prognosis of febrile seizure and wheezing child

1. Dr .LALIT MESHRAM
MD PEDIATRICS

2. Many common illness when present to you for first time it became difficult to
prognosis about disease in future .
In depth knowledge is must about disease .
Parental worry and concern you should be firmly addressed.
Comorbid condition and family history you should evaluate .
Various scoring system and risk factor for particular disease you should
know .

3. riskfactorsfor a first febrile seizure .
Following four factors were associated with an increased risk of febrile seizures:
 A history of febrile seizures in a first- or second-degree
relative.
 A neonatal nursery stay of more than 30 days.
 Developmental delay.
 Attendance at day care.
Children with two of these factors had a 28 percent chance of experiencing at
least one febrile seizure.(Bethune et al. 1993)

4. The incidence of meningitis in children with an apparent febrile seizure is
between 2 and 5 percent (AAP. 1996; Heijbel et al.).
Children with meningitis had one of the following four
features:
 A visit for medical care within the previous 48 hours,
 Seizures on arrival to the emergency room.
 focal seizures.
 suspicious findings on physical or neurologic examination. (AAP, 1996; Lorber
and Sunderland, 1980).

5. It recommended that
 A lumbar puncture be strongly considered in the infant younger than 12 months of age.
 A lumbar puncture is still recommended in children with a first complex febrile seizure, as well
as in any child with persistent lethargy.
 It also should be strongly considered in a child who has already received prior antibiotic
therapy.
 A lumbar puncture also should be considered in the child older than 5 years of age who
presents with an apparent first febrile seizure, to exclude the possibility of encephalitis, as well as
meningitis.(AAP 1996).

6. Electroencephalograms (EEGs) are of limited value in the valuation of the
child with febrile seizures (AAP, 1996;).
They are more likely to be abnormal in
 Older child with febrile seizures .
 Children with a family history of febrile seizures.
 Complex febrile seizure.
 Pre-existing neurodevelopmental
abnormalities (Doose et al., 1983;).
 Febrile status epilepticus.

7. Approximately one-third of children with a first febrile seizure will experience a
recurrence, and 10 percent will have three or more febrile seizures (AAP, 1996;).
Definite risk factor;
 Family history of FS.(AAP 1996)
 Age younger than 18 months. (Annegers et al., 1990).
 Height of peak temperature. (Offringa et al., 1992, 1994)
 Duration of fever . [Berg et al., 1992,1997].

8. Possible risk factor;
 Family history of epilepsy . (Nelson and Ellenberg, 1978).
Not A risk factor ;
 Neurodevelopmental abnormality
 Complex febrile seizure .
 More than one complex feature .
 Gender.
 Ethnicity .
A child with two or more risk factors has a greater than
30 percent recurrence risk at 2 years, and the child with three
or more risk factors has a greater than 60 percent recurrence
risk [Berg et al., 1997].

9. Epilepsy subsequently develops in 2–10 percent of children who experience febrile seizures (Annegers et
al.,1979).
Definite risk factor ; (Annegers et al.,1979, 1987)
 Neurodevelopment abnormality .
 Complex febrile seizure.
 Family history of epilepsy .
 Duration of fever . [Berg and Shinnar, 1996b].
Possible risk factor ;
 More than one complex feature .( prolonged and focal).
Not A risk factor ;
 Family history of febrile seizure .
 Age at first febrile seizure .
 Height of peak temperature.
 Gender and ethnicity .

10. Let learn about natural course of wheezing in
child .