Tatalaksana Kejang Demam Mutakhir English Edition

7/28/2019 Tatalaksana Kejang Demam Mutakhir English Edition

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LATEST MANAGEMENT OF

FEBRILE SEIZURE

dr. Nelly Amalia Risan, SpANeuropediatric Subdivision

Department of Child Health FK UNPAD/RSHS


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Febrile Seizure

The most common form of seizure inchildren

4-5% children at least had 1 episodeof febrile seizure ( Nelson Ellenberg, 1976 )

Worry parents, labeled vulnerable

Hows theout come ?


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Definition

ILAE, 1980 : Seizure in children,mostly in age 6 months 5 years,which happen during fever (rectal

temperature > 38 C ) and not causedby CNS infection or others. (ConsensusDevelopment Panel, 1980 )


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Continued

A child who has an episode of afebrileseizure and then had an episode of febrileseizure is not clasified into Febrile Seizure.

GEFS+ syndrome (Generalized Epilepsy withFebrile Seizure plus ), Febrile seizure thatcontinues after >6 years old and followedby epilepsy in youth. Etiology is a defect insodium channel (autosomal dominant).


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Classification

1. Simple Febrile Seizure

2. Complex Febrile Seizure

ILAE, Commission on Epidemiology and Prognosis, 1993

Complex Febrile Seizure is (meet one ofthe following criteria ) :

1. seizure more than 15 minutes

2. focal/partial seizure

3. repeated seizure in 24 hours


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Epidemiology

70 80% simple febrile seizure

20 - 30% complex febrile seizure

- 4% focal

- 8% lasted more than 15 minutes

- 16% repeated in 24 hours


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Etiology

Interaction of 3 factors :1. Brain immaturity and

termoregulator

2. Fever ----> increase O2 demand

3. Genetic predisposition

> 7 chromosome locus (poligenic,

autosomal dominant)


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Continued

Fever caused by:

URTI 38%

Otitis media 23%

Pneumonia 15%

Gastroenteritis 7%

Post vaccination ( DTwP, Measles ) 25in every 100 000 children receivingvaccination


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Diagnosis

Anamnesis

Physical examination and neurologic

examination, if the level ofconsciousness is intact with etiology offever is well defined no need for

other lab exam


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Other Examination

LaboratoryComplete blood count peripheral bloodsmear performed to investigate the

fever sourceElectrolyte, glucose exam wereperformed if indicated (vomitting, or

diarrhea)


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Lumbal Puncture

Indication: if there is suspicion ofmeningitis.

Not performed routinely in febrile

seizure patient. Only if there issuspicion of meningitis.


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Continues

Infant less than 12 months needs special

attention as meningitis symptoms mostlynot clear.

Recommendation for Lumbal puncture:1. Infant < 12 mo: strongly recommended

2. Infant 12

18 mo: recommended3. Infant > 18 mo: not performed routinelyAAP, the neurodiagnostic evaluation of the child with first simple

febrile seizures. Pediatrics, 1996


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Electroencephalografy/ EEG

EEG cannot predict incidence of

epilepsi or repeated Febrile seizure.

Not recommended for Febrile seizurepatient.


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Prognosis and Complication

2 risk:1. Repeated febrile seizure 30 40%

in first years

2. Epilepsy ( 2

4% )


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Predictor of repeated febrile seizure:

1. Age less than 1 years old

2. Family histiry of febrile seizure

3. The temperature is not high andshort duration of fever when theseizure happen


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Predictor for epilepsy :

1. Neurologic defect or delayed

development

2. Family history of epilepsy

3. Complex febrile seizure


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Treatment

Mostly short seizure, and stops beforearriving at medical facility

If the seizure persist:

give diazepam per rectal 0,5 mg / kg,or

Body weight < 10 kg : 5 mg

Body weight > 10 kg : 10 mg

maximum 2 times


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Other medication

AntipyreticRecommended although there is noevidence can prevent febrile seizure.Camfiel et al,1980 ; Uhari et al, 1995


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Anticonvulsant

Oral diazepam 0,3 mg/kg TID,effective decreasing incidence of

febrile seizure. Side Effect: somnolenadn ataxia.

Phenobarbital, phenytoin or

carbamazepin is not effective toprevent Febrile Seizure.


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Maintenance anticonvulsant

Phenobarbital 4 5 mg /kg BB divedin 2 dose, maximum 200 mg/day, or

Valproic Acid 20-40 mg/kg/dayeffektive for decreasing the risk ofrepeated Febrile Seizure.

Side effect of phenobarbital: behaviourdisorder /hiperactivity and decreasingIQ untolerable


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Side effect

Valproic Acid in young children can causeliver disfunction.


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Indication for

maintenance medication Prolong seizure

There is evident neurological defects

before of after the seizure

Focal or partial seizure


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Prognosis

2 risk

1. Repeated Febrile Seizure (50% in 1st

years)2. Epilepsy (2-4%)

Predictor for repeated seizure:

1. Age


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Predictor for Epilepsy

1. Neurological defect or delayed

development

2. Family Histiry of epilepsy

3. Complex Febrile Seizure

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Tatalaksana Kejang Demam Mutakhir English Edition