Febrile convulsion

Question 1

What is the function of fever?

Answer 1

Prevent pathogen replication

Question 2

Why are babies prone to getting fever?

Answer 2

• Not good at thermoregulation
• Temperature goes down with the shaking

Question 3

How common are febrile convulsions?

Answer 3

Occurs between 6 months and 6 years in 5% of children

Question 4

How long do febrile seizures usually last?

Answer 4

Parents have poor recall

<5min

Question 5

List some viral causes of febrile seizures.

Answer 5

90% of fever is caused by viruses; 10% bacterial

• Herpes zoster 6 virus (roseola)
• Adenovirus
• Coxsackie virus
• Influenza

Question 6

What type of seizure are most febrile seizures?

Answer 6

tonic clonic

Question 7

What is a simple febrile seizure?

Answer 7

<15 min generalised

Complete recovery within 1hr

No repeat seizure within 24 hours

Question 8

What is a complex febrile seizure?

Answer 8

15-30min focal

may recur within 24 hours

Question 9

What is a status epilepticus febrile seizure?

Answer 9

>30 min

Question 10

Should a child be admitted if the febrile seizure is their first seizure?

Answer 10

• Yes
• Also if it is a complex seizure

NICE CKS: Admit if:

Arrange emergency ambulance transfer to A&E if:

• There is suspected meningitis/meningococcal disease, or encephalitis.
• There is another suspected serious or life-threatening cause of fever, such as pneumonia or sepsis.

Arrange immediate hospital assessment by a paediatrician if:

• It is the 1st presentation of febrile seizure (or a subsequent febrile seizure and the child has not had previous specialist assessment).
• The child is <18 months of age (clinical signs of CNS infection may be subtle or absent).
• There is diagnostic uncertainty about the cause of the seizure.
• There are any features of a recurrent complex febrile seizure.
• There is any focal neurological deficit.
• There was a decreased GCS prior to the seizure.
• The child has recently taken antibiotics (may mask the signs of CNS infection).
• There is parental/carer anxiety and/or difficulty coping.

Question 11

Do antipyretics reduce the occurrence of febrile seizures?

Answer 11

No

Question 12

What is the risk of developing epilepsy after having febrile seizures?

Answer 12

2.5% if they have no other risk factors (i.e. (1) no FH, (2) no complex febrile seizures, (3) no neurodevelopmental disorder)

NHS:

1. It’s estimated that children with a history of simple febrile seizures have a 1 in 50 chance of developing epilepsy in later life.
2. Children with a history of complex febrile seizures have a 1 in 20 chance of developing epilepsy in later life.
3. People who have not had febrile seizures have around a 1 to 2 in 100 chance of developing epilepsy.

Question 13

What is the chance of developing epilepsy in a child with Down’s syndrome who has had complex febrile seizures and a FH of epilepsy?

Answer 13

Up to 50%

Question 14

What is the risk of further febrile convulsions?

Answer 14

1 in 3

But varies if: age of onset < 18 months, fever < 39ºC, shorter duration of fever before seizure and a family history of febrile convulsions