Febrile Seizures

• Febrile convulsion is a seizure that usually occurs from 3-6months of age (but can occur in those up to 5 years of age) with associated fever (>38 degrees Celsius) without acute intracranial disease, metabolic disturbance or CNS infection.
• Most febrile seizures last between 1-3 mins and spontaneously resolve - these patients needs to be monitored in the emergency department and often do not require admission and the condition is self limiting.
• Diagnosis is clinical. The important thing to the presence of seizures with an associated high temperature. It is important to exclude other possible causes of seizure.
• Risk factors include: family history of febrile seizures, previous febrile seizures, febrile illness (such as underlying viral or bacterial infection), young age, high temperature .

Types:

• Simple febrile seizure: self limiting

• Complex febrile seizures: focal findings, prolonged >15mins, multiple within 24 hours or multiple without incomplete recovery between each episode.

• Febrile status epilepticus: prolonged seizure or one that does not recover - treat as per status - rectal/PO benzo +/- IV diazepam +/- fosphenytoin.

• If seizures are lasting >5 minutes - then medication is required to stop the seizure, this is done to reduce

• Choice of medication: midazolam (buccal, IN) or rectal diazepam and repeat after 10 mins if required. If still ongoing seizures -> antiepileptics are given including IV fosphenytoin. Consultation with paedatrician is recommended if prolonged seizure without adequate response to antiepileptics.

Reasons for hospital admission:

• uncertain focus of fever
• uncertain cause of seizure
• complex febrile seizure
• prolonged post ictal phase
• focal neurology

Patient information:

• Febrile seizures gives 35% of having another febrile seizure
• Febrile seizures gives patient slightly higher chance of developing epilepsy or non-febrile seizure later in life (5%). This percentage is higher if initial febrile seizure is complex (10-15%)