Febrile Seizure

By Hillary Crandall
April 25, 2011
Febrile Seizure
• Children aged 6 to 60 months
• Simple (All)
• <15 minutes, 1 seizure only in 24 hours
• Generalized, tonic-clonic
• Not postictal
• Complex (Any)
• >15 minutes, >1 seizure or >24 hours after fever
• Focal
• Beginning on one side, eye deviation, loss of muscle tone
• Postictal
Evaluation of Simple Febrile Seizure
• EEG: NO
• Neuroimaging: NO
• Labs: NO
• electrolytes, calcium, phosphorus, magnesium,
glucose, CBC
• Lumbar puncture: NO except…
• Clinical symptoms of meningitis
• Unvaccinated and 6-12 months
• Prevalence of acute bacterial meningitis - 2.4%
• Simple - 0.86%
• Complex - 4.81%
• Pretreated with antibiotics
Evaluation of Complex Febrile Seizure
• EEG: NO
• Labs: ?
• No data, no recommendations
• Neuroimaging: Maybe
• Otherwise well : probably not
• 6 studies, 200 patients, no NS interventions
• Ill-appearing : YES
Evaluation of Complex Febrile Seizure
• Lumbar puncture: Maybe
• 526 patients with CFS
• 64% underwent lumbar puncture
• 0.9% acute bacterial meningitis
• 1 non-responsive, 1 bulging fontanel/apnea, 1 failed LP/bacteremia
• 390 patients with CFS (19% referred)
• 37% underwent LP
• 1.5% acute bacterial meningitis
• 6 altered mental status
• 0.3% HSV meningitis
• 1 altered mental status
YES:
• clinical symptoms of meningitis/altered mental status
• unvaccinated
• pretreated with antibiotics
• Harriet Lane says: strongly recommend <12 months, consider 12-18 months

NO (Probably): Otherwise well

Clinical Features of Meningitis
(Likelihood Ratios)
• Petechiae - 37x • Seizure
• Bulging Fontanel - 8x • Complex – 2x
• Neck Stiffness - 7.7x • Multiple – 1.5x
• Other – 1.4x
• Toxic – 5.8x
• Abnormal cry – 1.8x
• Kernig – 3.5x
• Lethargy – 1.9x
• Fever (>40⁰ C) – 2.9x
• Comatose – 1.8x
• Brudzinski – 2.5x
• Irritability – 1.3x
• Decreased feeding – 2x
References
1. Neurodiagnostic evaluation of the child with a simple febrile seizure. Pediatrics. 2011
Feb;127(2):389-94.
2. Batra P et al. Predictors of meningitis in children presenting with first febrile seizures.
Pediatr Neurol. 2011 Jan;44(1):35-9.
3. Teng D, Dayan P, Tyler S, et al. Risk of intracranial pathologic conditions requiring
emergency intervention after a first complex febrile seizure episode among children.
Pediatrics. 2006;117:304–308
4.Seltz LB, Cohen E, Weinstein M. Risk of bacterial or herpes simplex virus
meningitis/encephalitis in children with complex febrile seizures. Pediatr Emerg Care.
2009 Aug;25(8):494-7.
5. Kimia et al. Yield of lumbar puncture among children who present with their first
complex febrile seizure. Pediatrics. 2010 Jul;126(1):62-9
6.Kimia et al. Utility of lumbar puncture for first simple febrile seizure among children 6 to
18 months of age. Pediatrics. 2009 Jan;123(1):6-12.
7. Curtis et al. Clinical features suggestive of meningitis in children: a systematic review of
prospective data. Pediatrics.