Febrile convulsion
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
