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Febrile Convulsions - Paediatrics - Lecture Slides, Slides of Pediatrics

Febrile Convulsions, Metabolic Disorders, Neurologically Normal, Form of Epilepsy, Etiology and Pathogenesis, History of Vaccination, History of Trauma, Focal Signs of Infection. Paediatrics is the branch of medicine that deals with the medical care of infants, children, and adolescents. Important keywords of the lecture are given above.

Typology: Slides

2011/2012

Uploaded on 12/23/2012

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Download Febrile Convulsions - Paediatrics - Lecture Slides and more Slides Pediatrics in PDF only on Docsity!

Febrile Convulsions

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.

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.

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.

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%.

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) Docsity.com

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.

Differential Diagnosis

• CNS infection.

• Metabolic Disorder as hypogylcemia and

Hyponatremia.

• Poisoning.

• Shigella toxins

• Post vaccination.

• Epilepsy.

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.

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.