CASE REPORT

FEBRIL SEIZURE OF CHILD

BY :
Syeba Jochebed
 Definition
• Febrile seizures are seizures or convulsions that
occur in young children and are triggered by
fever. Young children between the ages of about
6 months and 5 years old are the most likely to
experience febrile seizures.
• Most febrile seizures last only a few minutes and
are accompanied by a fever above 101°F (38.3°C).
Although they can be frightening for parents,
brief febrile seizures (less than 15 minutes).
 Mortality and Morbidity
• Children with a previous simple febrile seizure are at increased risk of recurrent
febrile seizures; this occurs in approximately one third of cases.

• Children younger than 12 months at the time of their first simple febrile seizure
have a 50% probability of having a second seizure. After 12 months, the probability
decreases to 30%.

• Children who have simple febrile seizures are at an increased risk for epilepsy. The
rate of epilepsy by age 25 years is approximately 2.4%, which is about twice the
risk in the general population.

• The literature does not support the hypothesis that simple febrile seizures lower
intelligence (ie, cause a learning disability) or are associated with increased
mortality.

• Males have a slightly (but definite) higher incidence of febrile seizures.

• Simple febrile seizures occur most commonly in children aged 6 months to 5 years.
 Signs and symptoms

• Simple febrile seizure :

• The setting is fever in a child aged 6 months to 5 years
• The single seizure is generalized and lasts less than 15
minutes
• The child is otherwise neurologically healthy and without
neurologic abnormality by examination or by developmental
history
• Fever (and seizure) is not caused by meningitis, encephalitis,
or any other illness affecting the brain
• The seizure is described as either a generalized clonic or a
generalized tonic-clonic seizure
 Classified
1. Complex febrile seizure
• Age, neurologic status before the illness, and fever are
the same as for simple febrile seizure
• This seizure is either focal or prolonged (ie, >15 min),
or multiple seizures occur in close succession
2. Symptomatic febrile seizure
• Age and fever are the same as for simple febrile seizure
• The child has a preexisting neurologic abnormality or
acute illness
PATHWAY
 Risk factors

• Factors that increase the risk of having a febrile seizure

include:
• YOUNG AGE. Most febrile seizures occur in children
between 6 months and 5 years of age. It's unusual for
children younger than 6 months to have a febrile seizure,
and it's rare for these seizures to occur after 3 years of age.
• Family history. Some children inherit a family's tendency to
have seizures with a fever. Additionally, researchers have
linked several genes to a susceptibility to febrile seizures.
• HIPOKSIA
 DIAGNOSE
• Simple febrile seizures
• To determine the cause of infection, your doctor may recommend:
• A blood test
• A urine test
• A spinal tap (lumbar puncture), to find out if your child has a central
nervous system infection, such as meningitis

• Complex febrile seizures

• For complex febrile seizures, your doctor also may recommend an
electroencephalogram (EEG), a test that measures brain activity.
• If the seizure involved just one side of the child's body, your doctor
may also recommend an MRI to check your child's brain.
 Identity
• Patient
• Name : An. S
• Sex : fFemale
• Tanggal Lahir : 18 Juni 2017
• Usia : 9 Bulan
• Agama : Islam
• Alamat : Jl. Raden Saleh 4
•
• Identitas Orang Tua Pasien
• Ayah
• Nama : Tn. A Agama : Islam
• Tanggal Lahir : 03 Mei 19862 Pendidikan: SMA
• Suku Bangsa : Padang Pekerjaan : Tukang Ojek
• Alamat : Jl. Raden Saleh 4 Penghasilan : 6 Juta / Bulan
• Ibu
• Nama : Ny. M Agama : Islam
• Tanggal Lahir : 17 April 1986 Pendidikan: SMA
• Suku Bangsa : Betawi Pekerjaan : IRT
• Alamat : Jl. Raden Saleh 4 Penghasilan : 3 Juta / Bulan
• Patient came to IGD RS PGI Cikini escorted by his mother with complaints seizure
since this morning. Her parents said the seizure lasted for about 4-5 minutes.
When the patient's hand clenched clenched and moved simultaneously with
eyes glaring up the right. Seizures lasted as much as 3x on the same day. First at
half thirty in the morning, then five o'clock in the morning and then back again
at 7:00 am.
• Originally appeared first seizure on December 3, 2017. Seizure lasted for 2
minutes. The patient's mother told the moment of the seizure, the patient's eyes
glared up right and then the patient's body stiffened like a statue, without any
movement. Then a few moments later the patient awakens and cries.
• Then the patient seizures to the 2nd time in the same month, December 26,
2017, for about 5 minutes. Seizures are just like the first seizures. Then the
patient was taken to Rs.Hermina and the doctor said there was congenital heart
disease, then the patient was given the drug but not taken at all.
• Then the seizures repeated again on February 1, 2018, just like the previous
seizures. Then the patient's mother took the patient to an alternative clinic and
sorted it out. Until 28 February 2018 the seizures recurred but the seizures were
different from the previous ones, as the patient's hands clenched and clenched
his hands and accompanied by a fever.
• Past medical history :
• The patient had had a seizure about 2 months ago and
was hospitalized, then repeated again.

