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Paediatric Clinical Guideline Febrile Seizure

Febrile Seizure Guideline

Title of Guideline (must include the word Guideline(not protocol, pol icy, procedure etc)

Contact Name and Job Title (author ) Kiran Damera (Specialist Registrar), Colin Dunkley(Consultant Paediatrician) on behalf of ChildrensEpilepsy Workstream in Trent (CEWT) Steering Group

Directorate & Speciality PaediatricsDate of submis sion July 2011Date on which guideline must be reviewed (this shouldbe one to thr ee years)

July 2014

Explicit definition of patient group to which i t applies(e.g. inclusion and exclusion c riteria, diagnosis)

Children and young people presenting with seizure withfever to acute paediatric services

Abst rac t as aboveKey Words Febrile convulsion, Febrile Fit, Febrile SeizureStatement of the evidence base of the guideline hasthe guideline been peer reviewed by colleagues?

Evidence base: (1-5)

1a meta analysis of randomis ed contr olledtrials

1b at least one randomised controlled trial

2a at least one well-designed controlled studywithout randomisation

2b at least one other type of well-designed quasi-experimental study

3 well designed non-experimental descriptivestudies (ie comparative / correlation and casestudies)

4 expert committee reports or opinions and / orclinical experiences of respected authorities

5 recommended best practise based on theclinical experience of the guideline developer

Multiple evidence based sources largely 3-4.

Consultation Process Nottingham Childrens Hospital Guideline GroupChildrens Epilepsy Workstream in Trent (CEWT)Steering GroupDerived from RCPCH GUIDELINE APPRAISAL.Paediatric Accident and Emergency Research Group.

Evidence-based Guidelines for Post SeizureManagement.(www.rcpch.ac.uk/publications/clinical_docs/post_seizure.pdf)

Target audience Paediatric health professionals

This guideline has been registered with the trust. However, clinical guidelines are guidelines only. The

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Paediatric Clinical Guideline Febrile Seizure

Scope

Children and young people presenting with seizure with fever to acute paediatric services

Definitions and background

Fever:

DefinitionRecorded temperature >37.8 or perceived to have fever by parents/carers around time of seizure

Febrile Seizures: (Sometimes termed Febrile Convulsion)

Definition:An event in infancy or childhood between 6 months and 5 years of age (peak age 20 months) associatedwith fever but without evidence of intracranial infection or defined cause of seizure. Population studiesreport a cumulative incidence of 25%.

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Risk Factors:

Previous febrile seizure

Family history (first degree relative): 10 - 45%

Types of febrile seizures:

Simple Febrile Seizures: A single generalised (no focal features) seizure lasting 15 min or focal features.

Acute symptomat ic seizures with fever

Other conditions can cause seizure associated with fever. These include

Intracranial infections (e.g. meningitis/encephalitis),

Metabolic or neurodegenerative disease.

Epilepsy with fever-related seizures

Seizures can be precipitated by fever in children with a known epilepsy

Other situations e.g. Fever with rigors

There are other types of episode occurring with fever that may need to be considered

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Seizure(s) with Fever

Meningism orMeningococcal shock?

Concerning Features?*

First Febri le Seizure?OR

No clear focus of in fection?OR

Parental concern?

Meningitis /Meningococcal SepsisGuidelines

Further Paediatric Assessment History and examination

Identify source of fever, investigate &treat according to NICE feverish illnessguidelines

Paracetomol and/or ibuprofen prn

Routine investigations are not indicated inall children with febrile seizures

Consider LP if concerning features*(note contraindications)

Senior review prior to discharge

Minimum 2 hours observations

Care for any child may need

supplementing with other guidelines e.g.Petechial rashUrinary Tract InfectionChest InfectionDiarrhoea and VomitingBone and Joint Infection

Once fit for discharge:

Discuss risk of future seizures

Consider home Buccal Midazolam if

prolonged convulsive seizure >10minutes. Ensure prescribed withindividualised care plan and appropriateparental training.

Febrile seizure and fever managementadvice and written information

*Concerning Features: Complex febrile seizures

o Multiple seizures in same illnesso Prolonged >15 mino Focal features

Infant < 18 months

Prior treatment with antibiotics

Drowsy before the seizure

More than 3 days illness

GP contact in last 24 hrs

Vomiting at home

Drowsy > 1 hr post seizure Neck stiffness

Petechial rash

Bulging fontanelle

Hypertension

Previous febrile seizuresAND

Focus of infection identifiedAND

No signif icant parental concern

Manage according to cause

Consider discharge

Discuss risk of future seizures Febrile seizure and fever management advice and

written information

Known or suspected epilepsy?

Review epilepsy and management

Inform epilepsy specialist nurse Review need for admission or earlier outpatient

appointment

The management of epilepsy is outside scope ofthis guideline

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NoYes

Yes

No

Continuing convulsiveseizure > 5 minutes?

Decreased conscious level? Before seizure onset

Or > 1 hour after seizure end

Or longer than typical post-ictalperiod for child in question

Prolonged Convulsive SeizureGuideline

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Reduced Conscious LevelGuideline4

Reproduced from RCPCH Reduced Conscious Level Guideline4

No

No

No

Yes

Yes

Yes

Yes

Yes

No

For further info please see www.cewt.org.uk