Makindo Medical Notes

Related Subjects: |Status Epilepticus (Epilepsy) |Coma management |Lorazepam |Phenytoin |Levetiracetam |Epilepsy - General Management |First Seizure |Epilepsy in Pregnancy |Febrile seizures

🌡️ Febrile seizures usually occur on the first day of a fever. They are generally harmless, do not indicate epilepsy in most cases, and most children recover quickly without complications. ✅

📖 About

• 👶 Common between 6 months – 5 years of age.
• ♻️ Recurrence rate: ~40% (often within 1 year).
• ⚡ Risk of epilepsy: very low (~1%) if seizure <30 mins and single episode.
• ⏱️ Prolonged (>15–30 min) or focal/recurrent seizures may increase risk of later temporal lobe epilepsy (TLE).

🧬 Aetiology

• 🦠 Infections: Viral/bacterial fevers are the main trigger. HHV-6 (roseola) is classic.
• 💉 Post-immunisation: Sometimes seen after MMR or DTaP vaccines.
• 👨‍👩‍👧 Family history increases risk.

🩺 Clinical Presentation

• 🌡️ Seizures occur as temperature rises >38.3 °C.
• ⚡ Typically generalised tonic-clonic with loss of consciousness.
• ❌ No evidence of CNS infection, epilepsy, or underlying neurological disease.
• 🚩 Red Flags: stiff neck, persistent vomiting, marked drowsiness → consider meningitis/encephalitis.

🔍 Differential Diagnoses

• 🧠 Encephalitis / meningoencephalitis.
• 🧪 Hypoglycaemia.
• 🩸 Intracranial haemorrhage or mass lesion.
• ⚡ Epilepsy or atypical seizures.

🧪 Investigations

• 🧾 Basic: FBC, U&E, MSU, CXR (to find the fever source).
• 💉 LP: if meningitis/CNS infection suspected (esp. <18 months).
• 🖥️ Imaging: MRI/CT only if seizures are prolonged, focal, or atypical.

💊 Management

• ✅ Place in recovery position, ensure airway and safety, protect head.
• ⏱️ If >5 min: IV lorazepam (0.1 mg/kg) or rectal diazepam/buccal midazolam if IV not available.
• 🌡️ Antipyretics (paracetamol/ibuprofen) for comfort, though do not prevent recurrence.
• 🚑 Call emergency services if:
  • First seizure ever.
  • Seizure >5 mins or recurrent.
  • Child not recovering as expected.

💡 Teaching Pearls

• ⭐ Most febrile seizures are simple: generalised, <15 min, single episode in 24 hrs → benign course.
• ⚠️ Complex febrile seizures: focal features, >15 min, recurrent within 24 hrs → higher risk of epilepsy, investigate further.
• 👩‍⚕️ Always check ears, chest, throat, urine → fever source is often simple (e.g., viral URTI).
• 📚 Key exam tip: Antipyretics do not prevent recurrence, but reassure parents they keep the child comfortable.

📚 References

• NICE: Febrile seizures in children
• American Academy of Pediatrics. Febrile Seizures: Clinical Practice Guideline.