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FEBRILE SEIZURES

Shrikant joshi

DEFINITION
Brief (<15 min), generalized, tonic-clonic seizure associated with a febrile illness, but without any CNS infection, severe metabolic disturbance, or other known neurological cause The most common seizure disorder during childhood

INTRODUCTION
Age: 6 m/o ~ 5 y/o Incidence: 2% ~ 4% in children <5 y/o Peak age of onset: 18 ~ 22 m/o

GENETICS
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

CLINICAL PRESENTATION
Typical - simple Atypical - complex

TYPICAL PRESENTATION
80~90% of cases Occur early when core temperature reaches 38 C or greater Generalized, tonic-clonic For seconds to 15-min Not recur within 24 hrs

ATYPICAL PRESENTATION
Age < 6 m/o or > 5 y/o Onset >24 hr after fever onset Duration >15 min Occur more than once in 24 hr Focal motor manifestations Abnormal neurological examination

FEBRILE STATUS EPILEPTICUS

Febrile seizure lasting > 30 min.

INVESTIGATION

Typical: not required

Atypical: required
EEG Toxicology screening Assessment of electrolytes CT or MRI

CSF STUDY
To

rule out meningitis When CNS infection was suspected Atypical febrile convulsion Age < 1yr ?

EEG
Restricted to special cases to outline the type of epilepsy Performed > 2 wks of febrile seizures , as EEG performed <3 weeks have nonspecific slowing EEG done for atleast 30 min in wakefullness & in sleep.

NEUROIMAGING
CT or MRI not indicated after simple febrile seizure. Required in complex febrile seizure particularly if child is neurologically abnormal.

TREATMENT

Rational goal Preventing or aborting prolonged febrile seizures to prevent status epilepticus with its attendant complications

TERMINATING FEBRILE SEIZURE IN HOSPITAL

Terminate the seizure by IV Diazepam or Lorazepam. Rectal Diazepam appropriate in prehospital settings such as ambulence & if IV access is difficult. Control of fever, by antipyretic & tepid sponging.

TERMINATING FEBRILE SEIZURE IN HOME


Rectal diazepam With caution & only by reliable caregiver who have been trained in its use.

PREVENTING FEBRILE SEIZURES

Intermittent medications Daily medications

INTERMITTENT MEDICATIONS
Anti pyretics: Little evidence that it reduce risk of recurrence. Bzs : Diazepam orally or rectally at time of onset of febrile illness reduce probability of febrile seizure. Barbiturates: Phenobarbital at onset of fever ; but not much effective.

DAILY MEDICATIONS
Barbiturates: Phenobarbital given daily at doses that achieve a blood level of 15 microgm/ml or higher is effective to reduce risk of recurrence , but has potential longterm adverse effect on cognition & behavior Valproate: Effective but risk of idiosyncratic hepatotoxicity

PROGNOSIS
Excellent prognosis in most children Risk of recurrence:

Onset

< 1 y/o or with family history:

50% Onset > 1 y/o: -30 % after 1st episode -After second episode: 50 % Age > 5 y/o: near zero

RISK FACTOR FOR RECURRENCE


SEIZURES

OF FEBRILE

Major - age < 1 yr - duration of fever <24 hr - fever 38-39 C Minor - Family history of febrile seizures - family history of epilepsy - complex febrile seizure - day care - male gender - lower serum sodium

RISK OF EPILEPSY DEVELOPMENT


1~2% in the general population increase up to 9% when two or more risk factors are present

Risk factors for epilepsy


Atypical febrile convulsion Previous abnormal development or neurological disorder Epilepsy in 1st degree relatives Young age (<12 Months) 1st degree consanguinity of parents

49%

22%

6%
2.5%

NO RISK FACTORS

1 RISK FACTORS

2 RISK FACTORS

>3 RISK FACTORS

Risk of future epilepsy in children with febrile seizures

Thank You for Your Attention !