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febrile seizure

Etiology: 1) related to rise in temperature 2) increased incidence with infections with: a) gram negative rods b) roseola c) varicella Epidemiology: 1) 6 months to 5 years of age 2) generally 6 months to 3 years of age; 97% prior to 48 months of age (CDC) 3) 2-5% of infants Genetics: - genetic variations in SEZ6 may be involved in susceptibility to febrile convulsions Clinical manifestations: - majority are simple febrile seizures a) generalized onset b) single seizures with a duration of < 30 minutes - complex febrile seizures are less ocmmon a) focal onset b) duration > 30 minutes, &/or more than one seizure in a 24 hour period Laboratory: - no laboratory tests routinely indicated [4] - lumbar puncture (LP) should be performed only if meningitis is suspected [4] Special laboratory: - electroencephalogram (EEG) not indicated in an otherwise neurologically healthy child with a simple febrile seizure Radiology: -> routine neuroimaging not necessary, even for complex febrile seizures* [2,4] * defined by duration 15-30 minutes, multiple episodes, or focality Complications: - afebrile, unprovoked seizures (2-7%) - likelihood: complex febrile seizures > simple febrile seizures Management: 1) intravenous diazepam 0.3 mg/kg 2) intranasal midazolam 0.2 mg/kg 3) treatment not recommended for most patients [3] 4) long term seizure prophylaxis generally NOT indicated

Interactions

disease interactions

Related

fever

Specific

familial febrile seizures

General

seizure; epileptic seizure

Database Correlations

OMIM 121210

References

  1. Journal Watch 20(17):139, 2000
  2. Teng D et al. Risk of intracranial pathologic conditions requiring emergency intervention after a first complex febrile seizure episode among children. Pediatrics 2006 Feb; 117:304-8. PMID: 16452347 - DiMario FJ Jr. Children presenting with complex febrile seizures do not routinely need computed tomography scanning in the emergency department. Pediatrics 2006 Feb; 117:528-30. PMID: 16452375
  3. Prescriber's Letter 15(9): 2008 Simple Febrile Seizures Detail-Document#: 240911 (subscription needed) http://www.prescribersletter.com
  4. Subcommittee on Febrile Seizures. Clinical practice guideline - Neurodiagnostic evaluation of the child with a simple febrile seizure. Pediatrics 2011 Feb; 127:389. PMID: 21285335
  5. NINDS Febrile Seizures Information Page https://www.ninds.nih.gov/Disorders/All-Disorders/Febrile-Seizures-Information-Page