FEBRILE CONVULSION

BACKGROUND

SEIZURE: Is a change in the brain’s electrical activity or a transient

occurrence of signs or symptoms resulting from abnormal excessive
synchronous neuronal activity in the brain.
CONVULSION: A sudden, violent, irregular movement of the body,
caused by involuntary contraction and relaxation of muscles.
FEBRILE CONVULSION: Is a convulsion that occur between the age
of 6 and 60 month with a temperature of 38 degree Celsius or
higher, that are not the result of Central Nervous System infection
or any metabolic imbalance, and that occur in the absence of a
history of prior afebrile seizure.
BACKGROUND CONT.

TYPES OF FEBRILE CONVULSION:

• Simple Febrile Convulsion; is a primarily generalized, usually
tonic-clonic, attack associated with fever, lasting for a maximum
of 15min, and not recurrent within a 24hr period.
• Complex Febrile Convulsion; is more prolonged (>15min but
<30min), is focal, and recurs within 24 hr.
PATHOPHYSIOLOGY

• Animal studies suggest a possible role of endogenous pyrogens,

such as interleukin 1beta,that, by increasing neuronal excitability
may link fever and seizure activity.
• Studies in children tend to support this hypothesis that the
cytokine network is activated and may have a role in the
pathogenesis of febrile seizure.
EPIDEMIOLOGY

• Between 2% and 5% of neurologically healthy infants and children

experience at least one, usually simple, febrile seizure.
• Mostly occur at age 6 to 18 months
• Simple febrile convulsion do not have an increased risk of mortality even
though they are concerning to the parents.
• Complex febrile convulsion may have a long term increase in mortality.
• There are no adverse effects of having >1 simple febrile seizures,
specifically, recurrent simple febrile seizures do not damage the brain.
• NB: Patients with febrile seizures do not have any increase in incidence
of abnormalities of behavior, scholastic performance, neurocognitive
function, or attention.
EPIDEMIOLOGY CONT.

• Febrile seizures recur in approximately 30% of those experiencing

first episode, in 50% after 2 or more episodes, and in 50% of
infants < 1yr old at febrile seizure onset.
AETIOLOGY

• In our setting, the major cause of Febrile Convulsion is MALARIA.

Other common causes are; Pneumonia, UTI, URTI, Gastroenteritis,
Influenza A, Roseola, chicken pox, Genetic and Familial factors,
most importantly after certain vaccinations such as diphtheria,
tetanus toxoid, mumps, rubella, pertussis and measles
RISK FACTORS

• Family history of febrile convulsion

• High temperature
• Maternal alcohol intake and smoking during pregnancy
• Daycare Attendance
SIGNS AND SYMPTOMS

Signs:
• You will see a child between the age 6-60 months
• Who looks acutely ill and lethargic
• Febrile (Tem:>38 Degree Celsius)
• In obvious respiratory distress
• Anemic
• Dehydrated( dry mouth, sunken eyes, sunken fontanelle, & lack of
tears)
SIGN and SYMPTOMS CONT.

• Central Nervous:
• Unconscious
• Appear dazed(eyes rolling back)
• Stiff body, then general twitch or shake
• Focal convulsion(one part of the body twitches or shakes)
• Sleepiness after convulsion
• Involuntary moaning or crying
NB: Convulsion may last for 15mins, more than 15mins, or more than
30mins. And can recur within 24hrs.
SIGNS and SYMPTOMS CONT.

Cardiovascular:
• Tachycardia

Respiratory:
• Transmitted breathe sounds
• Crepitation
• Reduction of air in the chest
SIGNS and SYMPTOMS CONT.

Symptoms:
• Cough
• Dyspnea
• Nasal congestion
• Nasal discharge
• Vomiting
• Involuntary passing of urine
• Involuntary passing of feaces
 INVESTIGATIONS and DIAGNOSIS

• BF for MPs
• FBC
• Chest X-ray
• Urine R/E
• Widal Test
• RBS
• *Lumbar Puncture Test*
• NB: For further or more advanced investigations; EEG, BUE & Cr, &
Cranial CT.
MANAGEMENT

• ABC; Check the Airway, if its patent, Breathing; if breathing is not

normal give oxygen. Circulation; pass iv line and take samples for
test. Give IVF 1/5 N/S in 4.3% Dextrose
• Give Antipyretic ( supp. Paracetamol).
• If seizures recurs, give rectal Diazepam 0.5mg/kg stat.
• Vital signs should be monitored half hourly and a seizure chat
drawn.
• Treat the underlying cause.
• NB: *clients should be nursed at a left lateral position*
COMPLICATIONS

• Febrile Status Epilepticus: Is a febrile seizure lasting > 30 min.

• Epilepsy (abt 1% in simple and abt 29% in focal complex febrile
seizures)
DIFFERENTIAL DIAGNOSIS

• Meningitis
• Encephalitis
• Peadiatric Status Epilepticus
• Epidural Infections(Spinal Epidural Abscess)
• Subdural Infections(Subdural Empyema)
REFRENCES

• Nelson Textbook of Peadiatrics 19th Edition

• The Merck Manual 18th Edition
• Medscape
• Pathologic Basics of Disease 18th Edition