Download MBBS Febrile Convulsion Lecture PPT

Definition
They are defined as seizures during fever ,occurring
between 6 months and 5 years of age in the absence of
infection of CNS , in a neurologically normal child.

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They are frequently genetically determined.

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The convulsions are not related to the degree of
temperature, but are frequent if temperature rises
rapidly.

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Febrile convulsions are of 2 types
:Simple febrile convulsions

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:Atypical febrile convulsions

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Simple febrile convulsions
:seizure occur within 24 hour after the onset
of fever, last less than 15min and are usually single per
febrile episode

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:convulsions are generalised
:there is no postictal neurological deficit

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Atypical /complex febrile convulsions
:Lasts more than 15mins /multiple episodes occur
within 24hrs

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:generally seizures are focal
? A febrile seizure that lasts more than 30mins is called
febrile status epilepticus.It occurs in upto 5% febrile
seizures

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Differentiation from meningitis

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Infections of CNS like meningitis ,encephalitis can also
cause convulsions associated with convulsions .
Lumbar puncture is done in first episode of febrile
seizures ,in infants below 1year who are not
immunized with Hib and pneumococcal vaccine/if

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immunization status is not known/if meningitis is
suspected.

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Investigations
Lumbar puncture: done in children below 12months
of age after first febrile seizure to rule out meningitis.

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:children between 12-18 months of age also considered as clinical
signs of meningitis maybe subtle in this group
:for more than 18 months of age its is done in the presence of
clinical signs and symptoms of meningitis [stiff neck, kernig sign]
or if history or clinical examination suggest intracranial infection

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Electroencephalogram
? if first febrile seizure and neurological y healthy then not
required
? If done then usual y done after 2 weeks of seizure.
? Done for at least 30 min of wakefulness and sleep to avoid

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misinterpretations
? Can be done in cases where risk of epilepsy Is high
? if the seizure is prolonged ,then EEG can help distinguish
between ongoing seizure activity and a prolonged postictal
period termed as non epileptic twilight state[NETS]

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Blood studies
qCBC
qBlood glucose for children with postictal obtundation
or those with poor oral meal
qSerum electrolytes

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Neuroimaging
? CT
? MRI

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Treatment of febrile seizures
q Thorough history and detailed general and neurological

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examination must be done.
1. Reduction of temperature by
:antipyretics
:hydro therapy
2. Maintain airway , breathing and circulation

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3.If seizure lasts for>5min then acute treatment with
diazepam/ lorazepam/midazolam is needed

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4.Rectal diazepam is given for recurrence of seizures lasting
for>5min
5.If parents are anxious then intermittent oral diazepam can

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be given during the febrile seizures[.33mg/kg every 8 hr
during fever]
6.For prolonged convulsions i.v access
: for hydration
:anticonvulsants

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7.Iron therapy is done incase of febrile seizure because many
studies have shown that they were associated with low
serum iron.

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Prophylaxis
2 types : continuous

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: intermittent

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Intermittent prophylaxis
done when : 3 or more febrile seizures in 6 months/6 or
more in 1 year /febrile seizure lasting for more than 15
min/need drugs to control seizures

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Includes: clobazam {.75mg/kg/day}
:antipyretics
:hydrotherapy
:temperature recording

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Continuous Prophylaxis

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done when : failure of intermittent therapy
:recurrent atypical seizure
:patient cannot promptly recognize onset
of fever

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vSodium valproate{10-20mg/kg/day}

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vPhenobarbitone{3-5mh/kg/day}
vDuration of therapy : for 1-2 year / until 5 years of age.

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Prognosis
Risk factors for epilepsy
?Major : age <1 year

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:duration of fevr <24hr
:Fever 38-39 degree celsius

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?Minor: family h/o febrile seizures
:family h/o epilepsy-generalised epilepsy with
febrile seizures+[GEFS+] and Dravet syndrome/severe

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myoclonic epilepsy of infancy
:complex febrile seizure
:day care
:male gender
:lower serum sodium

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Risk % for reccurrence
?No risk factors -12 %
?1 risk factor-25-50%
?2 risk factor-50-59%
?3 or more ? 73-100%

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Risk of occurrence of subsequent epilepsy
Simple febrile seizure -1%
Neurodevelopmental abnormalities-33%
Focal complex febrile seizures-29%
Family history of epilepsy -18%

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Fever <1hr before febrile seizure-11%
Complex febrile seizure anytype-6%
Recurrent febrile seizure -4%

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Management of risk
Low risk-no therapy or investigations are required.

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High risk-EEG and imaging
-Intermittent oral diazepam / for recurrence
give continuous therapy.

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