PAEDIATRICS CENTRAL NERVOUS SYSTEM GO-508/I-451/ N-838

FEBRILE CONVULSION D. ETIOPATHOGENESIS:

a. Risk Factors: (Ref: Emedicine)
A. INTRO: i. Family history: 10% risk if 1st degree relative
a. Ghai:
i. Seizure
FAMILY HISTORY IS MORE SIGNIFICANT
ii. During spikes of fever
IN FEBRILE CONVULSION THAN EPILEPSY
iii. In a child between 6 months to 5 years
(Nelson: 6 months to 6 years), peak
incidence at 18 months ii. High temperature: Sudden rise, not slow
iv. In the absence of organic neurological rise
disease iii. Developmental delay
National Institutes of Health: iv. Neonatal discharge after 28 days → Peri-
"An event in infancy or childhood usually natal illness requiring hospitalization
occurring between three months and v. Daycare attendance
five years of age, associated with fever, vi. Maternal alcohol intake and smoking during
but without evidence of intracranial pregnancy: X 2 times ↑
infection or defined cause vii. Presence of 2 of the above factors ↑ the
International League against Epilepsy risk of 1st episode to 30%
(ILAE):
"A seizure occurring in childhood after 1 b. Etio: Infections that can lead to febrile
month of age associated with a febrile convulsion: (Ref: A to Z)
illness not caused by an infection of the i. Viral URTI: Commonest
central nervous system (CNS), without ii. LRTI: Pneumonia
previous neonatal seizures or a previous iii. ASOM
unprovoked seizure, and not meeting the iv. Measles
criteria for other acute symptomatic v. Shigellosis
seizures" vi. UTI
B. INCIDENCE:
a. Commonest cause of seizure in childhood
c. Patho: (Ref: Emedicine)
b. Age: 3% between 6 months - 5 years
i. During dev, low threshold + frequent infec
c. Sex: M>F
↓
ii. Body responds with higher temp
C. TYPES:
↓
Simple/Benign Atypical/Complex
iii. Release of IL 1β
Age 6m–5y <1 m or >5 y
↓
Type GTC Focal
iv. Neuronal excitability
Duration <10 min >10 min
(Nelson: <15min) (Nelson:>15 min) ↓
No. Single per febrile Multiple per v. Febrile seizure
episode, within 24 febrile episode
hrs
Post Ictal phase Absent Altered sensorium
Focal Neurologic
deficits
H/O neuro prob Absent Present
or dev prob
F/H/O Epilepsy Absent, but H/O Present
febrile convulsion
EEG Normal within few Abnormal
days after seizure
Recurrence 10% further 7% further
simple seizure atypical seizure
Risk of epilepsy 1-2% (same as 4 – 12%
other children)

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PAEDIATRICS CENTRAL NERVOUS SYSTEM GO-508/I-451/ N-838

E. DIAGNOSIS: (Ref: emedicine)

a. History: d. Procedure: Lumbar Puncture
i. Type of seizure (generalized or focal) and its i. Indication: (Ref: emedicine)
duration (Refer types) 1. Age < 12 – 18 months
ii. Fever and it’s duration: Usually with sudden 2. Signs or circumstances suggestive of
spikes of fever meningitis:
iii. Cause of fever (Refer Etio) a. A visit to a healthcare setting within
iv. Recent antibiotic use: Partially Rx the previous 48 hours
Meningitis b. Seizure activity at the time of arrival
v. History of seizures, neurologic problems, in the ED
developmental delay, or other potential c. Focal seizure, suspicious physical
causes of seizure (eg, trauma, ingestion of examination findings (eg, rash,
toxic substances) petechiae) cyanosis, hypotension, or
grunting
b. Examination: d. Abnormal neurologic examination
i. Otitis media, pharyngitis, or a viral
exanthema
ii. Neurologic status H. TREATMENT:
iii. Meningeal signs a. At home:
iv. Signs of trauma or toxic ingestion i. Lt lat position
ii. Bring down the temp:
1. Tepid sponging of the whole body
F. D/D: (Ref: emedicine) 2. Antipyretic: PCM, 15 mg/kg, repeated 8
a. Status Epilepticus hrly
b. Meningitis and encephalitis iii. Control the seizure: If lasting >5 min, Rectal
c. Epidural and subdural infections Diazepam (if available) or
d. Sepsis iv. Hospital

b. At Emergency:
G. INVESTIGATIONS: Routinely not necessary i. Reassurance to the parents
a. Lab: ii. ABC
i. Blood: CBC, Culture iii. Antipyretic:
ii. Urine: R/E , Microscopy, Culture 1. Acetaminophen, 10-15 mg/kg PO/PR q4-
iii. Electrolyte assessment 6h
2. Ibuprofen, 200-400 mg PO q4-6h while
b. Imaging: symptoms persist
i. CXR: Rule out LRTI 3. Aspirin to be avoided as it can cause
ii. CT: If >4 episodes or clinically indicated Reye’s Syndrome
iv. Anticonvulsants:
c. Other: 1. Diazepam
i. EEG: a. 2-5 years: 0.5 mg/kg PR
1. Indi: b. 6-11 years: 0.3 mg/kg
a. Atypical febrile convulsion c. May repeat rectal dose once after 4-
b. F/H/O Epilepsy 12 h if needed
2. After 6 weeks of 1st attack 2. Midazolam, 0.2 mg/kg IV
3. Normal in Simple seizure v. Antibiotics: If infec present
vi. If seizure not controlled, RX in the line of
status epilepticus

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PAEDIATRICS CENTRAL NERVOUS SYSTEM GO-508/I-451/ N-838

I. COMPLICATIONS:
a. Recurrence:
i. Risk factors:
1. Young age at time of first febrile seizure
2. Female
3. Relatively low fever at time of first
seizure
4. Family history of a febrile seizure in a
first-degree relative
5. Brief duration between fever onset and
initial seizure
6. Multiple initial febrile seizures during
same episode
ii. Prophyllaxis:
1. General measures:
a. Temperature control during fever
with tepid sponging
b. Use of antipyretics
2. Specific:
a. Oral Diazepam or Midazolam before
the spike of fever (Intermitternt)
b. If Atypical seizure or F/H/O Seizure
(Continuous)
i. Sod valproate, 10-20 mg/kg/day
ii. Phenobarbitone, 3-5 mg/kg/day
iii. For 1-2 yrs or age of 5 yrs,
whichever comes earlier
3. Vaccine: Influenzae

b. Temoral lobe epilepsy ← if progression to

febrile status epilepticus

J. PARENT COUNSELLING:
a. Steps to be taken in case child has another
seizure
b. Call for assistance if the seizure lasts longer
than 10 minutes or if the postictal period lasts
longer than 30 minutes
c. Benign nature of febrile seizures
d. Reassured that simple febrile seizure does not
lead to neurologic problems or developmental
delay

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