1.
Febrile seizures
Prof. Dr. Saad S Al Ani
Senior Pediatric Consultant
Head of Pediatric Department
Khorfakkan Hospital
Sharjah ,UAE
saadsalani@yahoo.com

2.
A febrile seizure
Is defined as:
an event in infancy or childhood, usually
occurring between 3 months and 5 years of age,
associated with fever but without evidence of
intracranial infection or defined cause
Engel J, Jr. Report of the ILAE classification core group. Epilepsia. 2006;47:1558-1568
12/30/2015
Febrile seizures Prof. Dr. Saad S Al Ani
Khorfakkan Hospital
2

3.
Pediatric febrile seizures
Represent the most common childhood
seizure disorder, exist only in association
with an elevated temperature
12/30/2015
Febrile seizures Prof. Dr. Saad S Al Ani
Khorfakkan Hospital
3
http://emedicine.medscape.com/article/1176205-overview

4.
Febrile seizures groups
12/30/2015
Febrile seizures Prof. Dr. Saad S Al Ani
Khorfakkan Hospital
4
Epidemiologically; febrile seizures are
grouped into 3 groups, as follows:
1.Simple febrile seizures
2.Complex febrile seizures
3.Symptomatic febrile seizures

5.
Simple febrile seizures
12/30/2015
Febrile seizures Prof. Dr. Saad S Al Ani
Khorfakkan Hospital
5
The setting is fever in a child aged 6 months to
5 years

6.
Simple febrile seizures (cont.)
12/30/2015
Febrile seizures Prof. Dr. Saad S Al Ani
Khorfakkan Hospital
6
The single seizure is generalized and lasts
less than 15 minutes

7.
Simple febrile seizures (cont.)
12/30/2015
Febrile seizures Prof. Dr. Saad S Al Ani
Khorfakkan Hospital
7
The child is neurologically healthy and
without neurologic abnormality by
examination or by developmental history

8.
Simple febrile seizures (cont.)
12/30/2015
Febrile seizures Prof. Dr. Saad S Al Ani
Khorfakkan Hospital
8
Fever (and seizure) is not caused by
meningitis, encephalitis, or any other
illness affecting the brain

9.
Simple febrile seizures (cont.)
12/30/2015
Febrile seizures Prof. Dr. Saad S Al Ani
Khorfakkan Hospital
9
The seizure is either:
• Generalized clonic
or
• Generalized tonic-clonic seizure

10.
Complex febrile seizures
12/30/2015
Febrile seizures Prof. Dr. Saad S Al Ani
Khorfakkan Hospital
10
Age, neurologic status before the illness,
and fever are the same as for simple
febrile seizure

11.
Complex febrile seizures (cont.)
12/30/2015
Febrile seizures Prof. Dr. Saad S Al Ani
Khorfakkan Hospital
11
This seizure is either:
• Focal or prolonged (ie, >15 min)
or
• Multiple seizures occur in close
succession

12.
Symptomatic febrile seizures
12/30/2015
Febrile seizures Prof. Dr. Saad S Al Ani
Khorfakkan Hospital
12
Age and fever are the same as for simple
febrile seizure

13.
Symptomatic febrile seizures(cont.)
12/30/2015
Febrile seizures Prof. Dr. Saad S Al Ani
Khorfakkan Hospital
13
The child has a preexisting neurologic
abnormality or acute illness

14.
Physical examination
12/30/2015
Febrile seizures Prof. Dr. Saad S Al Ani
Khorfakkan Hospital
14
Neurologically and developmentally
healthy child
No signs of meningitis or encephalitis

15.
Diagnosis
12/30/2015
Febrile seizures Prof. Dr. Saad S Al Ani
Khorfakkan Hospital
15
No specific laboratory studies are
indicated for a simple febrile seizure.
Other laboratory tests may be indicated by
the nature of the underlying febrile illness.

