Makindo Medical Notes

Related Subjects: |Status Epilepticus (Epilepsy) |Coma management |Lorazepam |Phenytoin |Levetiracetam |Epilepsy - General Management |First Seizure |Epilepsy in Pregnancy |Febrile seizures

Febrile seizures typically occur on the first day of a fever and are usually harmless, not indicating a lasting seizure disorder. Most children recover quickly without complications.

About

• Febrile seizures commonly affect children aged 6 months to 5 years, with a recurrence rate of approximately 40%.
• The risk of developing epilepsy is low (1 in 100) if the seizure lasts less than 30 minutes and occurs as a single episode.
• Prolonged or recurrent febrile seizures may increase the risk of developing temporal lobe epilepsy (TLE) later in life.

Aetiology

• Infection: Viral or bacterial infections, especially human herpesvirus-6 (roseola), are common triggers.
• Post-immunization: Febrile seizures may occur after measles, mumps, and rubella (MMR) vaccination.
• Family history of febrile seizures increases a child’s risk.

Clinical Presentation

• Characterized by a generalized tonic-clonic seizure occurring as the body temperature rises above 38.3°C (101°F).
• No evidence of central nervous system (CNS) infection, neurological abnormality, or epilepsy.
• Red Flags: Symptoms such as a stiff neck, extreme lethargy, or persistent vomiting warrant immediate medical attention to rule out other serious conditions.

Differential Diagnoses

• Encephalitis
• Meningoencephalitis
• Hypoglycemia
• Brain lesion
• Other neurological conditions, such as migraines or tics

Investigations

• Basic Tests: Blood tests including FBC, U&E, midstream urine (MSU) analysis, and chest X-ray (CXR) to identify underlying causes of fever.
• Additional Testing: Lumbar puncture (LP) with cerebrospinal fluid (CSF) analysis if meningitis or CNS infection is suspected.
• Brain imaging, such as MRI or CT, may be considered in cases of prolonged or complex febrile seizures.

Management

• Position the child in the recovery position, ensuring a safe environment, and protect their head during the seizure.
• For Seizures Lasting >5 Minutes: Administer IV lorazepam or rectal diazepam if available.
• Use tepid sponging and paracetamol to manage the fever, though fever control may not prevent recurrence.
• Call emergency services if it is the child’s first seizure or if the seizure lasts longer than 5 minutes.