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Febrile Convulsions

Febrile Convulsions. DR AMANULLAH DEPARTMENT OF PEDIATRICS YENEPOYA MEDICAL COLLEGE. Definition.

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Febrile Convulsions

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  1. Febrile Convulsions DR AMANULLAH DEPARTMENT OF PEDIATRICS YENEPOYA MEDICAL COLLEGE.

  2. Definition • FEBRILE SEIZURES are seizures that occur between the age of 6months & 5 yrs with a temperature of 38 C or higher ,that are not the result of Central nervous system infection or any metabolic imbalance ,& that occur in the absence of a history of prior afebrile seizure . • It is not a form of epilepsy because brain is normal.

  3. Febrile Seizures Convulsions in Children with Fever due to Pyogenic meningitis ,Hypernatremic Dehydration ,or other Metabolic disorders are not labeled as febrile seizures . Febrile seizures are provked Seizures & do not constitute Epilepsy. Infections commonly encountered in Children with Febrile Seizures include infections of the middle ear, upper respiratory, Urinary tract & Gastrointestinal

  4. Etiology and Pathogenesis • The exact etiology of febrile convulsion is unknown. • A strong genetic Predispostion is Observed. • An increase frequency among family members is has noted. • The convulsions are not related to the degree of temperature rise but are frequent if TEMPERATURE RISES ABRUPTLY..

  5. Any febrile illness with tempeature of more than 38 degree centigrade can pecipitate a seizure. • Certain fevers have a greater pre deliction to precipitate a convulsion. • Most febrile seizures occur within the first 2 to 3 days of fever.

  6. Clinical Picture • In most cases it is generalized tonic clonic convulsion. • Febrile seizure is divided into three main groups based on symptoms of the seizure: SIMPLE FEBRILE SEIZURES. COMPLEX FEBRILE SEIZURES. FEBRILE STATUS.

  7. SIMPLE FEBRILE SEIZURE • Constitutes upto 85% of Febrile seizures. • They are GENERALIZED SEIZURES, lasting less than 15 mins, not recurring within 24 hours, & no post ictal neurological abnormalities.

  8. COMPLEX FEBRILE SEIZURE • Are FOCAL, prolonged or recurrent within 24 hours or associated with post ictal neurological abnormalities including todds paresis. • They constitute around 15% of Febrile seizures.

  9. FEBRILE STATUS • Is a Febrile Seizure with duration of 30 MINUTES OR MORE, either one long lasting seizure or series of shorter seizures without regaining consciousness interictally.

  10. INVESTIGATIONS • Infections of the CNS such as Meningitis or Encephalitis are important causes of CONVULSIONS ASSOCIATED WITH FEVER & can be easily confused with FEBRILE SEIZURES. • Lumbar Puncture should be performed in the First episode of Seizure, Infants below 1 year, or if Meningitis is suspected. • L.P is Not Required Routinely.

  11. Investigations • Lab Investigations: Mainly to LOOKfor the sourceOf Infection or Fever. • Routine blood Investigations like CBC, CRP , blood for Malarial parasite. Urine Routine to R/o U.T.I • Imaging Studies as CT, MRI not indicated • EEG not indicated because most have normal EEG.

  12. Differential Diagnosis • CNS infection.-- Meningitis or Encephalitis. • Metabolic Disorder such as hypogylcemia and Hyponatremia. • Poisoning. • Shigella toxins • Post vaccination. • Epilepsy.

  13. PROGNOSIS AND RECURRENCE RISK • The Average recurrance after first Febrile Seizure is 30 – 40 percent. • Of these , 75% of recurrences occur would occur in the first year of life.

  14. RISK OF RECURRENT FEBRILE SEIZURES • Age less than 18 months at Onset. • Family history of Febrile Seizures. • Shorter duration of Fever prior to the onset of Seizure. • Low peak of temperature at the time of Seizure.

