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Febrile Seizure

Dr.Ravi Kumar,
Dept of Pediatrics,
MGMCRI,
Pondicherry

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Febrile Seizure

  1. 1. FEBRILE SEIZURE DR.RAVI KUMAR.S DEPT OF PEDIATRICS MGMCRI
  2. 2. INTRODUCTION DEFINITION: Febrile Seizures are Seizures accompanied by Fever in Children • Age : Between 6 months to 60 months • Temp : 100.4 F or more • Without underlying CNS infections or any metabolic imbalance • Occurs in absence of prior afebrile seizures.
  3. 3. CLASSIFICATION Clinically Classified as : • Simple : Usually GTCS associated with Fever lasting max of 15 mins and not recurrent within a 24 hours. • Complex/ SFS+ : Focal, lasting >15 mins and re-occurs within 24 hrs. • Febrile Status Epilepticus : Seizure associated with Fever, lasting >30 mins. Can be generalized or focal convulsion.
  4. 4. Risk Factors for Recurrence of Febrile Seizures Major • Age < 1 year • Fever of 100.4 – 102.2 F • Duration of Fever <24 hrs Minor • Family history of febrile seizures • Family history of epilepsy • Complex febrile seizure • Daycare • Male gender • Lower serum sodium at time of presentation
  5. 5. Risk Factors for Occurrence of Subsequent Epilepsy After a Febrile Seizure • Simple febrile seizure • Recurrent febrile seizures • Complex febrile seizures • Fever <1 hr before febrile seizure • Family history of epilepsy • Complex febrile seizures (focal) • Neurodevelopmental abnormalities 1% 4% 6% 11% 18% 29% 33%
  6. 6. Other Types Few epilepsy syndromes typically start with febrile seizures, these are : GEFS+ (Generalized Epilepsy with Febrile Seizure Plus) • Onset characterized by multiple febrile seizures and by several subsequent types of afebrile generalized seizures, including generalized tonic–clonic, absence, myoclonic, atonic, or myoclonic astatic seizures with variable degrees of severity. Dravet Syndrome : • Onset characterized by febrile and afebrile unilateral clonic seizures recurring every 1 or 2 mo. These early seizures are typically induced by fever, but they differ from the usual febrile convulsions in that they are more prolonged, are more frequent, are focal and come in clusters.
  7. 7. APPROACH HISTORY EXAMINATION TREAT DETERMINE THE RISK FACTORS PARENTAL COUNSELLING REGARDING RISK OF RECCURENCE & FIRST AID DETERMINE RISK FOR LATER EPILEPSY LOW RISK NO THERAPY/INVESTIGATION MODERATE/HIGH RISK CONSIDER IMAGING/EEG INTERMITTENT
  8. 8. EVALUATION Etiology: • HHV 6 & 7 • Para influenza • Adenovirus • RSV • Roseola • Shigella • Also Reported following Vaccination of DPT & MMR. Blood Studies (Not routinely indicated in First episode of Febrile Seizure) • CBC • Serum Sodium, Potassium, Calcium, Magnesium, Phosphorous levels.
  9. 9. EVALUATION Lumbar Puncture in Febrile Seizure Indications: • Age <6 months • In a child 6-12 months of age who is deficient in Haemophilus influenzae type b and Streptococcus pneumonia immunizations or for whom immunization status is unknown. • In children who have been pretreated with antibiotics. • Any child with Clinical Signs/Symptoms of Meningitis.
  10. 10. EVALUATION EEG: • EEG would not predict the future recurrence of febrile seizures or epilepsy even if the result is abnormal. • Not recommended in First episode of Simple Febrile Seizure • Indicated only when Epilepsy is highly suspected. NEUROIMAGING: • A CT or MRI is not recommended in evaluating the child after a first simple febrile seizure. • Indicated in a child with Complex Febrile Seizure along with EEG and if the child is Neurologically abnormal.
  11. 11. ACUTE MANAGEMENT In Hospital setting : • Maintenance of Airway, Breathing, Circulation • IV access must be established • First dose of IV Benzodiazepine is administered • Consider repeating the dose if seizure is not controlled. • Febrile Status Epilepticus should be treated as per Protocol for Status Epilepticus. • Paracetamol for Symptomatic relief
  12. 12. LIST OF DRUGS USED DRUG • Midazolam (IM, IV, Intranasal, Buccal) • Diazepam IV Rectal • Lorazepam (IV, Intranasal) DOSAGE 0.2 mg/kg/dose 0.3 mg/kg/dose 0.5 mg/kg/dose 0.1 mg/kg/dose
  13. 13. ACUTE MANAGEMENT In Home Setting: Parents should be instructed • To stay calm and avoid panic • Advised to observe the semiology and duration of seizure • Childs clothing should be loosened • Placement of the child to Left lateral position • Can administer rectal diazepam or intranasal midazolam if seizure lasting for longer duration.
  14. 14. PROPHYLAXIS INTERMITTENT PROPHYLAXIS: Clobazam (Frisium) is used at 1 mg/kg/day in 2 divided doses for first 48 hours after onset of fever. Indication: • Frequent seizures within a short period (3 or more in 6 months/ 4 or more in 1 year) • Prolonged seizures requiring AED. CONTINOUS PROPHYLAXIS: • Studies have shown AED preferably Sodium Valproate would reduce the risk of recurrences in child

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