I.

INRODUCTION

Benign Febrile Convulsion

Seizures or Convulsions are sudden, abnormal electrical discharges from

the brain that result in changes in sensation, behavior, movements, perception, or
consciousness. (Black, 2009) Febrile seizures is a non-epileptic type of seizure
which is provoked by fever (usually above 102oF or 38.9oC). (Hockenberry, 2007)

Febrile seizures (febrile convulsions) are the most common convulsive

events in human experience. They were recognized as distinct from other seizures
in the mid-19th century, and at that time, treatment was redirected to the
underlying causes of fever rather than the symptom of a seizure. With the
introduction of the thermometer at the end of the 1800s, fever was understood to
be the primary factor producing the convulsion. Until the early 20th century,
infantile convulsions were thought to be severe and often fatal. Unfortunately,
few effective treatments were available. Sentinel studies in the 1940s by Lennox
and Livingston investigated risk factors for recurrence and later epilepsy
(Livingston et al 1997). In the 1970s two population-based studies formed the
foundation of the current view of febrile seizures (Nelson and Ellenberg 1998):
they are common, many recur, developmental outcome is not altered, and few
children later develop epilepsy. In the late 1990s two evidence-based practice
parameters by the American Academy of Pediatrics Committee on Quality
Improvement Committee on Quality Improvement, Subcommittee on Febrile
Seizures were published reflecting the current evidence diagnosis and treatment of
febrile seizures (Anonymous, 1999).

About 3% to 4% of all children will have at least one febrile seizure

(Nelson and Ellenberg 1998). Although the seizures are associated with fever
(greater than 38.5°C), those provoked by central nervous system infection are
excluded. The peak age for febrile seizures is 18 to 22 months with a range
between about 6 months and 5 years (Anonymous, 1999).
 Febrile seizures can be subdivided into “simple/benign(gentle or mild)”
(generalized tonic-clonic, duration less than 15 minutes, and without recurrence
within the next 24 hours) or “complex” (focal, prolonged more than 15 minutes,
or occurring in a cluster of 2 or more convulsions within 24 hours). Febrile
seizures are now known to be benign and only 2% to 3% of children will later
develop epilepsy (Nelson and Ellenberg 1998). The risk of epilepsy following a
simple febrile seizure is about 2% and following a complex febrile seizure still
only 5% to 10%. Therefore, the syndrome of febrile seizures can be viewed as a
syndrome of reactive seizures, and not as a true epileptic syndrome where
seizures are unprovoked (Engel 2001).

The group’s client (baby Z) had benign febrile convulsion which was
related to severe infection from his cellulitis. Cellulitis is a
diffuse inflammation of connective tissue with severe inflammation of dermal and
subcutaneous layers of the skin. Cellulitis is caused by a type of bacteria entering
the skin, usually by way of a cut, abrasion, or break in the skin. This break does
not need to be visible. Group A Streptococcus and Staphylococcus are the most
common of these bacteria, which are part of the normal flora of the skin but cause
no actual infection while on the skin's outer surface. Predisposing conditions for
cellulitis include insect bites which was the said cause of his cellulitis.

Current Trends

A child who has a febrile seizure usually doesn't need to be hospitalized. If the
seizure is prolonged or is accompanied by a serious infection, or if the source of the
infection cannot be determined, a doctor may recommend that the child be hospitalized
for observation.

If a child has a fever most parents will use fever-lowering drugs such as
acetominophen or ibuprofen to make the child more comfortable, although there are no
studies that prove that this will reduce the risk of a seizure. One preventive measure
would be to try to reduce the number of febrile illnesses, although this is often not a
practical possibility.

Prolonged daily use of oral anticonvulsants, such as phenobarbital or valproate, to

prevent febrile seizures is usually not recommended because of their potential for side
effects and questionable effectiveness for preventing such seizures.

Children especially prone to febrile seizures may be treated with the drug
diazepam orally or rectally, whenever they have a fever. The majority of children with
febrile seizures do not need to be treated with medication, but in some cases a doctor may
decide that medicine given only while the child has a fever may be the best alternative.
This medication may lower the risk of having another febrile seizure.

It is usually well tolerated, although it occasionally can cause drowsiness, a lack

of coordination, or hyperactivity. Children vary widely in their susceptibility to such side
effects.

Source: www.ninds.nih.gov/disorders/febrile_seizures/detail_febrile_seizures.htm

Complementarity and Alternative Therapy

Low-Carbohydrate or Ketogenic Diet for Seizures

The ketogenic diet (KD) is actually a non-drug therapy for children with seizures.
It was developed in the 1920’s and was based on the clinical observation that fasting
suppresses seizures, probably through the induction of ketosis. Interestingly, the high-fat,
low-carbohydrate KD tends to mimic the ketogenic effects of fasting and places into a
constants state of ketosis. KD suppresses many different types of seizures, including
those that do not respond to the conventional anticonvulsant drugs. The KD is given only
after drug therapy has failed to provide adequate seizure control. KD is effective for
tonic-clonic, absence, complex partial, and multiple types of intractable seizures
associated with Lennox-Gastuat syndrome.

