Febrile Convulsion

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Febrile Convulsion

• Ri ??? 2003.01.27

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Reference

• Behrman Nelson Textbook of Pediatrics, 16th ed.
• Ferris Clinical Advisor Instant Diagnosis and
  Treatment, 2003 ed.
• John Hopkins The Harriet Lane Handbook A Manual
  for Pediatric House Officers, 16th ed.
• Pediatrics Vol. 103, No. 6, June 1999, Practice
  Parameter Long-term Treatment of the Child With
  Simple Febrile Seizures
• Goets Textbook of Clinical Neurology, 1st ed.
• Rakel Conns Current Therapy 2002, 54th ed.

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Definition

• Brief (lt15 min), generalized, tonic-clonic
  seizure associated with a febrile illness, but
  without any CNS infection, severe metabolic
  disturbance, or other known neurological cause
• The most common seizure disorder during childhood
  

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Introduction

• Age 6 m/o 5 y/o
• Incidence 2 4 in children lt5 y/o
• Peak age of onset 18 22 m/o
• Sex male female

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Genetics

• Strong family history in siblings and parents
  increase risk 23 times
• Febrile seizure gene Chromosome 19p and 8q 13-21
• Autosomal dominant inheritance in some families

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Common Causes

• Viral URI
• Reseola
• Acute otitis media

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Differential diagnosis

• CNS infection
• Eletrolyte disturbance
• Inborn errors of metabolism
• Intracranial mass
• Diagnosis by history and exclusion

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Clinical Presentation

• Typical - simple
• Atypical - complex

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Typical Presentation

• 8090 of cases
• Occur early when core temperature reaches 39 C or
  greater
• Generalized, tonic-clonic for seconds to 15-min,
  followed by a postictal period of drowsiness

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Atypical Presentation

• Age lt 6 m/o or gt 5 y/o
• Onset gt24 hr after fever onset
• Duration gt15 min
• Occur more than once in 24 hr
• Focal motor manifestations
• Abnormal neurological examination

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Investigation

• Typical not required
• Atypical required
• EEG
• Toxicology screening
• Assessment of electrolytes
• CT or MRI

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CSF Study

• To rule out meningitis
• When CNS infection was suspected
• Atypical febrile convulsion
• Age lt 1yr ?

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Treatment

• Routine treatment
• Search for the cause of fever
• Control fever (avoid excessive clothing,
  encourage fluids, tepid sponge bath, and
  antipyretics)
• Prophylactic anticonvulsants are not indicated
  for typical febrile convulsion

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Prognosis

• Excellent prognosis in most children
• Risk of recurrence
• Onset lt 1 y/o or with family history 50
• Onset gt 1 y/o 30 up to the age of 5 yr
• After second episode 50
• Age gt 5 y/o near zero

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Prognosis

• Risk of epilepsy development
• 12 in the general population
• increase up to 9 when two or more risk factors
  are present

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Prognosis

• Risk factors for epilepsy development
• Positive family history of epilepsy
• Atypical febrile convulsion
• Previous abnormal development or neurological
  disorder

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Recurrence Prevention

• Phenobarbital ineffective and may decrease
  cognitive function
• Carbamazepine ineffective
• Phenytoin ineffective
• Valpronic acid effective, but with potential
  risk of fatal hepatotoxicity, thrombocytopenia,
  GI disturbances, and pancretitis

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Recurrence Prevention

• Antipyretic agents ineffective
• Diazepam effective and safe
• Oral or rectal form
• For patients with frequent febrile convulsion or
  significant parental anxiety
• Dose 0.3 mg/kg q8h PO (1 mg/kg/d) for the
  duration of the illness (23 days)
• Side effects lethargy, irritable, ataxia

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• Thank You for Your Attention !