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Febrile Convulsion, Paediatrics

Febrile Convulsion, Paediatrics

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Published by: Sashmi Sareen Manandhar on Apr 23, 2010
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PAEDIATRICS CENTRAL NERVOUS SYSTEM GO-508I-451 N-838
©SASHMI MANANDHAR-KUSMS-5
TH
BATCH Page 1
F
EBRILE CONVULSION
 A.
 
INTRO:a.
 
Ghai:
i.
 
Seizureii.
 
During spikes of feveriii.
 
In a child between 6 months to 5 years(
Nelson: 6 months to 6 years),
peakincidence at 18 monthsiv.
 
In the absence of organic neurologicaldisease
B
.
 
INCIDENCE:
a.
 
Commonest cause of seizure in childhoodb.
 
Age: 3% between 6 months - 5 yearsc.
 
Sex: M>F
C.
 
TYPES:Simple/ 
B
enign Atypical/Complex  Age
6 m 5 y <1 m or >5 y
Type
GTC Focal
Duration
<10 min(Nelson: <15min)>10 min(Nelson:>15 min)
No.
Single per febrileepisode, within 24hrsMultiple perfebrile episode
Post Ictal phase
Absent Altered sensoriumFocal Neurologicdeficits
H/O neuro prob or dev prob
Absent Present
F/H/O Epilepsy 
Absent, but H/Ofebrile convulsionPresent
EEG
Normal within fewdays after seizureAbnormal
Recurrence
10% furthersimple seizure7% furtheratypical seizure
Risk of epilepsy 
1-2% (same asother children)4  12%
D.
 
ETIOPATHOGENESIS:a.
 
Risk Factors: (Ref: Emedicine)
i.
 
Family history: 10% risk if 1
st
degree relativeii.
 
High temperature: Sudden rise, not slowriseiii.
 
Developmental delayiv.
 
Neonatal discharge after 28 days  Peri-natal illness requiring hospitalizationv.
 
Daycare attendancevi.
 
Maternal alcohol intake and smoking duringpregnancy: X 2 times vii.
 
Presence of 2 of the above factors  therisk of 1
st
episode to 30%
b.
 
Etio: Infections that can lead to febrileconvulsion: (Ref: A to Z)
i.
 
Viral URTI: Commonestii.
 
LRTI: Pneumoniaiii.
 
ASOMiv.
 
Measlesv.
 
Shigellosisvi.
 
UTI
c.
 
Patho: (Ref: Emedicine)
i.
 
During dev, low threshold + frequent infecii.
 
Body responds with higher tempiii.
 
Release of IL 1iv.
 
Neuronal excitabilityv.
 
Febrile seizure
National Institutes of Health:
"An event in infancy or childhood usuallyoccurring between
three months and five yearsof age
, associated with fever, but withoutevidence of intracranial infection or definedcause
International League against Epilepsy (ILAE):
"A seizure occurring in childhood
after 1 monthof age
associated with a febrile illness notcaused by an infection of the central nervoussystem (CNS), without previous neonatalseizures or a previous unprovoked seizure, andnot meeting the criteria for other acutesymptomatic seizures"
 
F
AMILY HISTORY
IS MORE SIGNIFICANT IN
F
EBRILE CONVULSION
THAN EPILEPSY
 
PAEDIATRICS CENTRAL NERVOUS SYSTEM GO-508I-451 N-838
©SASHMI MANANDHAR-KUSMS-5
TH
BATCH Page 2
E.
 
DIAGNOSIS: (Ref: emedicine)a.
 
History:
i.
 
Type of seizure (generalized or focal) and itsduration (
R
efer types
)ii.
 
Fever and its duration: Usually with suddenspikes of feveriii.
 
Cause of fever (
R
efer Etio
)iv.
 
Recent antibiotic use: Partially RxMeningitisv.
 
History of seizures, neurologic problems,developmental delay, or other potentialcauses of seizure (eg, trauma, ingestion of toxic substances)
b.
 
Examination:
i.
 
Otitis media, pharyngitis, or a viralexanthemaii.
 
Neurologic statusiii.
 
Meningeal signsiv.
 
Signs of trauma or toxic ingestion
F.
 
D/D: (Ref: emedicine)
a.
 
Status Epilepticusb.
 
Meningitis and encephalitisc.
 
Epidural and subdural infectionsd.
 
Sepsis
G.
 
INVESTIGATIONS: Routinely not necessary a.
 
Lab:
i.
 
Blood: CBC, Cultureii.
 
Urine: R/E , Microscopy, Cultureiii.
 
Electrolyte assessment
b.
 
Imaging:
i.
 
CXR: Rule out LRTIii.
 
CT: If >4 episodes or clinically indicated
c.
 
Other:i.
 
EEG:1.
 
Indi:
a.
 
Atypical febrile convulsionb.
 
F/H/O Epilepsy2.
 
After 6 weeks of 1
st
attack3.
 
Normal in Simple seizure
d.
 
Procedure: Lumbar Puncturei.
 
Indication: (Ref: emedicine)
1.
 
Age < 12  18 months
2
.
 
Signs or circumstances suggestive of meningitis:
a.
 
A visit to a healthcare setting withinthe previous 48 hoursb.
 
Seizure activity at the time of arrivalin the EDc.
 
Focal seizure, suspicious physicalexamination findings (eg, rash,petechiae) cyanosis, hypotension, orgruntingd.
 
Abnormal neurologic examination
H.
 
TREATMENT:a.
 
 At home:
i.
 
Lt lat positionii.
 
Bring down the temp:1.
 
Tepid sponging of the whole body2.
 
Antipyretic: PCM, 15 mg/kg, repeated 8hrlyiii.
 
Control the seizure: If lasting >5 min, RectalDiazepam (if available) oriv.
 
Hospital
b.
 
 At Emergency:
i.
 
Reassurance to the parentsii.
 
ABC
iii.
 
 Antipyretic:
1.
 
Acetaminophen, 10-15 mg/kg PO/PR q4-6h2.
 
Ibuprofen, 200-400 mg PO q4-6h whilesymptoms persist3.
 
Aspirin to be avoided as it can causeReyes Syndrome
iv.
 
 Anticonvulsants:1.
 
Diazepam
a.
 
2-5 years: 0.5 mg/kg PRb.
 
6-11 years: 0.3 mg/kgc.
 
May repeat rectal dose once after 4-12 h if needed2.
 
Midazolam, 0.2 mg/kg IVv.
 
 Antibiotics
: If infec presentvi.
 
If seizure not controlled, RX in the line of status epilepticus

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