 DEFINITION/INTRODUCTION

 CLASSIFICATION(CLINICAL PRESENTATION)
 AETIOLOGY
 RISK FACTORS
 EVALUATION
 INVESTIGATION
 TREATMENT
 DIFFERENTIAL DIAGNOSIS
 PROGNOSIS
 CONCLUSION
 Febrile convulsions are events that occur
between the age of 3months to 5 years with a
temperature of 38° C or higher not caused by
an infection of the central nervous system,
without previous neonatal seizures or a
previous unprovoked seizure and not meeting
the criteria for other acute symptomatic
seizures.
 3-6% of children < 5yrs in the tropics
 2-4% of children < 5 years of age in US
 Incidence as high as 15% in some populations
 Peak occurrence is in children 18 - 24 months of age
 Majority (65 to 90%) of these are simple febrile seizures
 sex: male=female
 SIMPLE FEBRILE SEIZURES
 Lasts less than 15 minutes
 Occurs once in a 24-hour period
 Generalized tonic- clonic seizure
Do not have an increased risk of mortality.

COMPLEX FEBRILE SEIZURES

 Lasts 15 minutes or longer
 Occurs more than once in a 24-hour period
 Focal seizure

May have an approximately 2-fold long-term

increase
in mortality.
 FEBRILE STATUS EPILEPTICUS
Febrile status epilepticus is a febrile seizure
lasting >30 min.
 The mechanisms are unknown, it is uncertain
whether the degree of fever or the rate of rise in
temperature are triggers in febrile seizures
 Genetic factors have been implicated. Strong
family history in siblings and parents:
increase risk 2~3 times.
 Febrile seizure gene: Chromosome 19p and 8q
13-21.Autosomal dominant inheritance in
some families.
SYSTEM DISEASE
Respiratory Upper respiratory tract infection:
Tonsilitis, pharyngitis, sinusitis,
otitis media, epiglottitis
Lower respiratory tract infection:
Pneumonia, bronchitis, acute
laryngo-tracheo-bronchitis

Digestive Gastroenteritis, Gastritis

Musculoskeletal Arthritis, Osteomyelitis

Genitourinary Urinary Tract Infection

 OTHER CAUSES INCLUDE;
 Viral infection e.g Chicken pox,flu
 Post immunization
 Malaria
. FIRST FEBRILE SEIZURES
 Family history of febrile seizures
 HIgh temperature
 Parental report. of devlopmental delay
 Neonatal discharge at an age greater than 28days
 Daycare attendance
 Presence of two of these risk factors
 Maternal alcohol intake and smoking during
pregnancy
 Recurrent Febrile Seizures
MAJOR
 Age < 1 yr
 Duration of fever < 24hr (i.e., shorter duration of fever
before seizure equals higher risk of recurrence)
 Fever 38-39° C
 Multiple initial febrile seizures during same episode
MINOR
 Family history of epilepsy
 Family history of febrile seizures
 Complex febrile seizure
 Day care
Recurrent Febrile Seizures (cont.)
 Do not necessarily occur with the same degree
of fever as the first episode and do not occur
every time the child has a fever
 Values vary with age from as high as 50-65% in
children who are < 1 year of age at the time of
the first seizure to as low as 20% in older
children
 Simple febrile seizure……………………. 1%
 Neurodevelopmental abnormalities……33%
 Focal complex febrile seizure……………29%
 Family history of epilepsy……………….18%
 Fever <1hr before febrile seizure………..11%
 Complex febrile seizure any type……….6%
 Recurrent febrile seizures………………..4%
 Lumbar puncture- A must in all children with
convulsion and fever to rule out meningitis, for
CSF M/C/S and chemistry.
 Random blood sugar

 FBC, Malaria

Urine M/C/S, Urinalysis: if patient is

<18months,complex seizure or no focus of
infection found
Blood culture
 Treatment must be commenced before history
taking
 Abort seizure using Diazepam
 Resuscitate using ABC
 A- Airway clearing
 B- Breathing : ventilate as necessary usually with
AMBU bag if child is still not breathing
 C- Circulation by IV fluid
 Take the history to identify the cause of the fever
and a history of other disorders that can cause
convulsions.
 Proper examination. Dont forget the throat and ear
examination as they are common causes.
 If the seizure lasts for >5 min, then acute
treatment with diazepam, lorazepam, or
midazolam is needed
 Rectal diazepam is often prescribed to be given
at the time of recurrence of febrile seizure
lasting >5 min^
 Intravenous
benzodiazepines,phenobarbital,phenytoin, or
valproate may be needed in the case of febrile
status epilepticus.
 CONTINUED MANAGEMENT
. SUPPORTIVE
Tepid sponge and fan to bring down fever
Expose the child
Cold saline lavage in selected cases of persistent
high fever and repeated seizure despite above
measures
Treat underlying disease e.g. UTI, Malaria
Gastric lavage in history of concotion ingestion
Follow up the patient to rule out seizure disorder
 Rigors
 Meningitis
 Cerebral malaria
 Epilepsy
Generally good because mostly it doesn’t recur
beyond age 5. there is no evidence of an increased
risk of death, even for children with status
epilepticus.
Intellect is not affected.
Recurrence is in about 30% with risk factors.
Risk of developing epilepsy is only with some
features e.g. complex febrile seizures, other
neurologic abnormality, family history, fever
<1hr before seizure
 Always remember that febrile seizure is the
commonest seizure in childhood
 It causes no brain injury
 Fever prevention should be encouraged
 Use of anticonvulsant such as
phenobarbitone,valproic acid can prevent
recurrence but side effects outweighs benefits
 There is no evidence that preventing febrile
seizures decreases the risk of epilepsy