(Taken from the July Emergency Department edition of Paediatric Pearls)
‘A febrile seizure usually occurs between 3 months and 5 years of age, associated with fever but without evidence of intracranial infection or defined cause for the seizure’. NIH, USA
Most febrile seizures are generalised tonic clonic (GTCS), but fever can provoke other types of fits. Differential diagnoses include rigors and faints. At least 50% are caused by viruses, 1% of patients have meningitis or encephalitis instead.
Simple Febrile Convulsions (70%):
- Last < 10 minutes, usually < 2 minutes
- Do not recur within same illness
Complex Febrile Convulsions (30%):
- GTCS or focal
- Last > 10 minutes
- Recur within 24 hrs
- Need referral to paediatric team
- Febrile seizures are common – 3-4% of children by age 7 will have had one
- Short febrile seizures are not dangerous, those lasting > 30mins can be
- May have more febrile fits but does not mean that the child has epilepsy
Risk of recurrence is 30-40% overall. Depends on number of risk factors (low temperature, < 18/12 old, family history, short duration of illness) present. No risk factors = 4%, 1 = 23%, 2 = 32%, 3 = 62%, 4 = 72% risk of recurrence.
Risk of developing epilepsy also depends on risk factors (abnormal neurodevelopment, complex febrile seizures, family history of epilepsy).
No risk factors = 0.5% (same as background population risk), 1 = 6-8%, all 3 = almost 50% risk.
Reference: Paediatric Epilepsy Training (PET) Level 1 course guide. See http://www.bpna.org.uk/pet/which-course-pet123D.php
Taken from the July Emergency Department edition of Paediatric Pearls
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