Slideshows on febrile seizures.. Simple and basic details available. For medical students, housemen and training doctors who wish to revise on the topic.

1. Febrile seizures

2. Introduction
 About 1 in 20 children will have at least one febrile
seizure at some point.
 Mostly occurs between the ages of six months and
six years. The average is 18 months.
 The cause is unknown, although it appears to run in
some (but not all) families. Around 1 in 4 children
who are affected by febrile seizures will have a family
history of the condition. In half of all cases, there
are no obvious causes or risk factors.

3. Definition
 Having a seizure when the child’s body temperature
is high i.e. 38°C or above.
 Usually caused by infection, but exclude intracranial
infection (bacterial meningitis/viral encephalitis)
 Occur between 6 months and 6 years

4. Associated infections
 Viral infections e.g. chickenpox and influenza
 Otitis media
 Tonsillitis
 Gastroenteritis
 LRTI e.g. pneumonia, bronchitis

5. Types of febrile seizures
 Simple febrile seizure
 The most common type of febrile seizure (~90% of
cases)
 Features:
 Tonic clonic seizure
 Does not last >15 minutes
 Does not reoccur within 24 hours or during the period
in which the child has an illness.

6. Body
stiffness
Tonic
clonic
seizure
Loss of
concious-ness
Limbs
twitching
Urinary
inconti-nence

8.  Complex febrile seizure
 Less common than simple febrile seizures (~10% of
cases)
 Has one or more of the following features:
 Seizure lasts >15 minutes
 Partial or focal seizure
 Seizure reoccurs within 24 hours of the first seizure or
during the period in which they have an illness
 The child does not fully recover from the seizure within
one hour

9. Febrile seizures and epilepsy
 Epilepsy: repeated seizures without fever
 Children who have a history of febrile seizures have
an increased risk of developing epilepsy. However, it
should be stressed to the parents that the risk
increase is still quite small.
 Simple febrile seizures: 1 in 50 chance of developing
epilepsy in later life.
 Complex febrile seizures: 1 in 20 chance of
developing epilepsy in later life.

10. Outlook
 Almost all children make a complete recovery.
 Studies on febrile seizures showed that children with
a history of febrile seizures has no evidence of an
increased risk of death in later childhood or
adulthood.
 Simple seizures  no brain damage. Subsequent
intellectual performance similar as other children

11. Symptoms
 Febrile seizures often occur during the first day of a
fever.
 Temperature: 38°C or above.
 Seizures may also develop:
 After a mild temperature. It may not develop at all
with an extremely high temperature.
 Rapid rise in temperature
 Rapid drop in temperature

12. More Symptoms…
 Body stiffness
 Limbs twitching
 Lose of conciousness
 Urine incontinence ± soiling
 Vomiting
 Foam at the mouth
 Lasting <5 minutes
 Sleepiness/drowsiness after seizure ~1 hour

13. BEWARE!!
Signs of dehydration Other alarming signs
•Dry mouth
•Sunken eyes
•Lack of tears when crying
•Sunken fontanelle
•Seizure >5 minutes, no
sign of stopping
•Non-blanching rash
•SOB
•Focal CNS lesion/CNS
abnormality
•Previous h/o epilepsy
•>1 attack in 24h

14. Differential Diagnosis...which
we need to be aware of
 Meningitis
 Encephalitis
 CNS lesion
 Epilepsy
 Trauma
 Hypoglycaemia
 Hypocalcaemia
 Hypomagnesaemia

15. Investigations
 Source of infections! Do not forget ear and throat examinations!!
 FBC
 BUSE, Ca2+
 Glucose level
 Urinalysis
 CXR
 ENT swab
 Further investigations:
 EEG
 Lumbar puncture (particularly if the child is <12 months old)

16. Contraindications for LP
Cardiorespiratory
instability
Focal neurological
signs
Increased ICP
Coagulopathy Thrombocytopenia Local infection at
LP site
Procedure delays
Abx administration

17. Management
 Assess ABCDE
 If seizure >5 min, rescue therapy  diazepam PR/
buccal midazolam
 Antipyretics? Not been shown to prevent febrile
seizures. But, important to reduce temperature:-
 PCM
 Ibuprofen
 Remove unnecessary clothes or bedding
Remember, NO ASPIRIN for <16 YO (REYE’S
SYNDROME)

