Febrile Seizures

Janith Chandrakumara
What is a seizure?
• A seizure is a transient occurrence of signs and/or symptoms resulting
from abnormal excessive or synchronous neuronal activity in the
brain.
• Acute symptomatic seizures occur secondary to an acute problem
affecting brain excitability such as electrolyte imbalance.
• An unprovoked seizure is one that is not an acute symptomatic
seizure.
• Epilepsy is a disorder of the brain characterized by an enduring
predisposition to generate seizures and by the neurobiologic,
cognitive, psychologic, and social consequences of this condition.
What is a febrile seizure?
• Febrile seizures are seizures
• (that occur between the age of 6 and 60 month)
• with a temperature of 38°C (100.4°F) or higher,
• that are not the result of central nervous system infection or any
metabolic imbalance, and
• that occur in the absence of a history of prior afebrile seizures.

• The fever can occur at any time and sometimes after the seizure!
Simple and Complex febrile seizures
• A simple febrile seizure is a
• primary generalized, usually tonic–clonic, attack associated with fever,
• lasting for a maximum of 15 min, and
• not recurrent within a 24-hr period.

• A complex febrile seizure is moreprolonged (>15 min), is focal, and/or

reoccurs within 24 hr.
• Febrile status epilepticus is a febrile seizure lasting longer than 30
min. Occurs in 5% of cases.
• Between 2% and 5% of neurologically healthy infants and children
experience at least 1, usually simple, febrile seizure.
• Simple febrile seizures do not have an increased risk of mortality
• Complex febrile seizures may have an approximately 2-fold long-term
increase in mortality, as compared to the general population, over the
subsequent 2 yr, probably secondary to coexisting pathology.
• There are no long-term adverse effects of having 1 or more simple febrile
seizures, compared with age-matched controls, patients with febrile
seizures do not have any increase in the incidence of abnormalities of
behavior, scholastic performance, neurocognitive function, or attention.
What causes Febrile Convulsions?
• Causation is thought to be multifactorial with environmental factors
and increasing evidence for genetic factors contributing to
pathogenesis.
Focus for Fever
• Although it has been shown that febrile seizures are more likely to
occur with respiratory illnesses,any febrile illness may be the cause
• Viral upper respiratory infection, otitis media, pneumonia, and
gastroenteritis are all common.
• Urine analysis and urine culture should be considered if a source of
infection is not otherwise identifiable.
Red flags suggestive of CNS infection
• History of irritability, decreased feeding, or lethargy
• Complex febrile seizures
• Any physical signs of meningitis or encephalitis (bulging fontanelle,
neck stiffness, photophobia, focal neurological signs)
• Prolonged postictal altered consciousness or neurological deficit (>1
hour)
• Drowsiness with limited response to social cues (lasting >1 hour)
• Previous or current treatment with antibiotics
• Incomplete immunisation
Recurrence
• Febrile seizures recur in approximately 30% of those experiencing a
first episode, in 50% after 2 or more episodes, and in 50% of infants
younger than 1 yr old at febrile seizure onset.
Risk of Epilepsy
Management
• Routine bloods, EEG or imaging not recommended
• In general, antiepileptic therapy, continuous or intermittent, is not
recommended for children with 1 or more simple febrile seizures.
• Parents should be counseled about the relative risks of recurrence of
febrile seizures and recurrence of epilepsy, educated on how to
handle a seizure acutely, and given emotional support.
• If the seizure lasts for longer than 5 min, acute treatment with
diazepam, lorazepam, or midazolam is needed.
Intermittent therapy
• Used only when recurrent, prologed or high risk, decided by an expert.
• After a first prolonged febrile seizure, or in a child with other factors
giving a high risk of recurrence, benzodiazepines(buccal midazolam or
rectal diazepam) should be provided to parents on discharge.
• If seizure lasts >5min - buccal midazolam, rectal diazepam
• Preventers - Intermittent oral nitrazepam, clobazam or clonazepam
• Antipyretics can decrease the discomfort of the child but do not
reduce the risk of having a recurrent febrile seizure, probably because
the seizure often occurs as the temperature is rising or falling.
Thank you!