Febrile seizures 2016
4 things you have learned - Definition of seizure - When to do LP (concern for meningitis, meningeal signs) - Hib, Strep pneumo as 2 bacteria that are main causes of meningitis in this age group - No need for imaging if hx/physical consistent with simple febrile seizure - If partially immunized or not immunized, consider LP - More likely to recur, slightly higher risk of seizure disorder in future
3 ways to incorporate what you’ve learned into practice - Careful hx and physical important to define simple febrile seizure - Avoid LP, imaging, labs, EEG if sounds like simple febrile seizure - Reassurance for parents for what to expect in future (most don’t have neurologic sequelae), temperature control in future fevers
2 ‘pearls’ - Age range (6-60 months) (or to 6 years) - Definition of febrile seizure (generalized, <15 minutes, no recurrence in 24 hrs)
1 topic you’d like more information on - Is there higher future risk of developing seizure disorder with complex febrile seizure than with simple?
CMO's curriculum discussion: - - • List four (4) things you have learned from the article you read: - 1) Criteria for simple vs complex seizure - 2) Recommendations only apply to neurologically “normal” children - 3) Consider LP in unvaccinated (no Hib or Strep pneumo) children - 4) No need for imaging for most simple complex seizures - 5) If child is on antibiotics, can still consider LP as it may mask signs of meningitis - - • Prepare to discuss three (3) ways you will incorporate what you have learned into your practice - 1) Provide pt education that febrile seizure may recur - 2) Pt’s need to be seen within 12 hours, but may not necessarily have to go to the ED - 3) Information in the article will help with providing reassurance to the family that febrile seizures occur in up to 5 percent of children and often do not require further work-up - - • Write two (2) ‘pearls’ you consider essential knowledge regarding febrile seizures. - 1) Recurrence occurs in 1/3rd of pts - 2) Work-up should be focused on finding the source of fever - - • List one (1) topic about febrile seizures you would like more information on. - 1) Which vaccines are associated with a higher risk of febrile seizure ? - a. ProQuad at 1 year of age - b. PCV - c. Flu in same visit as prevnar and DTaP: rate of up to 30 in 100 000 - children immunized - Reference: Sawyer et al. Vaccines and febrile seizures: quantifying the risk. Pediatrics. 2016 Jul;138(1). pii: e20160976. doi: 10.1542/peds.2016-0976. Epub 2016 Jun 6.
Monday Patchogue CCC curriculum assignment
Things learned: 1 Good review of simple vs. complex definitions: > 15 minutes for definition of complex 2 Increased risk of recurrent febrile seizures with initial episode 3 LP can be considered even after antibiotics 4 Drawing electrolytes, calcium, phos, mag, CBC, glucose NOT necessary 5 Would not avoid vaccinations in the setting of h/o febrile seizures
Ways to incorporate what we have learned: 1 Minimize imaging and lab work, increase parental reassurance 2 Will consider performing lumbar puncture if antibiotics were given 3 Will advise parents that there is an increased risk of febrile seizures in the future if child presents with febrile seizure 4 Will guide parents to look for signs of illness/ fevers in the future and treat with antipyretics 5 Identify the source of the fever vs. cause of the seizure
Two “pearls” 1 Labs, EEG, and imaging is not necessary for simple febrile seizures 2 Reassurance and education for parents regarding febrile seizures can avoid unnecessary workup
*We would like more information regarding… Future risk of developing epilepsy