16.
Diagnosis (Cont.)
Concerning lumbar puncture :
12/30/2015
Febrile seizures Prof. Dr. Saad S Al Ani
Khorfakkan Hospital
16
Strongly considered in children younger
than 12 months
( because the signs and symptoms of
bacterial meningitis may be minimal or
absent in this age group)

17.
Diagnosis (Cont.)
12/30/2015
Febrile seizures Prof. Dr. Saad S Al Ani
Khorfakkan Hospital
17
Should be considered in children aged 12-
18 months
( because clinical signs and symptoms of
bacterial meningitis may be subtle in this
age group)
Concerning lumbar puncture (Cont.) :

18.
Diagnosis (Cont.)
12/30/2015
Febrile seizures Prof. Dr. Saad S Al Ani
Khorfakkan Hospital
18
In children older than 18 months, the
decision to perform lumbar puncture rests
on the clinical suspicion of meningitis
Concerning lumbar puncture (Cont.) :

19.
Diagnosis (Cont.)
12/30/2015
Febrile seizures Prof. Dr. Saad S Al Ani
Khorfakkan Hospital
19
Neither computed tomography (CT) nor
magnetic resonance imaging (MRI) is
indicated in patients with simple febrile
seizures

20.
Diagnosis (Cont.)
12/30/2015
Febrile seizures Prof. Dr. Saad S Al Ani
Khorfakkan Hospital
20
EEG is not indicated in children with
simple febrile seizures
Vast majority of these children have a
normal EEG

21.
Treatment
12/30/2015
Febrile seizures Prof. Dr. Saad S Al Ani
Khorfakkan Hospital
21
Neither long-term nor intermittent
anticonvulsant therapy is indicated for
children who have experienced 1 or more
simple febrile seizures.

22.
Treatment (Cont.)
12/30/2015
Febrile seizures Prof. Dr. Saad S Al Ani
Khorfakkan Hospital
22
Any therapy administered after a first
simple seizure will not reduce the risk of :
– Subsequent afebrile seizure
– Recurrent afebrile seizures
(ie, epilepsy).

23.
Treatment (Cont.)
12/30/2015
Febrile seizures Prof. Dr. Saad S Al Ani
Khorfakkan Hospital
23
Rectal diazepam or intravenous, 0.2-0.5
mg/kg for patients with febrile seizures,
particularly those with febrile seizures
lasting more than 5 minutes

24.
Treatment (Cont.)
12/30/2015
Febrile seizures Prof. Dr. Saad S Al Ani
Khorfakkan Hospital
24
Midazolam, administered intranasally,
0.2 mg/kg is as safe and effective as
intravenous or rectal diazepam in the
treatment of acute pediatric seizure
emergencies.
Brooks M. Intranasal Midazolam Works for Seizure Emergencies in Kids. Medscape Medical News. Nov 5 2013.

25.
Prognosis
12/30/2015
Febrile seizures Prof. Dr. Saad S Al Ani
Khorfakkan Hospital
25
Prognosis for normal neurologic function
is excellent

26.
Prognosis (Cont.)
12/30/2015
Febrile seizures Prof. Dr. Saad S Al Ani
Khorfakkan Hospital
26
About one third of children who
experience a single simple febrile seizure
will have another

27.
Conclusion
Children aged 3 months to 6 years may
have tonic-clonic seizures when they have
a high fever.
12/30/2015
Febrile seizures Prof. Dr. Saad S Al Ani
Khorfakkan Hospital
27
http://www.epilepsy.com/learn/types-seizures/febrile-seizures

28.
Conclusion (cont.)
More likely to occur if there is a family
history of febrile seizures.
12/30/2015
Febrile seizures Prof. Dr. Saad S Al Ani
Khorfakkan Hospital
28
http://www.epilepsy.com/learn/types-seizures/febrile-seizures

29.
Conclusions (cont.)
Most children do not require daily
treatment with medication.
12/30/2015
Febrile seizures Prof. Dr. Saad S Al Ani
Khorfakkan Hospital
29
http://www.epilepsy.com/learn/types-seizures/febrile-seizures

30.
Conclusions (cont.)
Among children who have their first
febrile seizure before their first birthday,
half will have at least one more.
12/30/2015
Febrile seizures Prof. Dr. Saad S Al Ani
Khorfakkan Hospital
30
http://www.epilepsy.com/learn/types-seizures/febrile-seizures

31.
Conclusions (cont.)
Long-term outlook is excellent.
12/30/2015
Febrile seizures Prof. Dr. Saad S Al Ani
Khorfakkan Hospital
31
http://www.epilepsy.com/learn/types-seizures/febrile-seizures

32.
12/30/2015
Febrile seizures Prof. Dr. Saad S Al Ani
Khorfakkan Hospital
32