fatal toxic
hepatitis
Carbamazepine and phenytoin are not effective

31. What in long run?
Very good prognosis
Do not develop epilepsy in most(risk2%)
Risk of development of mesial temporal
lobe sclerosis is only(2%)
Can lead to normal life
NO Effect on school performance and
intelligence, academic progress

33. Inheritance
Autosomal dominant
Polygenic pattern
Positive history of febrile seizures in first or
second degree relatives increases risk 2-3
fold