| ID | 392 |
|---|---|
| Name | SIMPLE FEBRILE SEIZURE |
| Cause | The cause of febrile seizures is unknown, although they're linked to the start of a fever (a high temperature of 38C (100.4F) or above) |
| Signs Symptoms | Child's body will become stiff and their arms and legs will begin to twitch. they'll lose consciousness and they may wet or soil themselves. they may also vomit and foam at the mouth and their eyes may roll back. the seizure usually lasts for less than five minutes. |
| Diagnosis | Diagnosis : Diagnosis mainly depends on- A. Clinical history & B. Physical examination. Laboratory investigations are done to exclude other causes of convulsions. 1. Routine blood count. 2. Routine urine test 3. CSF analysis by L.P. 4. EEG (if available)- normal. |
| Investigations | Have a fever higher than 100.4 F (38.0 C) Lose consciousness. Shake or jerk the arms and legs. |
| Management | Management: Emergency treatment- 1. Clear the airway; suckout secretions, loosen clothing about the neck. 2. Oxygen during convulsions or if cyanosed. 3. Protect from bodily injury Restraints; padding of cot. 4. Turn on the side- no aspiration of pooled secretions. (Note: Padded gag between the teeth to prevent bitting of tongue, only done if jaw is relaxed; other wise more damage with use of force). 5. Bring temperature down with- - tepid sponging. - antipyretics e.g paracetamol. 6. Control of seizure- Inj. Diazepam 0.2-0.3mg/kg (or Img/yr. of life) to a max. of l0mg may be given i.v as a bolus to control episode of seizure; it can be repeated within 10-15 minutes. If seizure, not controlled with above measure, should think on other causes rather than febrile convulsion, & in that case- Inj. Paraldehyde 0.15ml/kg/dose deep i.m (preferably in gluteal muscles) may be given. 7. Prevention of recurrence- Prophylactic use of anticonvulsant for prevention of recurrence is controversial. In uncomplicated febrile convulsion prophylaxis is usually not indicated. But, if it is complicated or prolonged or for releiving family anxiety prophylactic treatment has been advocated for the preiod when febrile convulsions occur i.e. until 5 years. At the onset of each febrile illness, oral diazepam 0.3mg/kg 8 hourly (i.elmg/kg/24 hours) is administered for the duration of the illness (usualy 2-3 days).’3 Since about 50% of children with a single febrile convulsion have no recurrenc, even if untreated. So at least half of the children would get no possible benefit from this therapy. A more resonable regimen is the administration of phenobarbitone therapy after a second or third febrile seizure. Disadvantage of prolonged use of phenobarbitone- - a high incidence of behavioral affects most commonly hyperkinesis. - allergic reactions. 8. Treatment of cause- If any infection- antibiotic therapy. |
| Introduction | Simple febrile seizures or convulsions are a form of generalized tonic (maintained)-clonic (repeatative) seizures seen characteristically in childhood & meeting the following diagnostic criteria- 1. Age of onset: Occurence in infancy & early childhood, usually between ages 6 months & 5 years, (peak age is around 14-18 months). 2. Family history: 50% will have a family history of febrile seizure and the common transmission is autosomal dominant with reduced penetration. ? 3. Preexisting ailment: No preexisting neurological or developmental abnormalities in the interictal period. a 4. Pyrexia: Seizure occurs with a high rise of temperature (> 38°C or 100.4°F), usually during the first 24 hours of fever or illness. 5. Infection: Primary infection of CNS is absent. 90% of cases are due to viral infection, most of which are upper respiratory tract infection. 6. Vaccination: Following vaccination, specially DPT and measles, seizure may occur. 7. Seizure character: On set- Seizure usually occurs within 24 hours of feve; Seizure type- generalized tonic-clonic; Duration- brief duration (few seconds to rarely up to 15 mins.); Number of accacks- there is normally only one fit with rapid rise of temperature, rarely there may be another fit, but it should not be more than 12 to 18 hours after the first, if second fit. Residual weakness- there must not be residual weakness of a limb after a fit (viz. todd’s paralysis after a fit e.g. epileptic); only a brief period of drowsiness (postictal phase or period). ECG between fits is normal. |
| History | Most children have simple febrile seizures which are short (<15 minutes ), generalised, have a short postictal period, and occur only once in 24 hours. Complex febrile seizures are longer (>15 minutes), focal, have a long postictal period, and may reoccur within 24 hours |
| Etiology | Place your child on his or her side on a soft, flat surface where he or she won't fall. Start timing the seizure. Stay close to watch and comfort your child. Remove hard or sharp objects near your child. Loosen tight or restrictive clothing. Don't restrain your child or interfere with your child's movements. |
| Clinical Features | Have a fever higher than 100.4 F (38.0 C) Lose consciousness. Shake or jerk the arms and legs. |
| Preventions | Place your child on his or her side on a soft, flat surface where he or she won't fall. Start timing the seizure. Stay close to watch and comfort your child. Remove hard or sharp objects near your child. Loosen tight or restrictive clothing. Don't restrain your child or interfere with your child's movements. |
| Treatment | Place your child on his or her side on a soft, flat surface where he or she won't fall. Start timing the seizure. Stay close to watch and comfort your child. Remove hard or sharp objects near your child. Loosen tight or restrictive clothing. Don't restrain your child or interfere with your child's movements. |
| Complications | Febrile seizures have been linked to an increased risk of epilepsy, as well as other problems. Recent research findings may indicate a link between febrile seizures and sudden unexplained death in childhood (SUDC), possibly due to the connection between febrile seizures and epilepsy |
| Prognosis | Prognosis of febrile convulsions: Usually there is a good prognosis with no residual affect. But in rare cases- - risk of anoxic brain damage. - subsequent intellectual impairment - behavioral disturbances. - complex partial seizure (epilepsy). |
| Types | Febrile seizures are classified as simple or complex: Simple febrile seizures. This most common type lasts from a few seconds to 15 minutes. Simple febrile seizures do not recur within a 24-hour period and are not specific to one part of the body |
| Classification | Simple febrile seizures. This most common type lasts from a few seconds to 15 minutes. ... Complex febrile seizures. This type lasts longer than 15 minutes, occurs more than once within 24 hours or is confined to one side of your child's body. |
| Observation | Febrile seizures typically occur within the first 24 hours of an illness, often within an hour of fever onset. The seizure is the first sign of a febrile illness in 25%–50% of cases. Febrile seizures have an average duration of 4–7 minutes, with only 10%–15% of them lasting longer than 10 minutes |
| Pathology |
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