Febrile Seizure

Presented by
Raksha Dhakal
 Introduction
 Febrile seizures are seizures that occurs:
 between the age of 6 months to 60 months with a
temperature of 38 C (100.4F) or higher,
 that are not the result of central nervous system
infection or any metabolic imbalance,
 and that occurs in the absence of a history of prior
afebrile seizures.

Types :
 Simple febrile seizure
 Complex febrile seizure
 Febrile status epileptics
1) Simple (Benign) Febrile Seizure
Generalized, usually tonic-clonic, attack associated
with fever, lasting for maximum of 15 minutes, not
recurrent within 24 hour.

2) Complex (Atypical) Febrile Seizure

Prolonged >15 minutes, focal and recurs within 24
hour.

3) Febrile Status Epilepticus

Febrile seizure lasting longer than 30 minutes.
Features Simple febrile seizure Complex febrile
seizure

Age Between 6 months to 5 Less than 6 months or

years of age more than 5 years of
age

Type of seizure Generalized Focal

Duration Less than 15 minutes More than 15 minutes

Number of seizure Usually single per Multiple per febrile

febrile episode episode

Post ictal deficit Absent Present

Febrile Seizure recur in approximately
 30% of those experiencing a first episode,
 50 % after 2 or more episodes,
 50 % of infants younger than 1 year old at febrile
seizure onset.

 2-7 % of children who experience febrile seizure

proceed to develop epilepsy in later life.
 Risk Factors for Recurrence of Febrile Seizure

Major
Age < 1 year
Duration of fever <24 hour
Fever 38-39 C (100.4-102.2 F)
Minor
Family history of febrile seizure
Family history of epilepsy
Complex febrile seizure
Daycare
Male gender
Low serum sodium at time of
presentation

 Having no risk factors carries a recurrence risk of approximately

12%; 1 risk factor 25-50%; 2 risk factors 50-59%; 3 or more risk
factors 73-100%
 Risk Factor For Recurrence of Subsequent Epilepsy
After a Febrile Seizure
Risk Factor Risk for Subsequent Epilepsy
Simple Febrile Seizure 1%
Recurrent Febrile Seizure 4%
Complex Febrile Seizure (more than 15 6%
minutes duration or recurrent within 24
hour)

Fever < 1 hour before febrile seizure 11%

Family history of Epilepsy 18%

Complex Febrile Seizure (Focal) 29%
Neurodevelopmental abnormalities 33%
Almost any type of epilepsy can be preceeded by febrile
seizures, and a few epilepsy syndromes typically start
with febrile seizure,

 Generalized Epilepsy with Febrile Seizure Plus

(GEFS+)

 Severe Myoclonic Epilepsy of Infancy ( Dravet

Syndrome)
Generalized Epilepsy with Febrile Seizure Plus
(GEFS+)
 Autosomal dominant syndrome with highly variable
phenotype,

 Onset: childhood, Remission: mid-childhood

 Characterized by multiple febrile seizures and several

subsequent types of afebrile generalized seizure,
including generalized tonic-clonic, absence, myoclonic,
atonic, or myoclonic astatic seizures
 Severe Myoclonic Epilepsy of Infancy
(Dravet Syndrome)
 Most severe spectrum of febrile seizure associated
epilepsy

 Onset: Infancy, characterized by febrile and afebrile

unilateral clonic seizures recurring every 1 or 2 month,

 These early seizures are typically induced by fever, but

are more prolonged, more frequent, are focal and come
in clusters than usual febrile seizure,
 Seizures subsequently start to occur with lower fever
and then without fever,

 Usually caused by de novo mutation , and rarely

inherited in an autosomal dominant manner.
Evaluation
 History
 Investigation
 Management
 History
 Type of seizure (generalized or focal) and its duration
 History of fever, duration of fever and potential exposure
to illness
 Recent antibiotic use (particularly for partially treated
meningitis)
 History of developmental delay, neurological
abnormalities or other causes of seizures (trauma,
poisoning)
 Family history of febrile seizure or epilepsy
 History of recent vaccination
 Evaluation
1) Lumbar Puncture:

 Meningitis should be considered on differential diagnosis and LP

should be performed in all infants younger than 6 months of age
who present with fever and seizure, or child is ill appearing or
any age if there are clinical signs or symptoms.

 Lumbar puncture is optional in a child 6-12 months of age who is

deficient in Haemophilus Influenzae type b and Streptococcus
pneumoniae immunizations or with unknown immunization
status or children pretreated with antibiotics.
2) Electroencephalogram (EEG)

 If a child presents with first episode of simple febrile

seizure and is neurologically healthy, an EEG is usually
not performed as a part of evaluation,

 Even if the EEG result is abnormal, it would not predict

the future recurrence of febrile seizures or epilepsy,

 EEG is usually done in cases where epilepsy is highly

suspected,

 Also helpful in patients with febrile status epilepticus.

3) Blood Studies

 Blood Glucose should be determined in children with

prolonged obtundation or with poor oral intake.

 Serum electrolyte values may be abnormal in children

after afebrile seizure.

 A low level of sodium is associated with higher risk of

recurrence of the febrile seizure within 24 hours.
4) Neuroimaging

 Children with complex febrile seizure need to be

evaluated with CT scan or MRI.

 It is usually not recommended in evaluating the child

after a first simple febrile seizure.

 Approx. 11% children with febrile status epilepticus

are reported to have unilateral swelling of their
hippocampus acutely followed by long term
hippocampus atrophy.
 Treatment

 If seizure last for longer than 5 mins, acute treatment

with diazepam , lorazepam or midazolam is used.

 Intravenous benzodiazepam, phenobarbital, phenytoin

or valporate may be needed in case of febrile status
epilepticus.

 During febrile illness oral diazepam 0.33 mg/kg tds or

rectal diazepam 0.5 mg/kg tds can be given if the
parents are very anxious concerning their childs
seizure.
 Such therapies help to reduce, but do not eliminate, the risk of
recurrence of febrile seizure.

 Other therapies include phenobarbital 4-5 mg/kg/day in 1 or 2

divided dose and valporate 20-30 mg/kg/day in 2 or 3 divided
dose.

 Antipyretics can reduce the discomfort but do not reduce the risk
of having a recurrence of febrile seizure.

 Chronic antiepileptic therapy may be prescribed in children with

high risk for later epilepsy.

 Iron deficiency is associated with and increased risk of febrile

seizure thus screening and treating appears appropriate.
Febrile Seizure Prophylaxis
1) Intermittent:
indicated if 3 or more febrile seizures in 6 months
or 6 or more in 1 year,
Febrile seizures lasting for > 15 minutes

2) Continuous:
failure to intermittent therapy
1) Intermittent Prophylaxis
Clobazam 0.75-1 mg/kg/day for 3 days during fever
episodes
Antipyretics, hydrotherapy and meticulous temperature
recording

2) Continous Prophylaxis
Sodium Valproate 10-20 mg/kg/day
Phenobarbitone 3-5 mg/kg/day
Duration: 1-2 year or until 5 years of age
Thank You
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