Febrile seizure

Febrile seizure
Presented by
Sah, Kalpana
Postgraduate intern

Contents
 Definition
 Classification
 Epidemiology
 Risk Factors
 Causes
 Diagnosis
 Treatment

Definition
• Febrile seizures are seizures that occur between the age of 6 and 60 month with
a temperature of 38°C (100.4°F) 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 seizures.
 Generally accepted criteria for febrile seizures include:
– A convulsion associated with an elevated temperature greater than 38°C
– A child older than 6 months and younger than 6 years of age
– Absence of central nervous system infection or inflammation
– Absence of acute systemic metabolic abnormality that may produce
convulsions
– No history of previous afebrile seizures

Classifications
 Febrile seizures are further divided into two categories, simple or
complex, based on clinical features :
1. Simple febrile seizures: the most common type, are characterized by
seizures associated with fever that are generalized, usually tonic-
clonic, last less than 15 minutes, and do not recur in a 24-hour period.
2. Complex febrile seizures: seizures associated with fever that are
characterized by episodes that have a focal onset (e.g. shaking limited
to one limb or one side of the body), last longer than 15 minutes, or
occur more than once in 24 hours.
• Febrile Status Epilepticus : febrile seizure lasting longer than 30 min or
intermittent seizure without neurologic recovery.

•Simple Febrile Seizure
•10 generalized,
•last for a max of 15 min
•not recurrent within a
•24-hour period
•majority of FS (85 %)
•Complex Febrile Seizure
•focal
•more prolonged (>15 min),
•recurrent within 24 hr
•may begin as stare or jerking on
one side of the body
Febrile Seizure (FS) Classification
•Febrile Status Epilepticus
•febrile seizure
•lasting >30 min.

Febrile seizure
• Between 2% and 5% of neurologically healthy infants
and children experience at least 1, usually simple,
febrile seizure.
• Simple febrile seizures do not have an increased risk
of mortality
• Complex febrile seizures may have an approximately
2-fold long-term increase in mortality, as compared
to the general population, over the subsequent 2 yr,
probably secondary to coexisting pathology.

Epidemiology
 The most common neurologic disorder of infants and
young children's.
 They are age dependent phenomenon.
 Occurs between the age of 6 months to 5 years
 Occurring in 2-4 % of children younger than 5 years.
 Peak incidence between 12-18 months.
 Male predominance with estimated male to female
ratio 1.6:1

Epidemiology
• Recur in approximately 30% of those experiencing
a first episode and 50 % of infants <1 year old at
febrile seizure onset.
• Although about 15 % of children with epilepsy
have had febrile seizures, only 2-7% of children
who experience febrile seizures proceed to
develop epilepsy later in life.

Genetic Factors
• Positive family history – the disorder is inherited
as an autosomal dominant trait, and multiple
single genes causing the disorder have been
identified.

Risk Factors for Recurrence of Febrile
Seizures
• Major
1. Age < 1year
2. Duration of fever < 24hr
3. Fever 38-39 (100.4-
102.2°F)
• Minor
1. Family history of febrile
seizure
2. Family history of epilepsy
3. Complex febrile seizure
4. Daycare
5. Male gender
6. Low serum sodium at time
of presentation

Risk factor
• Having no risk factors carries a recurrence risk of
approximately 12%;
• 1 risk factor, 25-50%;
• 2 risk factors, 50-59%;
• 3 or more risk factors, 73-100%.

Causes
 Upper respiratory tract infection
 Roseola infantum (HHV-6)
 Gastroenteritis ( Shigella or campylobacter)
 Influenza Virus
 Urinary tract infection

Work-up
• History
• Physical Examination
• Lumbar Puncture
• Electroencephalography - Prognostic Procedure
• Blood Studies
• Neuroimaging

Management
History: fever with actual
shaking, upward rolling of
eyes, and cyanosis that lasts
for a couple of minutes (1
episode only).
More than 3 FS episodes
may indicate another
problem.

Treatment
• If the seizure lasts for longer than 5 min, acute treatment
with diazepam, lorazepam, or midazolam is needed .
• Rectal diazepam is often prescribed to be given at the time
of reoccurrence of a febrile seizure lasting longer than 5
min
• Alternatively, buccal or intranasal midazolam may be used
and is often preferred by parents.
• Intravenous benzodiazepines, phenobarbital, phenytoin, or
valproate may be needed in the case of febrile status
epilepticus.

Treatment
• If the parents are very anxious concerning their
child’s seizures, intermittent oral diazepam can be
given during febrile illnesses (0.33 mg/kg every 8 hr
during fever) to help reduce the risk of seizures in
children known to have had febrile seizures with
previous illnesses.
• Intermittent oral nitrazepam, clobazam, and
clonazepam (0.1 mg/kg/day) have also been used.

Treatment
• Antipyretics can decrease the discomfort of the
child but do not reduce the risk of having a
recurrent febrile seizure, probably because the
seizure often occurs as the temperature is rising
or falling.
• Chronic antiepileptic therapy may be considered
for children with a high risk for later epilepsy.

References
 Nelson TEXTBOOK of PEADIATRICS 20th edition
 Nelson Essentials of Pediatrics 7th edition

Febrile seizure

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