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Febrile SeizureAka: Febrile Convulsion

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  1. Definition
    1. Seizure with fever in neurologically healthy child
  2. Epidemiology
    1. Ages affected: 6 months to 5 years
  3. Risk Factors: First Febrile Seizure
    1. Low grade fever
    2. Family History
      1. Febrile Seizure in parent or sibling (10% risk)
    3. Day care attendance
    4. Developmental delay
    5. Neonatal nursery hospitalization >30 days
  4. Risk Factors: Recurrent Febrile Seizure
    1. Age of onset of first Seizure
      1. First Seizure age 1 to 3 years: 30% risk
      2. First Seizure any other age: 50% risk
    2. More than one prior febrile Seizure
      1. Second febrile Seizure: 50% risk
    3. Short interval between fever onset and Seizure
    4. Lower peak fever
  5. Criteria for Febrile Seizure
    1. Simple febrile Seizure
      1. Generalized Seizure
      2. Seizure duration <15 minutes
      3. Occurs once in 24 hour period
    2. Complex Febrile Seizure
      1. Focal Seizure
      2. Seizure duration >15 minutes
      3. Occurs more than once in a 24 hour period
      4. Known neurologic condition (e.g. Cerebral Palsy)
  6. Causes: Common
    1. Viral infection
      1. Human Herpes Virus 6
      2. Human Herpes Virus 7
      3. Influenza A
      4. Influenza B
    2. Vaccination
      1. DTP Vaccine - Whole-cell Pertussis (within 24 hours)
      2. MMR Vaccine (within 14 days)
  7. Differential Diagnosis
    1. See Seizure
    2. Meningitis
  8. Exam: Identify source of fever
    1. Consider Meningitis (rare cause of febrile Seizure)
    2. Consider Bacteremia in Children
      1. Streptococcal Bacteremia (Streptococcus Pneumoniae)
      2. Urinary Tract Infection
  9. Labs
    1. Finger stick blood sugar (bedside glucose)
    2. Urinalysis
    3. Consider serum electrolytes if indicated by history
      1. Example: Diarrhea or Vomiting
  10. Diagnostics: Criteria for Lumbar Puncture (LP)
    1. No LP if otherwise normal history and exam
    2. Atypical Seizure history
      1. Focal Seizure
      2. Prolonged Seizure exceeding 15 minutes
      3. Multiple Seizures
    3. Physical exam findings
      1. Petechiae
      2. Nuchal Rigidity
      3. Decreased Level of Consciousness or Coma
      4. Hypotension
      5. Focal neurologic deficit
  11. Imaging: Neuroimaging (CT or MRI) Indications
    1. General
      1. No imaging if otherwise normal history and exam
      2. MRI Head is the preferred modality
    2. Criteria
      1. Cerebral abscess risk
      2. Increased Intracranial Pressure
      3. Head Trauma
      4. Suspected structural defect (e.g. Microcephaly)
      5. Status Epilepticus
      6. Complex Febrile Seizure
    3. References
      1. Offringa (2001) BMJ 323:1111
  12. Management: Prophylaxis
    1. May offer parent some sense of control
    2. Prophylaxis, however, is not recommended
      1. Significant adverse effects (lethargy, irritability)
      2. Does not effect future Seizure risk
      3. Agents taken continuously have adverse effects
      4. Agents taken intermittently (Diazepam) not protective
        1. Typically Seizure presents with fever onset
    3. Continuous Dosing (not recommended - adverse effects)
      1. Phenobarbital
        1. Age 2-24 months: 5-8 mg/kg/day
        2. Age >2 years: 3-5 mg/kg/day
      2. Valproic Acid 10-15 mg/kg/day (max 60 mg/kg) divided
    4. Intermittent dose for fever >38.5 (minimally effective)
      1. Diazepam (adjust dosing per age)
  13. Management: Seizure duration >15 minutes
    1. Emergency department
      1. Diazepam 0.2 to 0.5 mg/kg IV q15 minutes
        1. Maximum cummulative dose: 5 mg for age <5 years
      2. Lorazepam 0.1 mg/kg up to 4 mg
      3. Fosphenytoin (preferred over Phenytoin)
        1. Indicated for Seizure refractory to Benzodiazepine
    2. Home environment (emergency prescription)
      1. Agents
        1. Diazepam rectal suppository
        2. Diazepam gel
      2. Dosing
        1. Diazepam 0.5 mg/kg for single dose (age 2-5 years)
      3. Protocol
        1. Parents would have available at home for prn use
        2. Give for Seizure lasting longer than 15 minutes
        3. Immediate ER evaluation for prolonged Seizure
    3. References
      1. Offringa (2001) BMJ 323:1111
  14. Consultations: Neurology Indications
    1. Not recommended in simple febrile Seizures
    2. Complex febrile Seizure
    3. Abnormal findings on examination or diagnostics
  15. Prognosis: Excellent
    1. Normal school progression expected
    2. Seizure remission expected
      1. No further Seizures after age 5 years in 98% children
  16. Predictors of continued Epilepsy
    1. Developmental delay
    2. Cerebral Palsy
    3. Hydrocephalus
    4. Fever duration less than 1 hour
    5. Abnormal Neurologic Exam
    6. Family History of Epilepsy in first degree relative
    7. Complex Febrile Seizure (see above)
  17. References
    1. Millar (2006) Am Fam Physician 73(10):1761
    2. Shinnar (2002) J Child Neurol 17:S44
    3. Warden (2003) Ann Emerg Med 41:215

Febrile Convulsions (C0009952)

Definition (MSH)Seizures that occur during a febrile episode. It is a common condition, affecting 2-5% of children aged 3 months to five years. An autosomal dominant pattern of inheritance has been identified in some families. The majority are simple febrile seizures (generally defined as generalized onset, single seizures with a duration of less than 30 minutes). Complex febrile seizures are characterized by focal onset, duration greater than 30 minutes, and/or more than one seizure in a 24 hour period. The likelihood of developing epilepsy (i.e., a nonfebrile seizure disorder) following simple febrile seizures is low. Complex febrile seizures are associated with a moderately increased incidence of epilepsy. (From Menkes, Textbook of Child Neurology, 5th ed, p784)
Definition (CSP)seizures that occur during a fever; a common condition, affecting 2-5% of children aged 3 months to five years; majority are simple febrile seizures (generally defined as generalized onset, single seizures with a duration of less than 30 minutes); complex febrile seizures are characterized by focal onset, duration greater than 30 minutes, and/or more than one seizure in a 24 hour period.
ConceptsDisease or Syndrome (T047)
ICD9780.31, 780.31, 780.32
MSHD003294
EnglishFebrile Convulsion, Febrile Convulsion Seizure, Febrile Convulsion Seizures, Febrile Convulsions, Febrile Fit, Febrile Fits, febrile seizure, Febrile seizures, Fever Convulsion, FEVER CONVULSIONS, Fever Seizure, Fever Seizures, Pyrexial Convulsion, Pyrexial Convulsions, Pyrexial Seizure, Pyrexial Seizures
Spanishconvulsion febril, convulsion por fiebre, convulsiones febriles
Parent ConceptsConvulsions (C0009951), Fever (C0015967), Epilepsy (C0014544), Duplicate concept (C1274013), Seizures (C0036572)
SourcesCOSTAR, CSP, CST, ICD9CM, LCH, MSH, MTH, MTHICD9, NDFRT, OMIM, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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