Febrile convulsions
Pediatrics revision for AIIMS/AIPGE 2013:
Hot topic: Febrile Convulsions
Compiled from NELSON 19th Ed, Rudolph and Practical guide to seizure and epilepsy in children
Febrile Convulsions:- The most common seizure disorder during childhood-
Age : Febrile seizures are age dependent and are rare before 9 mo and after 5 yr of age. The peak age of onset is approximately 14-18 mo of age
- Incidence approaches 3-4% of young children.
- A strong family history of febrile convulsions in siblings and parents suggests a genetic predisposition. Linkage studies in several large families have mapped the febrile seizure gene to chromosomes 19p and 8q.
- Incidence approaches 3-4% of young children.
- A strong family history of febrile convulsions in siblings and parents suggests a genetic predisposition. Linkage studies in several large families have mapped the febrile seizure gene to chromosomes 19p and 8q.
Definition(Not given in Nelson): An event in infancy or childhood, occurring in children between 3 months to 5 yrs of age, associated with Fever(Rectal temp>38C), in a neurologically normal child, without evidence of intracranial infection.
PPt factors: Viral infections of the upper respiratory tract, roseola, and acute otitis media are most frequently the precipitating causes of febrile convulsions.
Types
1. Simple febrile convulsion (MC) : is usually associated with a core temperature that increases rapidly to 39°C or greater. The seizure is usually GTC type and lasts a few seconds to 10-min, and is followed by a brief post ictal period of drowsiness.
2. Atypical or complicated : when the duration is longer than 15 min, when repeated convulsions occur within the same day, or when focal seizure activity or focal findings are present during the postictal periodRisk of
1. Simple febrile convulsion (MC) : is usually associated with a core temperature that increases rapidly to 39°C or greater. The seizure is usually GTC type and lasts a few seconds to 10-min, and is followed by a brief post ictal period of drowsiness.
2. Atypical or complicated : when the duration is longer than 15 min, when repeated convulsions occur within the same day, or when focal seizure activity or focal findings are present during the postictal periodRisk of
Recurrence: Approximately 30-50% of children have recurrent seizures (Not Epilepsy)Risk of epilepsy in febrile Sz:
NELSON says: - atypical febrile convulsions- a positive family history of epilepsy- an initial febrile seizure before 9 mo of age, - delayed developmental milestones, or- a pre-existing neurologic disorder.As per Seizures and Epilepsy in Children By Proff.
Singhi(She is an authority in this topic in whole of Asia) as well as AAP guidelines, the risk factors for epilepsy in febrile sz are:- Family history- Preexisting neurologic disorder or development delay- Complex/atypical febrile seizures
NELSON says: - atypical febrile convulsions- a positive family history of epilepsy- an initial febrile seizure before 9 mo of age, - delayed developmental milestones, or- a pre-existing neurologic disorder.As per Seizures and Epilepsy in Children By Proff.
Singhi(She is an authority in this topic in whole of Asia) as well as AAP guidelines, the risk factors for epilepsy in febrile sz are:- Family history- Preexisting neurologic disorder or development delay- Complex/atypical febrile seizures
So remember, Age of onset is NOT CONSIDERED a risk factor as per all latest data!!!
In PGI however, u can mark all the options as given above
In PGI however, u can mark all the options as given above
Role of CSF examination:
Presence of CNS or meningeal signs; vomiting etc.EEG , CT and MRI : Only in atypical or complicated febrile seizures
Presence of CNS or meningeal signs; vomiting etc.EEG , CT and MRI : Only in atypical or complicated febrile seizures
Rx : Abort the seizure with BZD i.v.(Diazepam/Lorazepam), but most cases these are self limited
Most important cornerstone of Rx is Fever control with Paracetamol and External cooling
Most important cornerstone of Rx is Fever control with Paracetamol and External cooling
Prophylaxis:
1. Intermittent prophylaxis(Method of choice) : Oral diazepam is an effective and safe method of reducing the risk of recurrence of febrile seizures. At the onset of each febrile illness, oral diazepam, 0.3 mg/kg q8h is administered for the duration of the illness (usually 2-3 days). Alternatively Clobazam oral and Rectal diazepam can also be used
2. Continuous prophylaxis: With Phenobarbitone/Valproate; not recommendedPhenytoin and CBZ are NOT effective
1. Intermittent prophylaxis(Method of choice) : Oral diazepam is an effective and safe method of reducing the risk of recurrence of febrile seizures. At the onset of each febrile illness, oral diazepam, 0.3 mg/kg q8h is administered for the duration of the illness (usually 2-3 days). Alternatively Clobazam oral and Rectal diazepam can also be used
2. Continuous prophylaxis: With Phenobarbitone/Valproate; not recommendedPhenytoin and CBZ are NOT effective
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