Febrile Seizures: Dr Bharat Choudhary

Dr Bharat Choudhary Pediatric Emergency Physician Urgent Care

Seizures associated with fever are common presenting complaint in Pediatric emergency. Though it is benign condition but can have underlying serious disorders. As per medical literature it has incidence about 3-4% in young children. It occurs commonly in children of age group of 1 to 5 but rarely can be seen in infant and older children. Parents and family often get panicked when it occurs first time, so here by briefing about this condition.

Clinical features Typical febrile febrile seizure occurs in children of 1- 5 year, peak age is at 16-18 months. In typical febrile seizures generalized seizures occurs at first peak of fever, once in 24 hour, lasted for less than five minutes and does not associated with any neurological impairment and may be associated with transient loss of consciousness . When seizure seized child will gain his consciousness and behave normally. In Atypical seizures, seizures lasted longer than usual ( >15minute), may occur more than one episode in 24 hour and may not be generalized either focal or other variant. Febrile seizure may also be labeled as atypical if loss of consciousness lasted longer or if there is any abnormal behavior like irritability, drowsiness or associated with any neurological deficit.

Etiology Most of the typical febrile seizures are benign and idiopathic. Atypical seizure may have underling other disorders like meningitis, sepsis and seizure disorder. First episode of typical febrile seizure occurring in children less 18 month should also be seen suspiciously for any underlying pathology. Many children have strong history of febrile seizure so genetic factors do contribute to its etiology.

Investigations

All children with atypical febrile seizure as well children with first episode typical febrile seizure in less than 18 months should undergo thorough investigation to find underlying cause for fever and seizures because in these conditions it is difficult to rule out other disorders like meningitis, sepsis and seizures disorder. And if not treated accordingly they can affect the long term outcome. In children with previous episode of typical febrile seizure investigations are not require if child looks stable clinically. Routine investigations required are CBC profile, electrolytes and blood glucose level, CSF examination, Blood culture and urine culture. EEG and Imaging are required in atypical cases with multiple episodes, focal deficits but typical febrile seizure does not require any neuroimaging on routine basis.

Treatment In Hospital (Hospitals in Delhi) Main stay of treatment for febrile seizure is aggressive control of fever with management of ongoing seizure with benzodiazepines. Fever management includes removal of all clothes, hydrotherapy and antipyretics. Most of the seizure gets controlled with these steps but some time prolonged seizure may occur which may require oxygen, anticonvulsants and ventilation.

At Home Parents can start hydrotherapy, put child in lateral position and in safe area to avoid injury due to seizures. They can use Midazolam nasal spray or diazepam suppository after proper instruction from clinician. If seizure did not stop after this maneuvers child should be rushed to nearby urgent care center.

Prevention Febrile seizure known to recur in 30-40% of children. So parents can prevent further episode by aggressively controlling rapid rise of fever by early use of antipyretics and hydrotherapy. Sometime even after taking all precaution seizure do occurs, so they can consult to nearby urgent care center physician for use of nasal Midazolam spray at home. Children with recurrent and atypical febrile seizures can be started on prophylactic anticonvulsants.

Long term prognosis There is no evidence that simple febrile seizures cause any structural damage to the brain or that children with simple febrile seizures are at risk for cognitive decline. Population based studies have shown that febrile seizures in early childhood do not have adverse effects on behavior, scholastic performance and neurocognitive attention.