  15. RISK OF EPILEPSY. • OVERALL RISK OF SUBSEQUENT EPILEPSY AFTER FEBRILE SEIZURE IS 2 -2.5%. Risk factors are – COMPLEX FEBRILE SEIZURE, Preexisting Neurological or Developmental delay, Family History of EPILEPSY.

  16. Management • Prompt reduction of fever by antipyretics and Hydrotherapy. • Supportive therapy , nursing in semiprone position. • Adequate Airway & Oxygen should be asssured. • An Intravenous line should be started to maintain Hydration, to give Anticonvulsant medication , or to obtain blood specimens for investigations.

  17. Injection of Diazepam (0.2 to 0.3 mg /Kg/dose ) slow I.V. Push (maximum of 5mg /dose) is given for control of seizures. • Rectal diazepam, Intranasal or Buccal Midazolam can also be used. • Lorazepam can also be used in the the treatment of febrile seizures.

  18. Intravenous Benzodiazepines, Phenobarbital, Phenytoin or Valproate may be needed in case Of STATUS FEBRILE SEIZURES.

  19. FEBRILE SEIZURE PROPHYLAXIS • The Primary Goal of long term management of Febrile seizures is to prevent RECURRENCES. • Treatment options are • A) INTERMITTENT PROPHYLXIS • B) CONTINOUS PROPHYLAXIS

  20. INTERMITTENT PROPHYLAXIS • Intermittent prophylaxis is currently the desirable form of therapy during fever. • Drug prophylaxis is indicated for the first 3 days of fever since majority of seizure episodes occur within this period. • Diazepam & other benzodiazepines can used as solution per rectally or as Suppository or via oral route.

  21. INTERMITTENT PROPHYLAXIS • MIDAZOLAM or CLOBAZAM can also be used as effective prophylactics. • ANTIPYRETICS, HYDROTHERAPY & METICULOUS TEMPERATURE RECORDING should be advocated for all patients. • Domiciliary care is recommended.

  22. CONTINUOUS PROPHYLAXIS • CONTINUOUS PROPHYLAXIS in the form of ANTIEPILEPTIC DRUG THERAPY is advocated in the event of failure of intermittent therapy especially in recurrent ComplexFebrileSeizures OR if there is a family history of EPILEPSY .

  23. CONTINUOUS PROPHYLAXIS • SODIUM VALPROATE (10-20mg/kg/day) OR PHENOBARBITONE ( 3-5 mg/Kg /Day) are the only drugs effective for Febrile Seizure prophylaxis. The duration of therapy should be for 1 to 2 years or until 5years o age which ever is earlier.

  24. CONTINUOUS PROPHYLAXIS. • CARBAMAZEPINE & PHENYTOIN are not used in Continuous prophylaxis since they are ineffective.

  25. 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).

  26. Parents should be assured that the risk of Epilepsy after SIMPLE FEBRILE SEIZURE is not significantly greater than the general population.

  27. QUESTIONS 1) FEBRILE SEIZURES are not related to the Degree of temperature rise but are frequent if temperature rises abruptly. TRUE OR FALSE

  28. 3)ANTIPYRETIC containdicated in the managent of fever in children is • 1) Paracetamol • 2) Ibuprofen • 3) Aspirin • 4) Mefenemic acid.

  29. 4) Intermittent Prophylaxis is indicated in the first • 1) Five days of fever • 2) Three days of fever • 3) first day of fever only • 4) All days of Fever.

  30. 5)Which of the Following steps in the Mananagement of Febrile Seizure is Contraindicated, • 1) Prompt reduction of Temperature With Anti Pyretics & Hydrotherapy. • 2)Nursing In Prone Position • 3) Maintainng Adequate Airway & Oxygen

  31. Short notes Questions • 1)FEBRILE SEIZURES • 2) PROPHYLAXIS IN FEBRILE SEIZURES • 3)MANAGEMENT OF FEBRILE SEIZURES

  32. T HANK YOU.

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