Today, experts may recommend the ketogenic diet for children who have tried at
least two kinds of medication without success, have had intolerable medication side
effects, or have seizures that are very frequent or severe. About two-thirds of those who
try the ketogenic diet improve noticeably or even become seizure-free. Children who start
the diet while taking medication usually must stay on the drugs, at least initially, although
there is the possibility that they can reduce the dosage once the diet starts to have an
effect. Eventually, some children can discontinue their epilepsy medication completely.

Side Effects of the Ketogenic Diet

There are some potential side effects with putting a child on this diet for seizures. Your
child may or may not be affected, but it's always good to know what the potential
problems are before you get started, so that you know what to watch out for.

Just remember to keep a close eye for any irregularities because some of the side effects
can go away if caught early, and the child can continue on with the diet.

Potential side effects include:

 Constipation

 Decreased bone density

 Dehydration

 Eye problems

 Fat buildup in the blood

 Frequent infections

 High cholesterol

 Kidney stones or gall stones

 Pancreatitis

 Poor growth

 Vomiting
Source: http://www.everydayhealth.com/epilepsy/understanding/prevention.aspx

Treatment for cellulitis on the other hand consists of resting the affected area,
cutting away dead tissue and antibiotics, either oral or intravenous. Flucloxacillin
monotherapy (to cover staphylococcal infection) is often sufficient in mild cellulitis, but
in more moderate cases or where streptococcal infection is suspected then usually
combined with oral phenoxymethylpenicillin or intravenous benzylpenicillin, or
apicillin/amoxicillin. Pain relief is also often prescribed, but excessive pain should
always be considered relevant, as it is a symptom of necrotising fascitis, which requires
emergency surgical attention.

Source: http://en.wikipedia.org/wiki/Cellulitis#Treatment

Significance of the Study:

This study will enable the students to understand better about Benign Febrile
Convulsions and will encompass the different risk factors of the disorder, the
pathophysiology of the disorder, the treatment and managements done to prevent the
occurence of the disorder. Since we are client-centered, we really really should consider
our patient’s comfortand this study will help students have sufficient knowledge that will
help them plan and implement nursing care plans that will satisfy the patient’s needs.

Objectives

After the completion of the case study, the student nurses shall have:

A. General Objectives:

Acquired deeper knowledge and understanding regarding the development of

“Benign Febrile Convulsions t/c Cellulitis r/o Radial Dislocation” in relation to the risk
factors presented by (baby Z), discussed manage and treatment and provide better nursing
care and preventive measures through the utilization of the nursing process.

B. Specific Objectives:

 Enumerate the non-modifiable and modifiable risk factors presented by (baby Z) that
have contributed to the development of “Benign Febrile Convulsions t/c Cellulitis r/o
Radial Dislocation” through personal history, family health illness history and history
of past and present illness.
 Identified clinical manifestations presented by (baby Z), which resulted from the
disease process of “Benign Febrile Convulsions t/c Cellulitis r/o Radial Dislocation”.
 Related diagnosis findings to the development of “Benign Febrile Convulsions t/c
Cellulitis r/o Radial Dislocation”
 Discussed the disease process, treatment and management.
 Identified nursing problems and formulate a comprehensive plan of care with the
family of (baby Z) with “Benign Febrile Convulsions t/c Cellulitis r/o Radial
Dislocation” utilizing the nursing process.
 Educated (baby Z) significant others on the prevention of complications and foster
optimal level of functioning physically, physiologically, and psychologically.

SOURCES:

 Book: Medical Surgical Nursing: Clinical Management for Positive Outcomes 8 th

Edition, 2009, Black, J

 Book: Wong’s Clinical Manual for Pediatric Nursing 6 th Edition, 2007, Hockenberry,
MJ

 http://www.ninds.nih.gov/disorders/febrile_seizures/detail_febrile_seizures.htm

 http://en.wikipedia.org/wiki/Cellulitis#Treatment

 http://www.everydayhealth.com/epilepsy/understanding/prevention.aspx
 Livingston S, Bridge EM, Kajdi L. Febrile convulsions: a clinical study with special
reference to heredity and prognosis. J Pediatr 1997;

 Nelson KB, Ellenberg JH. Prognosis in children with febrile seizures. Pediatrics
1998;

 Engel J Jr; International League Against Epilepsy (ILAE). A proposed diagnostic

scheme for people with epileptic seizures and with epilepsy: report of the ILAE Task
Force on Classification and Terminology. Epilepsia