Febrile Convulsions - Paediatrics - Lecture Slides, Slides of Pediatrics

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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.