Febrile Seizure

Download as ppt, pdf, or txt
Download as ppt, pdf, or txt
You are on page 1of 32

FEBRILE SEIZURES /

CONVULSIONS

What Do We Need To Know?

Yoke Ayukarningsih

Paediatrics Departement
Dustira Hospital
DEFINITIONS
•Fever (>38.4ºC)
•Age > 1 month (mean 14 – 18 months)
•Extra cranial process or absence of CNS
infections
•Absence of neonatal fit or unprovoked seizure
Classifications
Previous

Livingstone criterias:
1. Simple Febrile Seizure
Not Use
2. ETOF Anymore

(Epilepsy Triggered Off by Fever)


Now :

1. Simple Febrile Seizure (SFS)


(< 15 minutes, generalized, single)

2. Complex Febrile Seizure (CFS)


(> 15 minutes, focal, multiple)
EPIDEMIOLOGY
Incidence : 3 – 4 % < 5 years old
Boys > girls
Prospective studies : CFS 20 %, SFS 80 %
Occurs in second year of life
EPIDEMIOLOGY
GENETIC DISPOSITION

chromosome 19 p and 8 q 13-21


autosomal dominant inheritance
or multigenic interaction
WHO IS MOST AT RISK
- young age
- family history of febrile seizure
- rapid increase of high fever
- maternal alcohol intake
- smoking during pregnancy
RISK FACTORS FOR FIRST FS

- Family History Of FS
- Neonatal Discharged > 28 days
(perinatal insults) (?)
- Neurological Deficit
- Child care attendance (?)
- High Fever

2 risk factors 30% of FS


RISK FACTORS FOR
RECURRENCY

Young age
Family history of epilepsy
Duration of fever
Temperature during seizure
Rapid increase of fever
Delayed developmental milestone
RECURRENCES AFTER FS
50 % within 6 months
75 % within first year
90 % within second year
First FS < 1 year : 50 %
First FS > 1 year : 28 %
RISK FACTORS FOR EPILEPSY
Delayed developmental milestones
Family history of epilepsy
Complex febrile seizure
1 factor + ---- 3 – 5 % risk
2 – 3 factors --- 13-15 % risk
CLINICAL MANIFESTATIONS
Usually generalized, tonic clonic
Lasts few seconds to 10 minutes ( 5 mins)
- 8 % --- > 15 minutes
- 4 % --- > 30 minutes

Rare cases : focal, CFS --- Todds paralysis


DIAGNOSIS
Based on :
good history
physical examination
determination source of fever

PRIME GOAL : Rule out Meningitis or


Encephalitis
DIAGNOSIS
Laboratory : as indicated

LUMBAR PUNCTURE :
< 12 months : imperative
12 – 18 months : recommended

Skull X ray, CT scan, MRI : as indicated


DIAGNOSIS
ELECTROENCEPHALOGRAPHY

Not warranted after SFS


Can not predict recurrence or epilepsy
Atypical FS
PROGNOSIS
Typically no sequelae
FS recurs
Epilepsy or neurological deficit

Recurrence
one third of children--- one recurrence
half of those ----- more than 1 recurrence
PROGNOSIS
Epilepsy 2–3%
Cohort Study
1 % after SFS
4 % after CFS within 24 hours
6 % after seizures > 15 minutes
29 % after FS with focal features
Highest in the months soon after the 1st FS
PROGNOSIS
NEUROLOGICAL DEFICITS
Status epilepticus
motor coordination deficits
mental retardation
learning and behavioral problems

extremely uncommon, only in CFS


GOALS OF TREATMENT
Focus on 3 goals :

ACUTE MANAGEMENT
PREVENTION OF RECURRENCES
MANAGEMENT OF NEUROLOGICAL SEQUELE

Treatment cannot prevent epilepsy


TREATMENT
Simple febrile seizures

search for cause of fever


control the fever ---- antipyretics
reassurance of the parents
TREATMENT
Acute management

ABC
secure airway, Oxygen
satisfactory perfusion and circulation
TREATMENT
Acute management

Anticonvulsants : Benzodiazepines
Rectal diazepam
5 – 15 minutes --- therapeutic level
90 minutes ---- peak plasma concentration
TREATMENT
Rectal diazepam
5 mg --- < 1 year, < 10 kg
10 mg --- > 1 year, > 10 kg
or 0,5 – 0,75 mg/kg BW/x
At home max. 2 x, interval 5-10 minutes
Intravenous diazepam : 0,2 – 0,5 mgg/kgBW
0,5 – 1 mg/kg/minute
Still + ------ PHENYTOIN : 10 – 20 mg/kgBW
1mg/kg/minute
TREATMENT
PREVENTION OF RECURRENT FS
Drug Indication Dose
-----------------------------------------------------------
Intermittent prophx
Diazepam, oral Frequent FS 0,3mg/kg q8h
Complex FS for 2-3 days
during fever
Diazepam rectal gel Complex FS <1 yr - 5 mg
>1 yr -10 mg
TREATMENT
PREVENTION OF RECURRENCE FS
Drug Indication Dose
--------------------------------------------------------
Continous Prophx
Phenobarbital Selected cases 4-5 mg/kgBW/day
of CFS divided in 2 doses
--------------------------------------------------------------------------
Valproic Acid Selected cases 15-40mg/kgBW/day
of CFS divided in 2-3 doses
TREATMENT
FEBRILE SEIZURE
A 1. Dzp rectal 0,5mg/kg
B 2. Dzp IV 0,2-0,5 mg/kg
C Seizure Stop
SEIZURE
Dzp rectal (5 – 10 minutes)
Seizure Stop
SEIZURE
DZP IV 0,5-1 mg/minute (3 – 5 minutes)
Seizure Stop
SEIZURE
Phenytoin Loading IV 10-20 mg/kg (20 – 30 minutes) ---- Phenobarbital IM
0,5-1 mg/kg/minute Loading dose

SEIZURE
To ICU
TREATMENT
DRUGS
Phenobarbital
Acute phase Continous prophylaxis
Loading dose 4 - 5 mg/kg BW/day
30 mg IM neonates
50 mg IM (1 mo-12 mos)
75 mg IM (> 1 year)

Maintenance
Day I-II 8-10 mg/kg BW/day in 2 doses
Day III 4 – 5 mg/kgBW/day in 2 doses
Side Effects : Hyperactivity, irritability, < cognitive functions
TREATMENT
DRUGS
Valproic Acid : for Continous prohylaxis in
selected cases
Dosage:15 – 40 mg/kg BW/day in 2-3 doses
for 1 year
Side effects : Thrombocytopenia,
hepatotoxicity, weight gain, GI problems
and pancreatitis
TREATMENT
DRUGS

Diazepam :
Intermittent prophylaxis
frequent FS and CFS :
Diazepam, oral : 0,3 – 0,5 mg kg q8h
Diazepam, rectal : 0,5 mg/kg or
5 mg for < 1 year, < 10 kg q8h
10 mg for > 1 year, > 10 kg q8h

Side effects : lethargy, ataxia, irritability


TREATMENT
DRUGS
Phenytoin
Loading dose
IV 15 – 20 mg/kg
0,5 – 1 mg/kg/minute (20-30 minute)
In drip with Normal Saline

SECURE AIRWAY

Side effects : GI problems, ataxia, slurred speech,


gingival hyperplasia etc
SUMMARY
Febrile Seizure has a good prognosis
SFS, epileptic risk is minimal
The younger the child the higher the
recurrence
Goal of treatment --- prevent recurrence
Intermittent prophylaxis : Diazepam oeral
or rectal
Continous prophylaxis : selected cases.
THANK YOU

You might also like