Watuhatai Paibool, MD Division of Neurology, Department of ...
Transcript of Watuhatai Paibool, MD Division of Neurology, Department of ...
Fever with seizure
Watuhatai Paibool, MD
Division of Neurology, Department of Pediatrics
Faculty of Medicine, Khon Kaen university
Fever with seizure
1. Febrile seizure (the most common)
2. CNS insults (less common but important group)
: meningitis, encephalitis, hypoglycemia, hyponatremia etc.
3. Epilepsy triggered with fever (the least common)
Definition of febriles seizure
Seizure with fever - BT ≥ 100.4°F or 38°C by any method (AAP 2011) - BT ≥ 38.4°C (NIH 1980)
No CNS infection, electrolyte imbalance
• 6-60 months of age , peak 18-24 months (AAP 2011) • > 1month without prior afebrile seizure (ILAE 1993)• 3 months – 5 years of age (NIH)
occur in 2% to 5% of children
Pathophysiology
• Unknown
• Infection : HHV-6, HHV-7
• Immature of thermoregulation center
• Immature neuronal membrane
• Genetic predisposition: SCN1A, SCN1B, SCN9A
GABRG2,GABRD
FEB 1-10
Febrile seizure
Simple febrile seizure Complex febrile seizure
- Generalized seizure- Brief - Isolated seizure
- Focal - Prolonged seizure
(> 10 or 15 mins)- Multiple (> one seizure
during the febrile illness)
Swaiman ,ed 6th
Investigation
• Blood glucose
• Blood studies (Electrolytes, Ca, Mg, and CBC)
• Lumbar puncture (LP)
- 6-12 mo, LP is option if no Hib or IPD immunization or unknown
immunization status and in children pretreated with ATB
**strongly considered in the infant younger than 12 months of age
• Electroencephalography(EEG), neuroimaging: not required
Clinical practice guideline-febrile seizures AAP,2011
Investigation
Complex febrile seizure
• LP if consider if suspected CNS infection
• CT brain: recommended esp. focal seizure
• EEG: recommended if suspected viral encephalitis esp. Herpes
Recommendations for the management of febrile seizures, Epilepsia, 2009
Initial management
• คลายเส้ือผา้ท่ีรัดออก และจบันอนตะแคงใหศี้รษะต ่าเพื่อไม่ใหส้ าลกั • ไม่ตอ้งใชว้สัดุใดๆ งดัปากหรือใหย้าทางปาก • เชด็ตวัโดยใชผ้า้ขนหนูชุบน ้าประปาบิดพอหมาด ถูเบาๆ เพ่ือใหเ้ส้นเลือดใตผ้ิวหนงัขยายตวัเพื่อท าใหไ้ข้ลดลง
Treatment
• General management: ABC
• Terminate seizure (prolonged seizure):
Diazepam - IV 0.3 mg/kg/dose (max 10 mg)
- Rectal 0.5 mg/kg/dose (max 10 mg)
*Can repeat once after 5-10 minutes
• Management of fever: Paracetamol, Tepid sponge, Treat cause of fever
Preventing a Febrile Seizure
• Anti-pyretic
• Intermittent prophylaxis• Oral diazepam (0.33 mg/kg/dose every 8 hours with fever)• Decrease risk of FS from 31% to 21% • RCT; comparing placebo with oral diazepam- seizure recurrence by 36 months
was noted in 22% of the diazepam treatment group, compared with 31% of the placebo treatment group.
• Must weight this reduction in seizure recurrence with the side effects of sedating children
• Long-term antiepileptic drug therapy is rarely indicated in the treatment of febrile seizures
Clinical practice guideline-febrile seizures AAP,2011
Counseling and education
• Febrile seizures are a common & mostly benign form of childhood seizures.
• Febrile seizures do not cause of brain damage or intellectual decline
• The vast majority of febrile seizures do not appear to have any
long-term sequelae.
Risk Factors for Recurrent Febrile Seizures & Epilepsy After a Febrile Seizure
Recurrent Febrile Seizures Epilepsy
DEFINITE RISK FACTOR
Family history of febrile seizures Neurodevelopmental abnormality Age less than 18 months Complex febrile seizure Height of peak temperature Family history of epilepsy Duration of fever
POSSIBLE RISK FACTOR
Family history of epilepsy More than 1 complex feature
Swaiman ,ed 6th
- General risk of recurrent is 30-40%- Less if no risk factor 10%- More if many risk factors >50-60%
- General risk of simple FS is 1-1.5%
- For complex seizure 4-15%- High risk if more risk factor