Febrile seizure: Difference between revisions
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==Background== | ==Background== | ||
*50% of patients never have | *50% of patients never have temperature >39 | ||
* | *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 patients | *50% of patients <12 mo will have another simple febrile seizure | ||
*30% of patients | *30% of patients >12 mo will have another simple febrile seizure | ||
==Clinical Features== | ==Clinical Features== | ||
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{{Pediatric fever DDX}} | {{Pediatric fever DDX}} | ||
== | ==Evaluation== | ||
===Work-Up=== | ===Work-Up=== | ||
*Glucose in all patients | *Glucose in all patients | ||
Line 49: | Line 40: | ||
**[[Hypomagnesemia]] | **[[Hypomagnesemia]] | ||
**[[INH ingestion]] | **[[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 | |||
**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== | ==Management== | ||
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*Simple febrile seizure if patient at baseline | *Simple febrile seizure if patient at baseline | ||
**Follow-up in 1-2d | **Follow-up in 1-2d | ||
**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 | *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
- Epileptic seizure
- First-time seizure
- Seizure with known seizure disorder
- Status epilepticus
- Temporal lobe epilepsy
- Non-compliance with or "outgrowing" AEDs
- Non-epileptic seizure
- Febrile seizure
- Brain inflammation
- Increased ICP
- Seizure with VP shunt
- Hydrocephalus
- Intracranial mass
- Toxicologic
- Metabolic abnormalities: hyponatremia, hypernatremia, hypocalcemia, hypomagnesemia, hypoglycemia, hyperglycemia
- Pyridoxine responsive seizure[1]
- Eclampsia
- Posterior reversible encephalopathy syndrome
- Impact seizure (head trauma)
- Other mimics
- Psychogenic nonepileptic seizure (pseudoseizure)
- Syncope (peds)
- Breath-holding spell
- Hyperventilation syndrome
- Migraine headache
- Movement disorders
- Narcolepsy/cataplexy
- Post-hypoxic myoclonus (Status myoclonicus)
- Infantile Spasms/West Syndrome
Pediatric fever
- Upper respiratory infection (URI)
- UTI
- Sepsis
- Meningitis
- Febrile seizure
- Pneumonia
- Acute otitis media
- Whooping cough
- Unclear source
- Kawasaki disease
- Neonatal HSV
- Specific virus
Evaluation
Work-Up
- Glucose in all patients
Simple febrile seizure
- Neither labs nor neuroimaging are absolutely necessary
- Normal 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:
- 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.
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
- Treat underlying infection if indicated
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