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Febrile seizures
1. Febrile SeizuresFebrile Seizures
Febrile seizure is a seizureFebrile seizure is a seizure
accompanied by fever (> 38accompanied by fever (> 3800
C)C)
without CNS infection of definedwithout CNS infection of defined
cause in infants and children 3cause in infants and children 3
months to 6 years of agemonths to 6 years of age
[Avg. 18 – 22 months][Avg. 18 – 22 months]
Does not include seizures occurring during feverDoes not include seizures occurring during fever
in children with past H/o. afebrile seizure.in children with past H/o. afebrile seizure.
Definition:Definition:
2. Febrile SeizuresFebrile Seizures
““ a seizure occurring in childhooda seizure occurring in childhood
after 1 month of age, associated withafter 1 month of age, associated with
a febrile illness not caused by ana febrile illness not caused by an
infection of the CNS, without previousinfection of the CNS, without previous
neonatal seizures or previousneonatal seizures or previous
unprovoked seizures”unprovoked seizures”
Definition:Definition: ILAEILAE
3. Febrile SeizuresFebrile Seizures
““ an event in infancy or childhoodan event in infancy or childhood
usually occurring between threeusually occurring between three
months and five years of age,months and five years of age,
associated with fever but withoutassociated with fever but without
evidence of intracranial infection orevidence of intracranial infection or
defined cause of the seizure”defined cause of the seizure”
Definition:Definition: NIH consensus statementNIH consensus statement
4. Febrile SeizuresFebrile Seizures
• 3 -4 % of children < 5 years3 -4 % of children < 5 years
• In India – 1.8 to 10.1%In India – 1.8 to 10.1%
• More in boysMore in boys
Incidence:Incidence:
5. Febrile SeizuresFebrile Seizures
Etiology:Etiology:
• Genetic Predisposition :Genetic Predisposition :
• A strong family history in siblings andA strong family history in siblings and
parentsparents
• Linkage studies mapped FS gene toLinkage studies mapped FS gene to
chromosomechromosome 9p9p andand 8q8q13-2113-21
• Autosomal dominant pattern in someAutosomal dominant pattern in some
familiesfamilies
6. Febrile SeizuresFebrile Seizures
Risk Factors for 1Risk Factors for 1stst
EpisodeEpisode
About 50% of FS no identifiable risk factorsAbout 50% of FS no identifiable risk factors
Positive family history
1st
degree or relatives – 4.5 times risk
Ante and perinatal factors
Metarnal preeclampsia, infections, proteinuria
Prematurity, LBW, neonatal jaundice, asphyxia,
birth injuries
Immunizations
Following DPT or MMR vaccinations
Infections
Human herpes virus 6 infection
Miscellaneous
Iron deficiency anemia
7. Febrile SeizuresFebrile Seizures
Infections commonly found in a child with FSInfections commonly found in a child with FS
Acute Otitis MediaAcute Otitis Media
UTIUTI
URIURI
RoseolaRoseola
GI InfectionsGI Infections
Precipitating Factors:Precipitating Factors:
Fever of any cause can precipitate seizure inFever of any cause can precipitate seizure in
a predisposed child.a predisposed child.
8. Febrile SeizuresFebrile Seizures
Usually a generalized tonic-clonicUsually a generalized tonic-clonic
And lasts for a few seconds to 10And lasts for a few seconds to 10
minutes and is followed by a briefminutes and is followed by a brief
postictal period.postictal period.
DescriptionDescription
10. Febrile SeizuresFebrile Seizures
Occur in typical age groupOccur in typical age group
Generalized tonic clonic typeGeneralized tonic clonic type
Last for less than 15 minLast for less than 15 min
Single within 24 hrsSingle within 24 hrs
SimpleSimple ::
11. Febrile SeizuresFebrile Seizures
Associated with Todd’s palsyAssociated with Todd’s palsy
Last for more than 15 minLast for more than 15 min
FocalFocal
Multiple in 24hrsMultiple in 24hrs
ComplexComplex :: (about 1/3 of FSs)(about 1/3 of FSs)
12. Febrile SeizuresFebrile Seizures
Seizure associate with fever inSeizure associate with fever in
appropriate age group,appropriate age group,
Lasting more than 30 min orLasting more than 30 min or
Multiple seizures lasting 30 minMultiple seizures lasting 30 min
or more without regainingor more without regaining
consciousness in betweenconsciousness in between
Febrile Status EpilepticusFebrile Status Epilepticus
About 25% of cases of SE in children areAbout 25% of cases of SE in children are
due to febrile FSdue to febrile FS
13. Febrile SeizuresFebrile Seizures
Rule out meningitis.Rule out meningitis.
