Febrile Convulsions

Prepared by: Dr. Basem Abu-Rahmeh

Directed by: Dr. Afaf Al-Arini

Definition
Seizure in children occurring between 6
months and 6 years precipitated by fever
from infection/inflammation/metabolic
disorders outside CNS in children who are
otherwise neurologically normal .
It is not a form of epilepsy because brain is
normal.

How Common
Prevalence is 2-4% of children less than 6 years.
4% of febrile convulsion occur at age less than 6
months.
6% occur after the age of 6 years
90% occur between 6 months and 6 years.
Vaccination is rarely followed by febrile
convulsion and mainly after:
DTP after one day of vaccination in 6-9/100000
MMR after 8-14 day of vaccine in 25-35/100000

Etiology and Pathogenesis

The exact etiology of febrile convulsion is
unknown.
A strong genetic influences is applied
because of increase frequency among
family members to have febrile
convulsions.

Clinical Picture
In most cases it is generalized tonic clonic
convulsion.
Febrile convulsion is divided into three main
groups based on symptoms of the seizure:
Simple febrile convulsion (convulsion occur in
majority of the cases ~ 75%, lasting less than 15
minutes and 80% less than 6 minutes and 50% less
than 3 minutes, not having focal features, single in
24 hours).
Complex febrile convulsion: represent 25% of the
cases, lasting more than 15 min, with focal features,
multiple in 24 hours.
Febrile status epilepticus.

Diagnosis
History:

Age
Fever (duration, peak and rate of increase).
History of trauma.
History of vaccination (pertussis).
Other sites of infection.
Family history.
Metabolic disorders.
GI symptoms.

Recurrence
If recurred it will be within 1st year of the first
attack and recurrence most likely will be if :
If first convulsion occur under age of 15 month (50%
recurrence rate)
Complex febrile convulsion.
First febrile convulsion with low grade fever.
Positive family history of febrile convulsion or epilepsy.

If first degree relative (one person) recurrence will be in 30%.

If first degree relative (2 persons) recurrence will be in 50%.
If first degree relative 3 persons recurrence will reach 100%.
If no family history recurrence will be 10%.

When to refer and admit

Strongly admit for LP or treatment if any of the following
factors present:

Age under 18 months (may have meningitis with no signs).

If signs of meningitis present.
Child is toxic (irritable or drowsy).
Current treatment with antibiotics because may mask meningeal
signs
Complex convulsion
First simple attack of febrile convulsion.
The course of fever requires hospital management in its own
right.
Parents wish (anxious)

Examination
Look for focal signs of infection.
50% was having otitis media in one study
Reseola Infantum detected in increased fequency.
Most causes of fever are simple infection rather than complex
infection (Otitis Media, Pharyngitis versus pneumonia).

Usually CNS examination in simple Febrile convulsion

in normal but in Complex type you can find Focal
neurological deficit.
Skin rash
Others

Investigations

LAB.: Mainly concentrated to look for the source

of infection or fever.
Imaging Studies as CT, MRI not indicated
EEG not indicated because most have normal
EEG.

Differential Diagnosis
CNS infection.
Metabolic Disorder as hypogylcemia and
Hyponatremia.
Poisoning.
Shigella toxins
Post vaccination.
Epilepsy.

Complications and Prognosis

Wrong diagnosis lead to delay diagnosis of meningitis.
Recurrence.
Status epilepticus represent 25% of status epilepticus
in children.
Epilepsy increase (1% compared with normal
populations which is about 0.5%with the following
factors:
Neurologically abnormal or developmentally delayed before onset of
febrile convulsion.
If atypical seizure
Family history of epilepsy

Management
Control fever by antipyretics (paracetamole
or ibubrufen) + cold compressors.
Rectal diazepam rarely need to abort febrile
convulsion because convulsion most of the
time is short in duration but prolonged give
it.
If children have risk factor for recurrence
give diazepam in early fever.

Prophylactic Treatment
Phenobarbitol / valproic acid daily oral dose are
effective in preventing febrile convulsion but
benefits of prophylaxis rarely outweighs the risk
of adverse effects
Vaccination is not contraindicated
No treatment is effective in decreasing risk of
future epilepsy
**so in general drug rational that included in febrile
convulsion are brufen , revanin, rectal dizepam.

Counseling of the Parents

Parents should be in formed about the
benign nature of febrile convulsion and that
it may recure.
Parents should be taught to manage the
convulsion by placing the child in recovery
position (lying In his or her side to prevent
aspiration and control fever).