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Pediatrics (Edition 20.) - Phialdelphia, PA: Elsevier

Febrile seizures are seizures that occur between 6-60 months of age associated with a fever of at least 100.4°F, that are not caused by central nervous system infection or metabolic imbalance, and that occur in the absence of a prior seizure history. A simple febrile seizure lasts less than 15 minutes and does not recur within a 24-hour period. Evaluation of a first simple febrile seizure typically does not require a lumbar puncture, EEG, or neuroimaging unless other neurological abnormalities are present. Treatment focuses on managing the seizure if it lasts more than 5 minutes with benzodiazepines, and managing the fever with antipyretics; chronic anticonvulsant therapy is not usually recommended.

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56 views2 pages

Pediatrics (Edition 20.) - Phialdelphia, PA: Elsevier

Febrile seizures are seizures that occur between 6-60 months of age associated with a fever of at least 100.4°F, that are not caused by central nervous system infection or metabolic imbalance, and that occur in the absence of a prior seizure history. A simple febrile seizure lasts less than 15 minutes and does not recur within a 24-hour period. Evaluation of a first simple febrile seizure typically does not require a lumbar puncture, EEG, or neuroimaging unless other neurological abnormalities are present. Treatment focuses on managing the seizure if it lasts more than 5 minutes with benzodiazepines, and managing the fever with antipyretics; chronic anticonvulsant therapy is not usually recommended.

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Joher
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FEBRILE SEIZURE

Source:

Kliegman, R., Stanton, B., St. Geme, J. W., Schor, N. F., & Behrman, R. E. (2016). Nelson Textbook of
Pediatrics (Edition 20.). Phialdelphia, PA: Elsevier.

Febrile seizures are seizures that occur between the age of 6 and 60 mo 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.A simple febrile seizure is a primary generalized,
usually tonic–clonic, attack associated with fever, lasting for a maximum of 15 min, and not recurrent within a
24-hr period.

RULE IN

Age: 1 year, 4 months

Sex: Male

Chief Complaint: “Nag-surip iya mata”

Temperature on HPI: 38.2 C

(+) Intermittent Fever

Evaluation:
Lumbar Puncture
A lumbar puncture is an option in children who have been pretreatedwith antibiotics. In patients presenting with
febrile status epilepticus in the absence of a central nervous system infection, a nontraumatic lumbar puncture
rarely shows cerebrospinal fluid (CSF) pleocytosis (96% have <3 nucleated cells in the CSF) and the CSF
protein and glucose are usually normal.

Electroencephalogram
If the child is presenting with the first simple febrile seizure and is otherwise neurologically healthy, an EEG
need not normally be performed as part of the evaluation.

Neuroimaging
A CT or MRI is not recommended in evaluating the child after a first simple febrile seizure. The work-up of
children with complex febrile seizures needs to be individualized. This can include an EEG and neuroimaging,
particularly if the child is neurologically abnormal.

Treatment

• In general, antiepileptic therapy, continuous or intermittent, is not recommended for children with 1 or
more simple febrile seizures.
• Parents should be counseled about the relative risks of recurrence offebrile seizures and recurrence of
epilepsy, educated on how to handle a seizure acutely, and given emotional support.
• If the seizure lasts for longer than 5 min, acute treatment with diazepam, lorazepam, or midazolam is
needed for acute management of seizures and status epilepticus). ‘
• 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.
• 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.
Currently available data indicate that the possibility of future epilepsy does not change with or without
antiepileptic therapy.
• Iron deficiency is associated with an increased risk of febrile seizures, and thus screening for that
problem and treating it appears appropriate.

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