Febrile Convulsion

IntroductionAge: 6 60 month oldIncidence: 2% - 4% in children

DefinitionBrief (

Simple febrile seizure [ 90% of cases ]1. Generalized, tonic-clonic for 15 minutes2. No recurrence within 24-hr period3. Very short postictal state (within minutes) with no neurological deficit

complex febrile seizure Age < 6 months or > 60 monthsDuration >15 minOccur more than once in 24 hrFocal seizure or neurological deficit

Common CausesViral URIReseolaAcute otitis media

Differential diagnosisCNS infectionEpilepsyEletrolyte disturbanceInborn errors of metabolismIntracranial mass

InvestigationSimple : not requiredComplex : required EEGToxicology screeningAssessment of electrolytes , Ca , PO4 , Mg , Blood sugarCT or MRI

CSF StudyTo rule out meningitis in child who have no or unknown HiB , S.pneumoniae immunizations

Age < 1 year old Any age with alteration of consciousness

Contraindication : signs of increase ICP , skin infection

PrognosisExcellent prognosis in most children

Risk of recurrenceOnset < 1 year old : 50%Onset > 1 year old : 30 %+ 10% with each risk factorAfter second episode: 50 %Age > 5 y/o: near zero

Risk of epilepsy development:1~3% in the general populationincrease up to 30% when risk factors are presentPositive family history of epilepsyComplex febrile seizure Previous neurodevelopemental abnormalities

Recurrence PreventionContinuous therapyValpronic acid - Dose: 20 mg/kg/d for the duration of 2 year- with potential risk of fatal hepatotoxicity, thrombocytopenia, GI disturbances, and pancretitis

Recurrence PreventionIntermittent therapyDiazepam:Oral or rectal formDose: 0.3 mg/kg q8h PO (1 mg/kg/d) for the duration of the feverFor patients with frequent febrile convulsion or significant parental anxiety Side effects: lethargy, irritable, ataxia

ReferenceNelson Textbook of Pediatrics, 20th ed.http://www.uptodate.com/contents/clinical-features-and-evaluation-of-febrile-seizuresThank You

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