Febrile Convulsion
Prevalence
6 months to 6 years, most before 4 years
Between 2% and 5% of children under 5 years will have a febrile convulsion
Cause
Interleukin-1, released in response to fever, is a pro-convulsant
Types
Simple febrile convulsion
Generalised tonic-clonic
< 10min
Not recur in 24 hours
Complex febrile convulsion
Focal or partial
> 10min
Recur within 24 hours
Features
Shake and jerk arms
Eyes roll back
Difficulty breathing
Postictal last hours
Neuro exam post-ictal should be normal
Assessment
Is this a true seizure?
Is the child febrile?
Is this meningitis, encephalitis, or encephalopathy?
Meningitis
Poor feeding
Neck stiffness
Bulging fontanelle
Irritability
Lethargy
Complex febrile convulsion
17% of prolonged febrile seizures are in the setting of meningitis
If meningitis, antibiotics - IM ceftriaxone > ED
First aid
Place the child on the side
Do not stop movements
Nothing in mouth
Watch clock
Ambulance
Benzodiazepine
Prognosis
Risk of epilepsy in the population = 1.4%
Risk with febrile convulsion = 2.4%
Risk factors
Family history of afebrile seizures
Pre-existing neurological conditions
Complex seizure
If 0/3 then chance epilepsy ~1%
If 1/3 then chance ~2%
If 2+/3 then chance ~10%
Recurrence
Age less than 1 = 50% chance
Age less than 3 = 20% chance