Febrile Seizures

Dr. Vinia Rusli Sp.A

Febrile Seizures
O Most common type of seizures in the

pediatric population.
O Age dependent

O Usually occur in ages 6 months 5 years

O Peak age at onset 18 months.
O Incidence : 3%-8% in children <5 years.

Febrile Seizures - Definition

O AAP:
Seizures occurring in childhood after age 1 month,

associated with febrile illness but not caused by

infection of the central nervous system (CNS),
unassociated with previous neonatal seizures or
unprovoked seizures, and not meeting criteria for
other acute symptomatic seizures.

O IDAI:
Kejang demam ialah bangkitan kejang yang terjadi

pada kenaikan suhu tubuh (suhu rektal di atas 38C)

yang disebabkan oleh suatu proses ekstrakranium.

Types of febrile seizures

Simple
febrile
seizures

The most
common type

Complex
febrile
seizures

Characterized by
(1) focal clinical
manifestation,
(2) duration >15
minutes,
(3) >1 seizure in
a 24-hour
period.

Febrile
seizures

Characterized by
(1) generalized
clinical features,
(2) duration <15
minutes,
(3) a single seizure
in a 24-hour
period.

Family history of febrile

seizures
O 25% - 40% of children who have febrile

seizures have a family history of febrile

seizures
O 9% - 22% of children have a sibling who has

a history of febrile seizures.

Risk factors
O Peak temperature during the illness,
O History of febrile seizure in first-degree

relatives,
O Neurodevelopmental delays,
O Vaccinations with MMR, DTP vaccines.

O Almost 50% of the children who present with

febrile seizures will not have any identified

risk factors.

Evaluation of children who

have febrile seizures
O Main purpose : determine the cause of the fever

and exclude underlying CNS infections.

O Viral infections of the upper respiratory tract,

roseola, and acute otitis media are most frequently

the causes of febrile convulsions.

Laboratory testing in febrile

seizures
O Not routine
O Should be ordered based on individual clinical

circumstances
O CBC to evaluate the cause of the fever
O Serum glucose determination
O Serum electrolytes when there is evidence of

dehydration.

Lumbal puncture
O Should be considered strongly in infants <12

months, those who have prolonged complex

febrile seizures or febrile status epilepticus.
O Infants 12-18 months consider LP
O Infants >18 months not routine
O If any doubt exists about the possibility of

meningitis, LP with examination of the

cerebrospinal fluid (CSF) is indicated.

Neuroimaging in febrile
seizures
O Routine EEG and neuroimaging not indicated

for simple febrile seizures.

O Neuroimaging is recommended in patients who
have complex febrile seizures, neurologic deficit
on examination, prolonged postictal state, and
signs of raised intracranial pressure.
O Patients who have febrile status epilepticus
require EEG testing.

Management of febrile
seizures
O Management of seizure: diazepam IV 0,3-0,5

mg/kg slowly in 3-5 minutes, max dose 20 mg

O Home management: rectal diazepam

O Dose: 0,5-0,75 mg/kg; or 5 mg for weight <10 kg

and 10 mg for weight >10 kg; or 5 mg for <3

years and 7,5 mg for> 3 years

Management of febrile
seizures - Antipyretic
O No evidence to decrease the risk of febrile

convulsions
O Paracetamol 10 15 mg/kg/dose
O Ibuprofen 5-10 mg/kg/dose

Management of febrile seizures

Anticonvulsant prophylaxis
O Oral diazepam effective and safe for reducing

the risk of recurrence of febrile seizures.

O At the onset of each febrile illness, oral
diazepam, 0.3 mg/kg q8h (1 mg/kg/24 hr), is
administered for the duration of the illness.
O Minor side effects : lethargy, irritability, and
ataxia, may be reduced by adjusting the dose.

Management of febrile seizures

Anticonvulsant maintenance
O Should be considered in:
infants<12 months,
complex febrile seizures,
neurologic deficit before or after seizure.
O Valproic acid (drug of choice): 15-40 mg/kg/d q8-12h
Possibility of valproate-induced hepatotoxicity in

children <2 years.

O Phenobarbital 3-4 mg/kg/d q12-24h.
O Duration of therapy: until 1 year with no seizure

Management of febrile
seizures - Education
O Reassurance and counseling very important &

essential, given the high degree of anxiety

surrounding seizures
O Information on how to manage seizure, possibility
of recurrence

Recurrence
O Usually occurs within 1 to 2 years after the initial

seizure.

O Risk of recurrence 60%.

O Risk factors for recurrence : younger age of

onset, an initial febrile seizure associated with a

relatively low temperature, family history of
febrile seizures in a first-degree relative, and
brief duration between the onset of the fever
and seizure.

Risk factors for epilepsy

O 2% - 7% of children who have a history of febrile seizures have a

risk of developing epilepsy.

O Risk factors for developing subsequent epilepsy after febrile seizures:

Complex febrile seizure,

Positive family history of epilepsy,
Initial febrile seizure <9 mo of age,
Delayed developmental milestones,
Pre-existing neurologic disorder.

O Incidence of epilepsy is 9% when several risk factors are present,

compared with an incidence of 1% in children who have febrile

convulsions and no risk factors.

Prognosis
O Generally excellent prognosis.
O No significant association between febrile

seizures and later significant cognitive

developmental delay or with sudden infant
death syndrome.

~fin~