Febrile seizure: Difference between revisions

(Text replacement - "Category:Peds" to "Category:Pediatrics")
(19 intermediate revisions by 7 users not shown)
Line 1: Line 1:
==Background==
==Background==
*50% of patients never have temp >39
*50% of patients never have temperature >39
*Antipyretics do not offer significant improvements in recurrence rates of febrile seizures<ref>Rosenbloom E, et al. Do antipyretics prevent the recurrence of febrile seizures in children? A systemic review of randomized controlled trials and meta-analysis. Eur J Paediatr Neurol. 2013; 17:585-588.</ref>
*Febrile seizures do not increase the risk of serious bacterial illness
 
===Prognosis===
===Prognosis===
*2-3% chance of developing epilepsy (1% for general population)
*2-3% chance of developing epilepsy (1% for general population)
*50% of pts &lt;12 mo will have another simple febrile seizure  
*50% of patients <12 mo will have another simple febrile seizure  
*30% of pts &gt;12 mo will have another simple febrile seizure
*30% of patients >12 mo will have another simple febrile seizure


==Clinical Presentation==
==Clinical Features==
*[[Seizure]] + [[fever]]
*[[Seizure]] + [[fever]]


Line 15: Line 16:
{{Pediatric fever DDX}}
{{Pediatric fever DDX}}


==Diagnosis==
==Evaluation==
===Work-Up===
*Glucose in all patients
 
====Simple febrile seizure====
*Neither labs nor neuroimaging are absolutely necessary
*Normal [[Fever (Peds)|pediatric fever workup]]
 
====Complex febrile seizure====
*Consider CBC, [[blood culture]], UA, urine culture, [[CSF studies]]
*Consider CT if:
**Persistently abnormal neuro exam (especially with focality)
**Signs/symptoms of [[increased ICP]]
**Patient has [[VP shunt]]
*Consider [[ECG]] if:
**Family history of [[long QT]], [[Brugada]], sudden death
*Routine EEG not indicated
**Consider only if developmental delay or for focal symptoms
*Causes amenable to specific treatment
**[[Hypoglycemia]]
**[[Hyponatremia]] (water intoxication, dilution of formula)
**[[Hypocalcemia]]
**[[Hypomagnesemia]]
**[[INH ingestion]]
 
===Diagnosis===
The key is to distinguish between simple febrile seizure secondary to minor illness vs. seizure from serious central nervous system infection, which may also present with fever and seizure.
[[File:Febrile Seizure.png|thumb|Algorithm for the differentiation between simple and complex febrile seizures. Guidelines for evaluation of each.]]
===Simple versus Complex===
===Simple versus Complex===
*Simple  
*Simple  
**Generalized tonic-clonic seizure  
**Generalized tonic-clonic seizure  
**<15 min in duration  
**<15 min in duration  
**Age 6mo - 6yr
**Age 6mo - 5yr
**Occurs only once in 24hr period  
**Occurs only once in 24hr period  
**No focal features
**No focal features
*Complex  
*Complex  
**Any exception to above
**Any exception to above
===Work-Up===
*Glucose in all pts
*Simple febrile seizure
**Neither labs nor neuroimaging are absolutely necessary
**Normal [[Fever (Peds)|pediatric fever workup]]
*Complex febrile seizure
**Consider CBC, blood cx, UA, Ucx, CSF studies
*Consider CT if:
**Persistently abnormal neuro exam (esp w/ focality)
**Signs/symptoms of increased ICP
**pt has VP shunt
*Routine EEG not indicated
**Consider only if developmental delay or for focal symptoms
*Causes amenable to specific Tx
**Hypoglycemia
**Hyponatremia (water intoxication, dilution of formula)
**Hypocalcemia
**Hypomagnesemia
**INH ingestion


==Management==
==Management==
Line 56: Line 64:
==Disposition==
==Disposition==
===Discharge===
===Discharge===
*Simple febrile seizure if pt at baseline
*Simple febrile seizure if patient at baseline
**Follow-up in 1-2d  
**Follow-up in 1-2d  
*Complex febrile seizure if pt well-appearing, work-up normal
**Around-the-clock acetaminophen may prevent seizure recurrence in the same febrile episode<ref>Murata et al. Acetaminophen and Febrile Seizure Recurrences During the Same Fever Episode. Pediatrics. November 2018, VOLUME 142 / ISSUE 5</ref>
 
*Complex febrile seizure if patient well-appearing, work-up normal
**Follow-up in 24hr
**Follow-up in 24hr
===Admit===
===Admit===
*Ill-appearing  
*Ill-appearing  

Revision as of 17:56, 18 July 2019

Background

  • 50% of patients never have temperature >39
  • Febrile seizures do not increase the risk of serious bacterial illness

Prognosis

  • 2-3% chance of developing epilepsy (1% for general population)
  • 50% of patients <12 mo will have another simple febrile seizure
  • 30% of patients >12 mo will have another simple febrile seizure

Clinical Features

Differential Diagnosis

Pediatric seizure

Pediatric fever

Evaluation

Work-Up

  • Glucose in all patients

Simple febrile seizure

Complex febrile seizure

Diagnosis

The key is to distinguish between simple febrile seizure secondary to minor illness vs. seizure from serious central nervous system infection, which may also present with fever and seizure.

Algorithm for the differentiation between simple and complex febrile seizures. Guidelines for evaluation of each.

Simple versus Complex

  • Simple
    • Generalized tonic-clonic seizure
    • <15 min in duration
    • Age 6mo - 5yr
    • Occurs only once in 24hr period
    • No focal features
  • Complex
    • Any exception to above

Management

Ongoing Seizure

See Seizure (peds)

Seizure Stopped

Disposition

Discharge

  • Simple febrile seizure if patient at baseline
    • Follow-up in 1-2d
    • Around-the-clock acetaminophen may prevent seizure recurrence in the same febrile episode[2]
  • Complex febrile seizure if patient well-appearing, work-up normal
    • Follow-up in 24hr

Admit

  • Ill-appearing
  • Lethargy beyond postictal period

See Also

References

  1. Baxter P. et al. Pyridoxine‐dependent and pyridoxine‐responsive seizures. Developmental Medicine & Child Neurology 2001, 43: 416–42
  2. Murata et al. Acetaminophen and Febrile Seizure Recurrences During the Same Fever Episode. Pediatrics. November 2018, VOLUME 142 / ISSUE 5