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Updated: Aug 26 2021

Febrile Seizures

  • Snapshot
    • A 2-year-old boy is brought to the emergency department due to a generalized tonic-clonic seizure. The seizure lasted about 4 minutes. His temperature was measured to be 103°F. He has no prior history of seizures.
  • Introduction
    • Most common seizure in infants and young children
      • occurs between 6 months and 5 years of age, with a slight male predominance
    • Associated with fever (≥ 38°C ) without evidence of CNS infection, afebrile seizure history, or metabolic disturbance
    • Risk factors:
      • elevated fever (≥ 38°C)
      • age – potentially due developing nervous system being vulnerable to fever
      • viral infection (i.e., HHV-6, Influenza virus)
      • family history – potential genetic component
      • recent immunizations – absolute risk is small
  • Presentation
    • Simple febrile seizures (70%-80%)
      • generalized, < 15 minutes long, 1 seizure within 24 hours
      • generalized tonic-clonic (most common)
    • Complex febrile seizures (20%-30%)
      • defined by presence of any of the following features
        • focal, > 15 minutes long, > 1 seizure within 24 hours
      • febrile status epilepticus - subset of complex febrile seizures
        • classically defined as seizure lasting > 30 minutes
        • neurologic emergency
  • Evaluation
    • A clinical diagnosis
    • Consider lumbar puncture if suspicious of meningitis
      • i.e., lack of Haemophilus influenza type B or Streptococcus pneumoniae vaccination
      • physical exam suggesting meningitis or some CNS infection
    • Lab
      • not for seizure evaluation
        • may be used for seizure evaluation in the setting of complex febrile seizure
      • do if useful to identify fever source
  • Treatment
    • Management for all febrile seizures
      • mostly observation, counseling, reassurance, and educating the parent
      • antipyretics help alleviate symptoms of fever
    • Further considerations for complex febrile seizures
      • more commony associated with infection or structural abnormalities
        • consider obtaining EEG though not required
        • may treat with benzodiazepine if lasts >5 minutes
        • terminate status epilepticus with benzo or phenytoin
        • initiate status epilepticus protocol if continues
  • Prognosis, Prevention, and Complications
    • Rarely develops into epilepsy
    • Monitor complex febrile seizures as more likely to recur
    • Differential
      • brief resolved unexplained event (BRUE)
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