Febrile seizure: Difference between revisions
ClaireLewis (talk | contribs) |
ClaireLewis (talk | contribs) No edit summary |
||
| Line 15: | Line 15: | ||
*Single seizure in 24hr | *Single seizure in 24hr | ||
*Duration <15min | *Duration <15min | ||
*Generalized | *Generalized with no focal features | ||
*Returns to neurologic baseline and has normal neuro exam after brief post-ictal period | *Returns to neurologic baseline and has normal neuro exam after brief post-ictal period | ||
===Complex Febrile Seizure=== | ===Complex Febrile Seizure=== | ||
* | *Any exception to above | ||
*May indicate more serious disease process | *May indicate more serious disease process | ||
| Line 30: | Line 27: | ||
==Evaluation== | ==Evaluation== | ||
*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. | |||
*Glucose in all patients | *Glucose in all patients | ||
| Line 54: | Line 51: | ||
**[[INH ingestion]] | **[[INH ingestion]] | ||
[[File:Febrile Seizure.png|thumb|Algorithm for the differentiation between simple and complex febrile seizures. Guidelines for evaluation of each.]] | [[File:Febrile Seizure.png|thumb|Algorithm for the differentiation between simple and complex febrile seizures. Guidelines for evaluation of each.]] | ||
==Management== | ==Management== | ||
| Line 79: | Line 65: | ||
*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> | **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 | ||
Revision as of 00:07, 15 September 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
Simple Febrile Seizure
- Age 6mo-5yr
- Single seizure in 24hr
- Duration <15min
- Generalized with no focal features
- Returns to neurologic baseline and has normal neuro exam after brief post-ictal period
Complex Febrile Seizure
- Any exception to above
- May indicate more serious disease process
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
- Juvenile Rheumatoid Arthritis
- Pneumonia
- Acute otitis media
- Whooping cough
- Unclear source
- Kawasaki disease
- Neonatal HSV
- Specific virus
Evaluation
- 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.
- 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
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