• Family Disease History :

• In the patient's family no one experiences the same
complaint.

• Allergy History :
• Disputed by the patient.
 Pregnancy History

• Antenatal Care
• • Trimester I → 1 time per month at Puskesmas
• • Trimester II → 1 time per month at Puskesmas
• • Trimester III → 2 times per month at the
Hospital
• Pregnancy Disease: Hypertension of pregnancy
 Birth History

• How to Delay: Partus Spontaneously

• Place of Birth: Hospital
• Birthmill: Doctor
• Gestation Period: Fair Months
• Difficulty: Denied by the patient's mother
Birth Weight: 3400 Grams
• Length: 51 cm
• Head circumference: The patient's mother does not
remember
 Growth and Development

• First gear growth: 8 months

• Impaired mental development: None
• Psychomotor
• Prone: 5 months
• Sitting: 8 months
•Stand up : -
• Walking: -
• Speaking: -
• Reading / Writing: -
 Food History

• • 0-6 Months
• Exclusive breastfeeding is given every 2-3 hours for <10
minutes in a day (the patient suckling only intermittently
because of rapid fatigue)
• • 6-9 Months
• Milk formula given as much as 90-120 cc a day as much as
3 times. In addition, it is also given filtered porridge with
side dish of chicken / liver aya / fish / eggs and carrots and
spinach are mashed given as much as 3 times a day (1/3
cup adults) and bananas / papaya 2 times a day.
 Generalist Status

• General Condition : Medium pain

• Awareness : Composmentis

• Vital sign
• Blood pressure : -
• Pulse Frequency : 132 times / min, regular, strong lift, enough content
• Respiratory Frequency : 30 times / min, abdominal, regular breathing
• Temperature : 39.70 C

• Anthropometric Data
• Weight : 6.8 kg
• Length : 51 cm
• Upper Arm Circumference: 23 cm
• Head : Normocephali, hair growth evenly, hair is not easily revoked, black hair
• Eyes : Conjunctival anemis (- / -), jaundice sclera (- / -)
• Sunken eyes (-/-)
• Ear : intact tympanic membrane (+ / +), serumen (+/-)
• Nose : Symmetrical, septum deviation (-), konka eutrophy, secretions (-)

• Mouth:
• Lips : Dry lips mucosa (-), hyperemic (-), cyanosis (-)
• Teeth: Tooth perforated (-), caries (-)
• Tongue : Coated tongue (+)
• Faring : Hyperemic (-)
• Tonsil : T1-T1, hyperemic (- / -)
• Lung:
• Inspection : Movement of right and left symmetric thoracic wall, Rearrangement of ribs (-)
• Palpation : Fremitive vowel is not megeras, symmetrical right and left
• Percussion : Sonor - Sonor
• Auscultation : vesicular BND (+ / +), wheezing (- / -), Ronkhi (- / -)
•
• Heart:
• Inspection : The curt pulse is not visible
• Palpation : The palpable cordis pulsation is palpable on the ICS 5 linea midclavicula sinistra
• Percussion : The right heart margin lies on the ICS IV linea parasternalis dextra. The left heart
border lies on the ICS V linea midclavicula sinistra
• Auscultation : Irregular I and II heart sound, murmur (+) systolic ejection, gallop (-)

• Abdomen:
• Inspection : Abdomen looks flat
• Auscultation : Bowel sound (+), 5 times per minute
• Percussion : Timpani, tap pain (-)
• Palpation : Supel, tenderness (-)

• Extremities : Superior → CRT <2 sec, warm acral, edema (- / -)

• Inferior → CRT <2 sec, warm acral, edema (- / -)
• Working Diagnosis: Complex
Febrile Seizures with Innate Heart
Disease type Asianotic
• Differential Diagnosis:
• 1. Epilepsy
• 2. Tetralogy of Fallot
• 3. Absans seizures
 Farmacotherapy
• IVFD : Ka En 3B 18 tpm (mikro)
•
• Mm/ : - Zinc pro 1x 20 mg
• - Lacto B / prolac 2x1 bungkus
• - Valeptik syrup 150 mg/ 5 ml
 Education:

• Stay calm and not panic

• Loosen tight clothes especially around the neck
• If unconscious, position your child back with your head tilted. Clean
vomit or mucus in the mouth or nose. Although the possibility of
tongue bitten, do not put something into the mouth.
• Measure temperature, observation and long notes and seizure
forms.
• Stay with the patient during a seizure
• Give diazepam rectal. And do not give when the seizure has stopped.
• Take it to a doctor or hospital if the seizure lasts 5 minutes or more.
• Prognosis
• Ad Vitam : Ad Bonam
• Ad Functionam : Ad Bonam
• Ad Sanationam : Ad Malam
THANKYOU