this has happened 3-4x before. What is the most likely dx?
a. Febrile convulsion
b. Absence seizures
c. Epilepsy
d. Partial complex seizure
answer: A
• most common cause of seizure in children (3-5% of
children)
• M>F; age 6 mo-6 yr
Clinical Presentation
• often with associated illness or fever and family history
• no evidence of CNS infection/inflammation before or after
seizure; no history of non-febrile seizures
Comparison of Typical and Atypical Febrile Seizures
Simple/Typical (70-80%)
All of the following:
• Duration <15 min (95% <5 min)
• Generalized tonic-clonic
• No recurrence in 24 h period
• No neurological impairment or developmental delay before
or after seizure
Complex/Atypical (20-30%)
At least one of the following:
• Duration >15 min
• Focal onset or focal features during seizure
• Recurrent seizures (>1 in 24 h period)
• Previous neurological impairment or neurological deficit
after seizure
Workup
• history: determine focus of fever, description of seizure,
medications, trauma history, development, family history
• physical exam: LOC, signs of meningitis, neurological
exam, head circumference, focus of infection
• septic workup including LP if suspecting meningitis
(strongly consider if child <12 mo; consider if child is 12-18 mo; only if
meningeal sign present if child >18 mo)
• if typical febrile seizure, investigations only for
determining focus of fever
• EEG/CT/MRI brain not warranted unless atypical febrile
seizure or abnormal neurologic findings
Management
• counsel and reassure patient and parents
-febrile seizures do not cause brain damage
-very small risk of developing epilepsy: 9% in child with
multiple risk factors; 2% in child
with typical febrile seizures compared to 1% in general
population
-33% chance of recurrence (mostly within 1 yr of first
seizure and in children <1 yr old)
• antipyretics and fluids for comfort (though neither
prevent seizure)
• prophylaxis with antiepileptic drugs not recommended
• if high risk for recurrent or prolonged seizures, have
rectal or sublingual lorazepam at home
• treat underlying cause of fever
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