18. Further Management
 Parents education
 10 first aid steps when your child has a seizure:
1. Stay calm
2. Look around, assess the environment
3. Note the time
4. Stay with them.
5. Cushion their head.
6. Don’t hold them down
7. Don’t put anything in their mouth
8. Check time again. If > 5mins, call 999
9. Recovery position if seizure stops. Check airway & breathing
10. Stay with them until full recovery

19. Complications
 Risk of developing epilepsy ~1.5%
 Risk rises to 2.5% if the child was under 12 months old when
they had their first seizures (in those who had multiple simple
seizures.
 Risk also increases with:
 Neurological abnormalities, or a developmental delay before
the onset of febrile seizures.
 A family history of epilepsy.
 A brief fever (<1 h) before the seizure.
 Complex seizures.

20. Short case History:
a clinical context
 GH, 2 years old girl admitted due to fever with fits.
 This is her 1st episode of fever with fits.
 Seizure lasted for 1-2 minutes.
 Seizure came from a rapid increase of temperature on
the 1st day of fever after visiting her grandfather who is
warded in HSI (due to chronic illnesses e.g. DM, HPT).
 Generalised tonic-clonic seizure. Eyes rolling upwards.
No tongue biting, no mouth frothing.
 Just once within 24 hours. No subsequent episode.

21.  Source of infection?
 Fever was NOT associated with:
 Sore throat
 Coughs
 Shortness of breath
 Changes in urinary/bowel habit
 Rashes
 Ear discomfort, discharge, hearing loss
 Neck stiffness
On examination, otitis media was found to be the cause.

22.  Family history of epilepsy. Uncle is epileptic with
medication.
 ICE:
 Mum thinks that it may be due to the hot weather.
 Mum is worried if she’ll get another febrile seizures.
 Worried if she will develop epilepsy in the future.
 Risk of:
 Getting another seizure?
 Developing epilepsy?

23.  Risk of getting another febrile fit?
 30-40% will have further febrile fits.
 More likely if:
 The younger the child
 The shorter the duration of illness before
seizure
 The lower the temperature at time of seizure
 Positive family history

24.  Risk of developing epilepsy later?
 Increased risk of 1.5%
 Family history of epilepsy
 Brief fever (<1h) before the seizure
 Simple versus complex? Simple: 1 in 50,
Complex: 1 in 20.
 Risk increase by 2.5% if under 12month old
when had 1st seizure.
 Neurological abnormalities/Developmental
delay.

25. Quiz!!
1. The followings are features of complex febrile
convulsion
a) Duration of seizures > 15 minutes (T , F)
b) Presence of focal convulsion (T ,F)
c) Recurrence of seizure within the same day (T , F)
d) Children with preexisting neurological disease (T ,F)
e) Age of onset before 12 months (T , F)

26. 2. The risk of recurrent febrile seizures is higher for these children
except:
a) young (less than 15 months)
b) Have frequent fevers
c) Have a parent or sibling who had febrile seizures or epilepsy
d) Have a short time between the onset of fever and the seizure
e) Had a high degree of fever before the seizure

27. 3. Answer true or false
a) Prophylactic antiepileptic drug treatment is recommended
b) Patients with early age of onset have higher risk of recurrent
febrile convulsion
c) Lumbar puncture is indicated in patients with even subtle clinical
features suggestive of CNS infection
d) Rescue therapy using PR Diazepam during seizure attack is
recommended provided parents are adequately counseled

28. 4. A 2-year-old boy presents to the emergency department
for evaluation following a witnessed seizure. The
seizure was described as generalized, lasting less than 5
minutes with a short post-ictal period. The child has no
history of seizures, no family history of seizures, and
no history of head injury. His exam currently is
normal, except for a red, bulging right tympanic
membrane and a temperature of 39 C. What is the
most appropriate management for this patient?
a)Urgent CT scan of the head
b) Antibiotics and antipyretics and monitored at home
c) Admitted to hospital and EEG is performed
d) Start on phenobarbital and sent home
e)LP and Blood culture performed and start anticonvulsant in hospital

29. Frightening but harmless!!
Thank you.