Febrile Seizure

Dr Mallikarjun DStudy Physician Dept Of Community MedicineKMC Manipal

Outline

Definitions Aetiology Classification Clinical presentation Treatment

Abnormal neuronal activity

A sudden biochemical imbalance at the cell membrane

Repeated abnormal electrical discharges

Seen clinically as changes in motor control, sensory perception and/or autonomic function

A Seizure Is:

Definition

Provoked seizures Seizures induced by somatic disorders

originating outside the brain E.g. fever, infection, syncope, head trauma,

hypoxia, toxins, cardiac arrhythmias

Definition

Epilepsy• Present when 2 or more unprovoked

seizures occur at an interval greater than 24 hours apart

Definition

Status epilepticus (SE) Continuous convulsion lasting longer than 30

minutes OR occurrence of serial convulsions between which there is no return of consciousness

Idiopathic SE Seizure develops in the absence of an underlying

CNS lesion/insult Symptomatic SE

Seizure occurs as a result of an underlying neurological disorder or a metabolic abnormality

Causes of seizures

Epileptic Idiopathic (70-80%) Cerebral tumor Neurodegenerative disorders Neurocutaneous syndromes Secondary to

Cerebral damage: e.g. congenital infections, HIE, intraventricular hemorrhage

Cerebral dysgenesis/malformation: e.g. hydrocephalus

Causes of seizures

Non-epileptic Febrile convulsions Metabolic

Hypoglycemia HypoCa, HypoMg, HyperNa, HypoNa

Head trauma Meningitis Encephalitis Poisons/toxins

Parents/caregivers may report seeing:

Repetitive non-purposeful movementsStaringRolling of Eye balls – Upwards Lip-smackingFalling down without causeStiffening of any or all extremitiesRhythmic shaking of any or all extremities

Clinical Presentation: Motor Changes

Parents/caregivers may report the child is:

Feeling nauseousFeeling odd or peculiarLosing control of bowel or bladderFeeling numbness, tinglingExperiencing odd smells or sounds

Clinical Presentation: Sensory and Autonomic

Consciousness is the usual alertness or responsiveness the child demonstrates.

Parents/caregivers may report or you may observe the child to have:Baseline alertness Diminished level of consciousnessUnresponsive and unconscious

Clinical Presentation:Consciousness

Apnea Breath Holding Dizziness Myoclonus Pseudoseizures Psychogenic Seizures

Rigors Syncope Transient Ischemic

Attacks

Clinical Presentation:Events That Mimic Seizures

Seizure Classifications

Generalized PartialComplex Simple

Involves BOTH hemispheres of the brain

Involves motor* or autonomic# symptoms with altered level of consciousness

Can involve motor,* autonomic# or somatosensory+ symptoms

Always involves loss of consciousness May start in one muscle

group and spreadMay start in one muscle group and spread

Types: Tonic or clonic movements

or combination (grand mal) Absence (petit mal) Myoclonic Atonic (e.g., drop attacks) Infantile spasms

Types of symptoms:1) Motor* - head/eye deviation, jerking, stiffening

2) Autonomic# - pupillary dilatation, drooling, pallor, change in heart rate or respiratory rate

3) Somatosensory+ - smells, alteration of perception (déjà vu)

Febrile seizures are the most common seizure disorder in childhood, affecting 2 - 5% of children between the ages of

6 months and 5 years

Febrile Seizure5

Caused by the increase in the core body temperature greater than 100.4o F or 38o C

Threshold of temperature which may trigger seizures is unique to each individual

Can occur within the first 24 hours of an illnessCan be the first sign of illness in 25 - 50% of patients

Febrile Seizure6

Are benign

Occurrence: between 6 months to 5 years of age

May be either simple or complex type seizure

Seizure accompanied by fever (before, during or after) WITHOUT ANY Central nervous system infection Metabolic disturbance History of previous seizure disorder

Febrile Seizure: Characteristics

Simple Febrile

6 months – 5 years of age Febrile before, during or

after seizure Includes all of the following

Seizure lasting less than 15 minutes

Generalized seizure Occurs once in a 24-hour

period

Complex Febrile

6 months – 5 years of age Febrile before, during or

after seizure One or more of the

following Prolonged (lasting more

than 15 minutes) Focal seizure Occurs more than once in

24 hours

Febrile Seizure: Two Types5

Reassess temperature

Consider giving antipyretic if not previously administered

As source of fever is identified, treat appropriately

Simple Febrile Seizure:ED Ongoing Management

Here are some frequently asked questionsparents/caregivers may have prior to discharge:

Is my child brain damaged?There is no evidence of impact on learning abilities after seizure

from SFS.

Will this happen again?If child is under 12 months of age at time of first seizure,

recurrence rate is 50%If child is greater than 12 months of age at time of first seizure,

recurrence rate is 30%Most recurrences occur within 6-12 months of the initial febrile

seizure

Simple Febrile Seizure:Family Education5,7

Will my child get epilepsy?For simple febrile seizures, there is no increased risk of

epilepsy

Why not treat for possible seizures or fever?Anticonvulsants can reduce recurrence. However

potential side effects of medications outweigh the minor risk of recurrence

Prophylactic use of antipyretics does not have impact on recurrence

Simple Febrile Seizure:Family Education5,7 (cont.)

For complex febrile seizures, there is a slight increase in the risk of epilepsy.

For complex febrile seizures, there is a slight increase in the risk of epilepsy.

Instruct parent/caregivers to prevent injury during a seizure:

Position child while seizing in a side-lying position

Protect head from injuryLoosen tight clothing about the neck Prevent injury from fallsReassure child during eventDo not place anything in the child’s mouth

Simple Febrile Seizure:Family Education8 (cont.)

Prior to discharge home…

Educate regarding use of: ThermometerAntipyretics for fever managementWhen to contact 9-1-1 or ambulance

Identify a Primary Care Provider for follow-up appointment and stress importance of follow-up

Provide developmentally appropriate explanationof event for child and family members

Simple Febrile Seizure:Disposition