Febrile Convulsions

1
Febrile Convulsions

• Prepared by Dr. Basem Abu-Rahmeh
• Directed by Dr. Afaf Al-Arini

2
Definition

• Seizure in children occurring between 6 months
  and 6 years precipitated by fever from
  infection/inflammation/metabolic disorders
  outside CNS in children who are otherwise
  neurologically normal .
• It is not a form of epilepsy because brain is
  normal.

3
How Common

• Prevalence is 2-4 of children less than 6 years.
• 4 of febrile convulsion occur at age less than 6
  months.
• 6 occur after the age of 6 years
• 90 occur between 6 months and 6 years.
• Vaccination is rarely followed by febrile
  convulsion and mainly after
• DTP after one day of vaccination in 6-9/100000
• MMR after 8-14 day of vaccine in 25-35/100000

4
Etiology and Pathogenesis

• The exact etiology of febrile convulsion is
  unknown.
• A strong genetic influences is applied because of
  increase frequency among family members to have
  febrile convulsions.

5
Clinical Picture

• In most cases it is generalized tonic clonic
  convulsion.
• Febrile convulsion is divided into three main
  groups based on symptoms of the seizure
• Simple febrile convulsion (convulsion occur in
  majority of the cases 75, lasting less than 15
  minutes and 80 less than 6 minutes and 50 less
  than 3 minutes, not having focal features, single
  in 24 hours).
• Complex febrile convulsion represent 25 of the
  cases, lasting more than 15 min, with focal
  features, multiple in 24 hours.
• Febrile status epilepticus.

6
Diagnosis

• History
• Age
• Fever (duration, peak and rate of increase).
• History of trauma.
• History of vaccination (pertussis).
• Other sites of infection.
• Family history.
• Metabolic disorders.
• GI symptoms.

7
Recurrence

• If recurred it will be within 1st year of the
  first attack and recurrence most likely will be
  if
• If first convulsion occur under age of 15 month
  (50 recurrence rate)
• Complex febrile convulsion.
• First febrile convulsion with low grade fever.
• Positive family history of febrile convulsion or
  epilepsy.
• If first degree relative (one person) recurrence
  will be in 30.
• If first degree relative (2 persons) recurrence
  will be in 50.
• If first degree relative 3 persons recurrence
  will reach 100.
• If no family history recurrence will be 10.

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When to refer and admit

• Strongly admit for LP or treatment if any of the
  following factors present
• Age under 18 months (may have meningitis with no
  signs).
• If signs of meningitis present.
• Child is toxic (irritable or drowsy).
• Current treatment with antibiotics because may
  mask meningeal signs
• Complex convulsion
• First simple attack of febrile convulsion.
• The course of fever requires hospital management
  in its own right.
• Parents wish (anxious)

9
Examination

• Look for focal signs of infection.
• 50 was having otitis media in one study
• Reseola Infantum detected in increased fequency.
• Most causes of fever are simple infection rather
  than complex infection (Otitis Media, Pharyngitis
  versus pneumonia).
• Usually CNS examination in simple Febrile
  convulsion in normal but in Complex type you can
  find Focal neurological deficit.
• Skin rash
• Others

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Investigations

• LAB. Mainly concentrated to look for the source
  of infection or fever.
• Imaging Studies as CT, MRI not indicated
• EEG not indicated because most have normal EEG.

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Differential Diagnosis

• CNS infection.
• Metabolic Disorder as hypogylcemia and
  Hyponatremia.
• Poisoning.
• Shigella toxins
• Post vaccination.
• Epilepsy.

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Complications and Prognosis

• Wrong diagnosis lead to delay diagnosis of
  meningitis.
• Recurrence.
• Status epilepticus represent 25 of status
  epilepticus in children.
• Epilepsy increase (1 compared with normal
  populations which is about 0.5with the following
  factors
• Neurologically abnormal or developmentally
  delayed before onset of febrile convulsion.
• If atypical seizure
• Family history of epilepsy

13
Management

• Control fever by antipyretics (paracetamole or
  ibubrufen) cold compressors.
• Rectal diazepam rarely need to abort febrile
  convulsion because convulsion most of the time is
  short in duration but prolonged give it.
• If children have risk factor for recurrence give
  diazepam in early fever.

14
Prophylactic Treatment

• Phenobarbitol / valproic acid daily oral dose are
  effective in preventing febrile convulsion but
  benefits of prophylaxis rarely outweighs the risk
  of adverse effects
• Vaccination is not contraindicated
• No treatment is effective in decreasing risk of
  future epilepsy
• so in general drug rational that included in
  febrile convulsion are brufen , revanin, rectal
  dizepam.

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Counseling of the Parents

• Parents should be in formed about the benign
  nature of febrile convulsion and that it may
  recure.
• Parents should be taught to manage the convulsion
  by placing the child in recovery position (lying
  In his or her side to prevent aspiration and
  control fever).