Febrile Seizures or Convulsions

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Homepage: EMNote.org ■ • 🚩Membership: https://tinyurl.com/joinemnote • 🚩ACLS Lecture: https://tinyurl.com/emnoteacls • • Febrile Seizures • Introduction • Febrile seizures occur in children 6-60 months old with fever ≥100.4°F (38°C) • Most common type of seizure in young children • Classified as simple, complex, or febrile status epilepticus • Epidemiology • Affects 2-5% of children in US/Europe, 8-10% in Asian populations • Peak incidence during second year of life • 90% of first episodes occur by age 3 • More frequent during winter months • Etiology • Genetic factors and family history play significant roles • Common triggers: viral infections (influenza, adenovirus, herpesvirus-6) • Can occur after certain vaccinations (measles, DTP, pneumococcal, influenza) • Height of fever is primary influencing factor • Clinical Manifestations • Typically occurs within first 24 hours of illness onset • Average duration 4-7 minutes • Key symptoms: loss of consciousness, irregular breathing, twitching, eye rolling • Post-seizure drowsiness/confusion may last up to 30 minutes • Classifications • Simple: generalized, less than 15 minutes, no recurrence within 24 hours • Complex: more than 15 minutes, may have focal features, may recur within 24 hours • Febrile status epilepticus: more than 30 minutes or series without consciousness recovery • Evaluation • Requires thorough history and physical examination • Laboratory testing not routine for simple cases • Neuroimaging not recommended for simple cases • Lumbar puncture considered based on immunization status and age • Management • Most resolve spontaneously • Anticonvulsants given for seizures lasting more than 5 minutes • Treatment for febrile status epilepticus same as non-febrile • Prevention • Antipyretics don't prevent seizures • Long-term anticonvulsants not recommended despite effectiveness • Focus on managing underlying fever • Prognosis • No clear link to long-term neurologic/cognitive deficits • One-third experience recurrence • Risk of epilepsy depends on seizure type and other factors • Indications for Admission • Most can be discharged after observation • Admission needed for: lumbar puncture cases, status epilepticus, concerning features • Must return to neurological baseline before discharge • Future Considerations • Research focusing on preventive medications • Studies exploring role of iron, vitamin D deficiency • New prevention strategies under investigation • Conclusion • Common but frightening for parents • Most cases have good outcomes • Thorough understanding crucial for quality care

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