Managing febrile seizures

By Will Stahl-Timmins

Definition: Seizure types:

Childhood seizure Simple Complex Febrile status
1 After one month of age
Child has febrile illness Less than 15 mins More than 15 mins
epilepticus

More than
Is this a No CNS infection Generalised Focal
30 mins
No previous neonatal
febrile or unprovoked seizures No recurrence May have
seizure? within 24 hours repetitive seizures
Doesn’t meet criteria for other
acute symptomatic seizures No postictal Todd’s paresis
—International League Against Epilepsy pathology may be present

Beware an altern- Red flags suggestive of CNS infection: Any physical signs of
ative diagnosis, Antibiotic treatment Complex febrile seizures meningitis/encephalitis
especially if the • Bulging fontanelle
2 fever is less
than 38°C, or in
History of irritability, decreased feeding or lethargy
Incomplete Postictal symptoms
• Focal neurological signs
• Neck stiffness
infants younger immunisation: lasting more than 1 hour
Consider than 6 months.
• Photophobia
• Haemophilus • Limited social response
alternative Causes could influenzae B • Altered consciousness !
Symptoms and signs of
meningeal irritation may
diagnoses include CNS infec- • Streptococcus • Neurological deficit be absent in children
tions or other pneumoniae • Drowsiness under 2 years of age.
causes of fever.

Recurrence: Risk factors

Age at onset under 18 months
Overall recurrence is thought Fever less than 39°C
to be about 1 in 3. Parents can First degree relative has history of febrile seizure
be reassured that recurrence Shorter duration of fever before seizure (<1 hour)
is rare in children with no risk Multiple seizures during the same febrile illness
factors. Day nursery attendance
Epilepsy Children with no risk factors Children with all risk factors
Most children with
FS do not develop
an epilepsy.
3 Risk factors
Family history 4 in 100 80 in 100
Educate of epilepsy chance of further seizures chance of further seizures
and inform Complex febrile
parents seizure Cognitive Advice for Parents
Neurodevelop- impairment
mental Protect child from injury
impairment A single During Do not restrain child
simple seizure
Having all three Do not put anything in their mouth
febrile seizure
risk factors poses no threat Check airway
increases risk of to a child’s cognitive If seizure Place child in recovery position
epilepsy to 50%. development. ends
within 5 Explain that the child may
minutes be sleepy for up to an hour
Rescue medications Seek medical advice
If seizure
For children with high risk of recurrence, continues Call an ambulance
parents should be provided with longer than Administer rescue treatment
benzodiazepines (midazolam or rectal 5 minutes
diazepam) on discharge.

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