R56.0
DESCRIPTION
Seizures occurring in children between the ages of 3 months and 6 years associated with a fever but without evidence of intracranial infection or defined cause for the seizure.
Febrile seizures can be simple or complex febrile seizures.
Simple febrile seizures:
- are generalised tonic-clonic seizures,
- are self-limiting, usually less than 5 minutes and always less than 15 minutes,
- cause no neurological deficit after the convulsion,
- have a good prognosis and very rarely develop into epilepsy,
- consist of only one seizure during the febrile illness which needs no specific treatment, and
- there is often a family history of febrile seizures.
Complex febrile seizures – febrile seizures with one or more of the following:
- last longer than 15 minutes,
- are recurrent within the same febrile illness or occur within 24 hours,
- have a focal (partial) onset,
- have post-ictal, focal neurological abnormalities.
Risk factors for recurrent febrile seizures include:
- seizure disorder in a first degree relative,
- onset before 12 months of age,
- initial complex seizures.
DIAGNOSTIC CRITERIA
Clinical
- Exclude intracranial, extracranial and biochemical causes of fever or seizure.
- Signs of meningism are unreliable in children < 2 years of age.
- If raised intracranial pressure or meningitis cannot be excluded, then the diagnosis of febrile seizures cannot be made. Treat children empirically for meningitis if suspected.
Investigations
Lumber puncture
- Lumbar puncture is indicated in:
- all children with clinical features of possible meningitis,
- Lumbar puncture may be indicated in:
- Children where meningitis cannot be excluded, e.g. < 1 year of age or those who have received a course of antibiotics prior to the event.
- In children > 1 year of age, where a focus of extracranial infection is present and intracranial infection such as meningitis has been excluded clinically, no further investigation is required.
Neuroimaging
- All children with complex febrile seizures and persistent lethargy require neuro-imaging and then a lumbar puncture if raised intracranial pressure can be reliably excluded.
- Based on clinical findings, investigate complex febrile seizures for possible underlying conditions such as meningitis, focal brain lesions, and epilepsy.
Note:
- An EEG is of no value in simple febrile seizures, but consider in recurrent complex febrile seizures.
GENERAL AND SUPPORTIVE MEASURES
- Reassure parents and caregivers.
- Educate parents and caregivers regarding the first aid management of seizures.
MEDICINE TREATMENT
For fever related symptoms (temperature > 38.5˚C):
- Paracetamol, oral, 15 mg/kg/dose 6 hourly.
- Paracetamol has no effect on seizure prevention.
If convulsing:
See: Status epilepticus (convulsive) .
Continuous anticonvulsant drug prophylactic therapy
Routine daily antiepileptic drug prophylaxis is not recommended for patients with simple febrile seizures.
For children with recurrent complex febrile seizures, discuss the treatment options with a specialist.
REFERRAL
- All patients with recurrent complex febrile seizures without an obvious cause of the seizure and/or not responding to initial management should be discussed with a specialist.
- Developmental delay/regression.