Febrile Convulsion
NeuC3 Neurology MRCEM syllabus
| Find the focus of infection | |
|---|---|
| History | Age group: 6m (1y?) - 5y MUST be febrile Duration of seizure? (>3 min - unlikely to stop) Key aspects that suggest a true seizure: - rhythmic tonic or tonic-clonic movements → focal seizure less likely to be febrile seizure - lateral tongue biting - eye deviations with flickering - incontinence (in the older child) - post-ictal phase |
| Examination | |
| Diagnostic investigations | Temperature Blood glucose - seizure mimics! ECG - exclude cardiac causes |
| Differentials | Reflex anoxic seizures - lasts <60s, quick recovery Complex febrile seizures = >1 seizure in 24h Other significant signs: - History inconsistent/unexplained bruising (NAI) - Café au lait spots (think neurofibromatosis) - Ash leaf spots (think tuberous sclerosis) - Meningism (think meningitis/intracranial bleed) - Dysmorphic features - Hepatomegaly or jaundice (think metabolic disease) |
| Immediate management | Actively seizing: as per APLS and/or Status epilepticus Antipyretics do not prevent recurrence → do not give solely to ↓ Tº ➥ If child does not return to normal, they need more work up |
| Ongoing management | discharge advice: ➥ recurrence about 33%, more likely if initial presentation at young age ➥ Risk of later developing epilepsy is no greater with one off simple febrile convulsion, however seizure >30 min → 30-40% risk of developing epilepsy ➥ Using antipyretics does not reduce or prevent seizure recurrence; higher fevers are not linked to higher risk of febrile seizures ➥ no evidence for continuous antiepileptic treatment ➥ no long term risk to brain! ➥ continue with routine imms |
sources/links
Reflex anoxic seizures - https://heartrhythmalliance.org/stars/uk/reflex-anoxic-seizures-ras-syncope-in-the-young
https://dontforgetthebubbles.com/febrile-seizures-2/
https://www.rcemlearning.co.uk/modules/paediatric-seizures-pem-induction/
https://dontforgetthebubbles.com/proof-and-schedule-5-febrile-convulsion-myths/
https://cks.nice.org.uk/topics/febrile-seizure/management/management-after-a-febrile-seizure/