Febrile Convulsions

Question 1

What are febrile convulsions?

Answer 1

• = Fit or seizure caused by acute febrile illness (without previous afebrile seizures, significant prior neurological abnormality, and no CNS infection)

Question 2

Epidemiology of febrile convulsions:

• age it occurs in
• %incidence

Answer 2

• Between 6mo - 6yo

- Common - 3% of healthy children, occur in 1 in 30 children when febrile

Question 3

Differentiate between the types of febrile convulsions.

Answer 3

Simple febrile convulsions:
○ generalised, tonic-clonic seizures lasting less than 15 minutes that do not recur within the same febrile illness

Complex febrile convulsions:
○ One or more of the following:
- Focal features at onset or during the seizure
- Duration of more than 15 minutes
- Recurrence within the same febrile illness
- Incomplete recovery within 1 hour

- Includes - Febrile status epilepticus: febrile convulsion lasting for longer than 30 minutes

Question 4

What is some DDx for febrile convulsions?

Answer 4

• Epilepsy
• Infection
  ○ Meningitis
  ○ Encephalitis
• Injury
• Electrolyte disturbances
• Breath-holding spells
• Not a fit - rigors

Question 5

What kind of acute mx is needed for febrile convulsions?

Answer 5

• Supportive care for 5-10 minutes is appropriate - ensure adequate airway and breathing while waiting for convulsion to stop spontaneously

If seizure persists or the onset has not been witnessed, pursue active management as per afebrile seizure:
- Support airway and breathing, O2via mask, monitor
- Secure IV access, check bedside BSL and send urgent specimen for calcium/electrolytes/VBG
- Give benzodiazepine (midazolam/diazepam)
○ Repeat benzodiazepine after 5 minutes of continuing seizures

- If convulsion continues for a further 5-10 minutes, commence IV phenytoin or phenobarbitone (consider IO if IV not possible)
- Consult with senior clinician if not controlled, anticipating need for rapid sequence induction and supported ventilation

Question 6

Detail some points

Answer 6

• Reassurance: common, benign, don’t result in brain damage or cause epilepsy
• Epidemiology: very common - 3% children, increased risk of having febrile convulsions once they have oneesp. very young
• If they have a seizure again:
  
  • put them on ground, recovery position with head and neck in neutral (can vomit), call ambo
  • Don’t put your fingers in pt mouth
  • If seizure lasts for more than 3-5 minutes (or look sick/don’t wake up), call an ambulance
• There is nothing that you can do to stop them having a febrile convulsion (Panadol and Nurofen do not help)