Febrile Seizures in Emergency Medicine Clinical Presentation

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emedicine.medscape.com/article/801500-clinical#showall

History

The type of seizure (generalized or focal) and its duration should be described to help differentiate between

simple and complex febrile seizures.

Focus on the history of fever, duration of fever, and potential exposures to illness.

A history of the cause of fever (eg, viral illnesses, gastroenteritis) should be elucidated.

Recent antibiotic use is particularly important because partially treated meningitis must be considered.

A history of seizures, neurologic problems, developmental delay, or other potential causes of seizure (eg,

trauma, ingestion) should be sought.

Physical

The underlying cause for the fever should be sought.

A careful physical examination often reveals otitis media, pharyngitis, or a viral exanthem.

Serial evaluations of the patient's neurologic status are essential.

Check for meningeal signs as well as for signs of trauma or toxic ingestion.

Causes

Risk factors for developing febrile seizures [13, 19, 20, 21]

Family history of febrile seizures

High temperature

Parental report of developmental delay

Neonatal discharge at an age greater than 28 days (suggesting perinatal illness requiring

hospitalization)

Daycare attendance

Presence of 2 of these risk factors increases the probability of a first febrile seizure to about 30%.

Maternal alcohol intake and smoking during pregnancy has a 2-fold increased risk.

Interestingly, no data support the theory that a rapid rise in temperature is a cause of febrile

seizures.

About one third of all children with a first febrile seizure experience recurrent seizures.[22]

Risk factors for recurrent febrile seizures include the following: [23, 24]

Young age at time of first febrile seizure

Relatively low fever at time of first seizure

Family history of a febrile seizure in a first-degree relative

Brief duration between fever onset and initial seizure

Multiple initial febrile seizures during same episode

Patients with all 4 risk factors have greater than 70% chance of recurrence. Patients with no risk

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Febrile Seizures in EmergencyMedicine Clinical Presentation

Author: Nooruddin R Tejani, MD; Chief Editor: Richard G Bachur, MD more...

Updated: Aug 31, 2011
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factors have less than a 20% chance of recurrence.

Contributor Information and DisclosuresAuthor

Nooruddin R Tejani, MD Assistant Professor, Department of Emergency Medicine, SUNY Health Sciences

Center Brooklyn; Director, Pediatric Emergency Medicine, Downstate Medical Center

Nooruddin R Tejani, MD is a member of the following medical societies:American Academy of Pediatrics

Disclosure: Nothing to disclose.

Specialty Editor Board

Debra Slapper, MD Consulting Staff, Department of Emergency Medicine, St Anthony's Hospital

Debra Slapper, MD is a member of the following medical societies: American Academy of Emergency Medicine


Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of

Pharmacy; Editor-in-Chief, Medscape Drug Reference


Wayne Wolfram, MD, MPH Associate Professor, Department of Emergency Medicine, Mercy St Vincent

Medical Center

Wayne Wolfram, MD, MPH is a member of the following medical societies:American Academy of Emergency

Medicine,American Academy of Pediatrics, and Society for Academic Emergency Medicine


John D Halamka, MD, MS Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess

Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School;

Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies:American College of Emergency

Physicians,American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency

Medicine


Chief Editor

Richard G Bachur, MD Associate Professor of Pediatrics, Harvard Medical School; Associate Chief and

Fellowship Director, Attending Physician, Division of Emergency Medicine, Children's Hospital of Boston

Richard G Bachur, MD is a member of the following medical societies: American Academy of Pediatrics,

Society for Academic Emergency Medicine, and Society for Pediatric Research


Additional Contributors

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author,

William T Zempsky, MD, to the development and writing of this article.

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Febrile Seizures in Emergency Medicine Clinical Presentation