Managing Febrile Seizures by Will Stahl-Timmins

Managing febrile seizures By Will Stahl-Timmins

Denition: Seizure types: Childhood seizure Simple Complex Febrile status A er one month of age epilepticus Child has febrile illness Less than 15 mins More than 15 mins No CNS infection Generalised Focal More than Is this a 30 mins No previous neonatal febrile or unprovoked seizures No recurrence May have within 24 hours repetitive seizures seizure? Doesn’t meet criteria for other acute symptomatic seizures No postictal Todd’s paresis —International League Against Epilepsy pathology may be present

Beware an altern- Red flags suggestive of CNS infection: Any physical signs of ative diagnosis, Antibiotic treatment Complex febrile seizures meningitis/encephalitis especially if the • Bulging fontanelle History of irritability, decreased feeding or lethargy fever is less • Focal neurological signs than 38°C, or in Incomplete Postictal symptoms • Neck stiness infants younger immunisation: lasting more than 1 hour Consider • Photophobia than 6 months. • Haemophilus • Limited social response Symptoms and signs of alternative Causes could influenzae B • Altered consciousness ! include CNS infec- meningeal irritation may diagnoses • Streptococcus • Neurological decit be absent in children tions or other pneumoniae • Drowsiness under 2 years of age. causes of fever.

Recurrence: Risk factors Age at onset under 18 months Overall recurrence is thought Fever less than 39°C to be about 1 in 3. Parents can First degree relative has history of febrile seizure be reassured that recurrence Shorter duration of fever before seizure (<1 hour) is rare in children with no risk Multiple seizures during the same febrile illness factors. Day nursery attendance Epilepsy Children with no risk factors Children with all risk factors Most children with FS do not develop an epilepsy.

Risk factors Family history 4 in 100 80 in 100 Educate of epilepsy chance of further seizures chance of further seizures and inform Complex febrile parents seizure Cognitive Advice for Parents Neurodevelop- impairment mental Protect child from injury impairment A single During seizure Do not restrain child simple Do not put anything in their mouth Having all three febrile seizure risk factors poses no threat Check airway increases risk of to a child’s cognitive If seizure Place child in recovery position epilepsy to 50%. development. ends within 5 Explain that the child may minutes be sleepy for up to an hour Rescue medications Seek medical advice If seizure For children with high risk of recurrence, continues Call an ambulance parents should be provided with longer than Administer rescue treatment benzodiazepines (midazolam or rectal 5 minutes diazepam) on discharge.