Lumbar puncture ?Lumbar puncture ?
Blood glucoseBlood glucose
HypoglycemiaHypoglycemia
Evaluation :Evaluation :
EEG – Not warrantedEEG – Not warranted
Neuroimaging – not usefulNeuroimaging – not useful
15. Status EpilepsyStatus Epilepsy
Intravenous:
0.1 to 0.3 mg / kg
at a rate not > 2 mg/min
for a maximum of 3 doses repeated at 10
min.
Rectal:
Injectable form diluted in NS by a syringe & a
flexible tube at a dose of 0.3 – 0.5 mg/kg
Rectal Diazepam gel : 2.5, 5, 10 mg
Can be repeated after 10 min.
Intravenous:
0.1 to 0.3 mg / kg
at a rate not > 2 mg/min
for a maximum of 3 doses repeated at 10
min.
Rectal:
Injectable form diluted in NS by a syringe & a
flexible tube at a dose of 0.3 – 0.5 mg/kg
Rectal Diazepam gel : 2.5, 5, 10 mg
Can be repeated after 10 min.
Diazepam
16. Status EpilepsyStatus Epilepsy
Lorazepam
Intravenous : 0.05 to 0.10 mg / kg
Rectal : Ditto
Sublingual : 0.05 to 0.1 mg / kg
Intravenous : 0.05 to 0.10 mg / kg
Rectal : Ditto
Sublingual : 0.05 to 0.1 mg / kg
19. Febrile SeizuresFebrile Seizures
Tepid spongingTepid sponging
AntipyreticsAntipyretics
Reassurance of parentsReassurance of parents
Management :Management :
20. Febrile SeizuresFebrile Seizures
33% Of these 9 % have > 333% Of these 9 % have > 3
recurrencesrecurrences
75 % of recurrences within75 % of recurrences within
1 year1 year
90 % of recurrences within90 % of recurrences within
2 years2 years
Risk of Recurrence :Risk of Recurrence :
21. Febrile SeizuresFebrile Seizures
Early age at seizure onsetEarly age at seizure onset
Low temperature at theLow temperature at the
onsetonset
Short duration of temp.Short duration of temp.
before FSbefore FS
Positive family historyPositive family history
Factors Predisposing Recurrence :Factors Predisposing Recurrence :
•Complex FS are not a predictors of recurrenceComplex FS are not a predictors of recurrence
22. Febrile SeizuresFebrile Seizures
9% when several risk factors +9% when several risk factors +
1% when no risk factors1% when no risk factors
Risk of Epilepsy in children with FS:Risk of Epilepsy in children with FS:
• Risk Factors:Risk Factors:
•Atypical features of seizures or Postictal periodAtypical features of seizures or Postictal period
•Positive family h/o. epilepsyPositive family h/o. epilepsy
•Initial FS before 9 mo. Of ageInitial FS before 9 mo. Of age
•Delayed developmental mile stonesDelayed developmental mile stones
•Pre-existing neurological disorderPre-existing neurological disorder
23. Febrile SeizuresFebrile Seizures
Prolonged anticonvulsant prophylaxisProlonged anticonvulsant prophylaxis
is no longer recommended.is no longer recommended.
Phenytoin and carbamazepine havePhenytoin and carbamazepine have
no effect on febrile convulsionsno effect on febrile convulsions
Phenobarbitone reduces the congnitivePhenobarbitone reduces the congnitive
function in childrenfunction in children
Sodium valproate – potential risk ofSodium valproate – potential risk of
hepatotoxicity in childeren < 2 yrs.hepatotoxicity in childeren < 2 yrs.
Prevention of Recurrences :Prevention of Recurrences : DontDontss
24. Febrile SeizuresFebrile Seizures
Evaluat the causeEvaluat the cause
Early antipyreticsEarly antipyretics
Oral diazepam at the onsetOral diazepam at the onset
of each febrile episodeof each febrile episode
0.3 mg/kg q8h0.3 mg/kg q8h
Prevention of Recurrences :Prevention of Recurrences : DoDoss