Febrile Convulsions

Posted by e-Medical PPT Friday, November 9, 2012
Seizure in children occurring between 6 months and 6 years precipitated by fever from infection/inflammation/metabolic disorders outside CNS in children who are otherwise neurologically normal .
It is not a form of epilepsy because brain is normal.

Prevalence is 2-4% of children less than 6 years.
4% of febrile convulsion occur at age less than 6 months.
6% occur after the age of 6 years
90% occur between 6 months and 6 years.
Vaccination is rarely followed by febrile convulsion and mainly after:
DTP after one day of vaccination in 6-9/100000
MMR after 8-14 day of vaccine in 25-35/100000

Etiology and Pathogenesis
The exact etiology of febrile convulsion is unknown.
A strong genetic influences is applied because of increase frequency among family members to have febrile convulsions.

Clinical Picture
In most cases it is generalized tonic clonic convulsion.
Febrile convulsion is divided into three main groups based on symptoms of the seizure:
Simple febrile convulsion (convulsion occur in majority of the cases ~ 75%, lasting less than 15 minutes and 80% less than 6 minutes and 50% less than 3 minutes, not having focal features, single in 24 hours).
Complex febrile convulsion: represent 25% of the cases, lasting more than 15 min, with focal features, multiple in 24 hours.
Febrile status epilepticus

If recurred it will be within 1st year of the first attack and recurrence most likely will be if :
If first convulsion occur under age of 15 month (50% recurrence rate)
Complex febrile convulsion.
First febrile convulsion with low grade fever.
Positive family history of febrile convulsion or epilepsy.

When to refer and admit
Strongly admit for LP or treatment if any of the following factors present:
Age under 18 months (may have meningitis with no signs).
If signs of meningitis present.
Child is toxic (irritable or drowsy).
Current treatment with antibiotics because may mask meningeal signs
Complex convulsion
First simple attack of febrile convulsion.
The course of fever requires hospital management in its own right.
Parents wish (anxious)
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