Febrile Convulsion

1. Febrile Convulsion

2. Definition • Brief (<15 min), generalized, tonic-clonic seizure associated with a febrile illness≥39°C, but without any CNS infection, severe metabolic disturbance, or other known neurological cause • The most common seizure disorder during childhood

3. Introduction • Age: 6 m ~ 5 y • Incidence:3% ~ 4% in children <5 y • Peak age of onset: 18 ~ 22 m • Sex: male > female

4. Genetics • Strong family history in siblings and parents: increase risk one-third of cases.

5. Common Causesviral infection is commonest >85% of casess: • Viral URI • Reseola • Acute otitis media And may occur with pneumonia, gastroenteritis & UTI. May also occur following immunization especially with pertussis or measles immunization.

6. Differential diagnosis • CNS infection • Eletrolyte disturbance • Inborn errors of metabolism • Intracranial mass Ofcourse the Diagnosis Accourding by history and exclusion.

7. Clinical Presentation • Typical - simple • Atypical - complex

9. Atypical Presentation • Age < 6 m or >5 y • Onset >24 hrs after fever onset • Duration >15 min • Focal(unilateral)or generalized. • Occur more than once in 24 hrs. • Focal motor manifestations. • Abnormal neurological examination.

10. Investigation • Typical: not required • Atypical: required • EEG • Toxicology screening • Assessment of electrolytes • CT or MRI

11. CSF Study • To rule out meningitis • When CNS infection was suspected • Atypical febrile convulsion • Age < 1yr

12. 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.

13. Don’t forget: Counseling of parents as emergency resuscitation they can do it at home: • Put in semi-prone position. • Extend the neck,elevate the jaw. • Remove tight cloth,don’t restrain. • Nothing per mouth (spoon handle!) • No mouth to mouth breathing. • No water on the face.

14. Prognosis • Excellent prognosis in most children • Risk of recurrence: • Onset < 1 y or with family history: 50% • Onset > 1 y: 30 % up to the age of 5 yr • After second episode: 50 % • Age > 5 y: near zero

15. Prognosis • Risk of epilepsy development: • 1~2% in the general population • increase up to 9% when two or more risk factors are present

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

17. 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

18. 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/dl) for the duration of the illness (2~3 days) • Side effects: lethargy, irritable, ataxia

19. أي سؤال ياشباب؟

20. 8years male brought to the emergency room by his mother c/o feeding dificulty , contraction of lims , arching of the back while feeding , the contraction were symmetrical in both limbs mainly in extension manners that ends whithin few seconds this repeated several times per day especially after wake up from sleep ,

21. and no significants family history or history of birth trauma or perinatal infection . CBC serum,electroltes & glucose all within normal.

22. What is the investigation of choice? • What is the abnormality in the investigation? • What is the treatment of choice? • What is the long term sequelae?

23. An 18 mounth male was brought to emergency center by his parents after having agenaralized tonic clonic seizures that last approximately 5 minites the parents say the child has been previously well but developed cold symtomes earlier today with a temperature of 39C.

24. What is your diagnosis? • Other point significant in the history? • When called atypical febrile convulsion? • It is associated with high risk of epilepsy? • Out lines of breif manegment of such condition?

25. An 8years old girl brought to emergency unit of the school by her teachers because she developed generalized tonic clonic convulsion 2hrs ago at class room at break time.they said she was convulsing her eyes rolled up , tongue bitting,loss of bladder control .& loss of consciousness for few minutes after which regained her convulsion but was drawsy.

26. What other questions you will ask in the history? • If she had previous attacks what is your diagnosis? • What is the drug of choice?

27. Bibliography Thank You for Your Attention ! • Provisional committee on quality improvement, subcommittee on febrile seizures. Practice parameter: the neurodiagnostic evaluation of the child with a first simple febrile seizure. Pediatrics 1996;97:769. • Shinnar S and Glauser TA. Febrile seizures. J Child Neurol 2002;17:S44-52. • Thomas KE et al. The diagnostic accuracy of Kernig’s sign, Brudzinski’s sign, and nuchal rigidity in adults with suspected meningitis. Clin Inf Dis 2002;35:46. • Warden CR et al. Evaluation and management of febrile seizures in the out-of-hospital and emergency department settings. Ann Emerg Med 2003;41:215.