Febrile seizure: Difference between revisions
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===Work-Up=== | ===Work-Up=== | ||
*Glucose in all patients | *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, Ucx, [[CSF studies]] | |||
*Consider CT if: | *Consider CT if: | ||
**Persistently abnormal neuro exam ( | **Persistently abnormal neuro exam (especially with focality) | ||
**Signs/symptoms of increased ICP | **Signs/symptoms of [[increased ICP]] | ||
** | **Patient has [[VP shunt]] | ||
*Consider ECG if: | *Consider [[ECG]] if: | ||
**Family | **Family history of [[long QT]], [[Brugada]], sudden death | ||
*Routine EEG not indicated | *Routine EEG not indicated | ||
**Consider only if developmental delay or for focal symptoms | **Consider only if developmental delay or for focal symptoms | ||
*Causes amenable to specific | *Causes amenable to specific treatment | ||
**Hypoglycemia | **[[Hypoglycemia]] | ||
**Hyponatremia (water intoxication, dilution of formula) | **[[Hyponatremia]] (water intoxication, dilution of formula) | ||
**Hypocalcemia | **[[Hypocalcemia]] | ||
**Hypomagnesemia | **[[Hypomagnesemia]] | ||
**INH ingestion | **[[INH ingestion]] | ||
==Management== | ==Management== | ||
Revision as of 15:23, 6 July 2016
Background
- 50% of patients never have temp >39
- Antipyretics do not offer significant improvements in recurrence rates of febrile seizures[1]
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 Presentation
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[2]
- 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
- Juvenile rheumatoid arthritis
- Pneumonia
- Acute otitis media
- Whooping cough
- Unclear source
- Kawasaki disease
- Neonatal HSV
- Specific virus
Diagnosis
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
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, Ucx, 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
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
- Complex febrile seizure if patient well-appearing, work-up normal
- Follow-up in 24hr
Admit
- Ill-appearing
- Lethargy beyond postictal period
See Also
References
- ↑ 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.
- ↑ Baxter P. et al. Pyridoxine‐dependent and pyridoxine‐responsive seizures. Developmental Medicine & Child Neurology 2001, 43: 416–42