Febrile Convulsion

Question 1

Define febrile seizure.

Answer 1

Seizure provoked by fever in otherwise normal child in absence of intracranial infection

Question 2

What is a simple febrile seizure?

Answer 2

Isolated, brief, generalised clonic/ tonic-clonic seizure.

<15 mins

No brain damage

No increased risk of epilepsy

Question 3

What is a complex febrile seizure?

Answer 3

>15 minutes

Focal features

Repeated seizure during same illness or incomplete recovery from seizure <1 hour.

Increased risk of epilepsy

Question 4

What is febrile status epilepticus?

Answer 4

Duration >30 min (up to 5% present as status epilepticus).

Question 5

Give 3 risk factors for febrile seizure.

Answer 5

FH

Infection

High temperature

Question 6

Summarise the epidemiology of febrile seizure.

Answer 6

3-4% in Western Europe + USA.

6m-5y: Peak 18m.

Question 7

What are the symptoms of febrile seizure?

Answer 7

Usually brief seizure < 5 mins

Usually Tonic-clonic

Hx of viral URTI, otitis media, pneumonia, UTI or gastroenteritis.

Question 8

What are the signs of febrile seizure?

Answer 8

Fever >38

No signs of meningitis/ encephalitis (behaviour, drowsiness or irritability).

Question 9

What are the investigations for febrile seizure?

Answer 9

Clinical dx.

Identify + manage cause of fever

Question 10

What is the management for febrile seizure?

Answer 10

Admission to hospital for observation.

Rectal diazepam or buccal midazolam if the seizure prolongs.

Ibuprofen or paracetamol.

Question 11

What are complications associated with febrile seizure?

Answer 11

Mesial-temporal sclerosis with prolonged febrile status epilepticus.

Question 12

What is the prognosis for febrile seizure?

Answer 12

Recurrence, small increase in epilepsy.

Question 13

When are further Ix indicated in febrile seizures?

Answer 13

If suspicion of sepsis, menigitis or encephalitis.

Bloods: FBC, Sodium (U+Es), Glucose, blood culture + viral studies.

LP

Brain MRI and EEG.

Question 14

Describe management during a seizure in a home setting

Answer 14

Protect from injury: cushion head, remove nearby objects, DONT restrain

If <5 mins: do nothing unless 1st seizure/ breathing problems

If >5 mins: call ambulance

Question 15

Describe management during a seizure in a home with drugs available

Answer 15

If >5 mins:

PR diazepam (repeated once after 5 mins if seizure hasn’t stopped)

OR

Buccal midazolam

If 10 mins after 1st dose ongoing seizure, twitching, another seizure: call ambulance

Question 16

When should an ambulance be called in febrile seizures?

Answer 16

1st seizure (of any duration/ cause)

Suspect seizure caused by serious illness

Seizure lasts >5 mins (no drugs)

Breathing difficulties

Question 17

What is the immediate management post-seizure?

Answer 17

ABCs

Place in recovery position

Question 18

Which patients need admission for febrile seizure?

Answer 18

1st febrile seizure

<18m

DIagnostic uncertainty about cause

Complex febrile seizure

Currently on abx

Question 19

What education do parents need to receive about febrile seizures?

Answer 19

Not = to epilepsy

Simple = no increased risk of epilepsy

Complex = slight increased risk of epilepsy

⅓ have another febrile seizure

If recurrent: teach how to give meds

Continue routine immunisations

Question 20

What advice can you give parents about managing fever?

Answer 20

Do not try to cool the child

Ensure adequate fluid intake

Regular paracetamol + ibuprofen

Seek advice if prolonged fever