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)