Fever with seizure

Watuhatai Paibool, MD

Division of Neurology, Department of Pediatrics

Faculty of Medicine, Khon Kaen university

Fever with seizure

1. Febrile seizure (the most common)

2. CNS insults (less common but important group)

: meningitis, encephalitis, hypoglycemia, hyponatremia etc.

3. Epilepsy triggered with fever (the least common)

Definition of febriles seizure

Seizure with fever - BT ≥ 100.4°F or 38°C by any method (AAP 2011) - BT ≥ 38.4°C (NIH 1980)

No CNS infection, electrolyte imbalance

• 6-60 months of age , peak 18-24 months (AAP 2011) • > 1month without prior afebrile seizure (ILAE 1993)• 3 months – 5 years of age (NIH)

occur in 2% to 5% of children

Pathophysiology

• Unknown

• Infection : HHV-6, HHV-7

• Immature of thermoregulation center

• Immature neuronal membrane

• Genetic predisposition: SCN1A, SCN1B, SCN9A

GABRG2,GABRD

FEB 1-10

Febrile seizure

Simple febrile seizure Complex febrile seizure

- Generalized seizure- Brief - Isolated seizure

- Focal - Prolonged seizure

(> 10 or 15 mins)- Multiple (> one seizure

during the febrile illness)

Swaiman ,ed 6th

Investigation

• Blood glucose

• Blood studies (Electrolytes, Ca, Mg, and CBC)

• Lumbar puncture (LP)

- 6-12 mo, LP is option if no Hib or IPD immunization or unknown

immunization status and in children pretreated with ATB

**strongly considered in the infant younger than 12 months of age

• Electroencephalography(EEG), neuroimaging: not required

Clinical practice guideline-febrile seizures AAP,2011

Investigation

Complex febrile seizure

• LP if consider if suspected CNS infection

• CT brain: recommended esp. focal seizure

• EEG: recommended if suspected viral encephalitis esp. Herpes

Recommendations for the management of febrile seizures, Epilepsia, 2009

Initial management

• คลายเส้ือผา้ท่ีรัดออก และจบันอนตะแคงใหศี้รษะต ่าเพื่อไม่ใหส้ าลกั • ไม่ตอ้งใชว้สัดุใดๆ งดัปากหรือใหย้าทางปาก • เชด็ตวัโดยใชผ้า้ขนหนูชุบน ้าประปาบิดพอหมาด ถูเบาๆ เพ่ือใหเ้ส้นเลือดใตผ้ิวหนงัขยายตวัเพื่อท าใหไ้ข้ลดลง

Treatment

• General management: ABC

• Terminate seizure (prolonged seizure):

Diazepam - IV 0.3 mg/kg/dose (max 10 mg)

- Rectal 0.5 mg/kg/dose (max 10 mg)

*Can repeat once after 5-10 minutes

• Management of fever: Paracetamol, Tepid sponge, Treat cause of fever

Preventing a Febrile Seizure

• Anti-pyretic

• Intermittent prophylaxis• Oral diazepam (0.33 mg/kg/dose every 8 hours with fever)• Decrease risk of FS from 31% to 21% • RCT; comparing placebo with oral diazepam- seizure recurrence by 36 months

was noted in 22% of the diazepam treatment group, compared with 31% of the placebo treatment group.

• Must weight this reduction in seizure recurrence with the side effects of sedating children

• Long-term antiepileptic drug therapy is rarely indicated in the treatment of febrile seizures

Clinical practice guideline-febrile seizures AAP,2011

Counseling and education

• Febrile seizures are a common & mostly benign form of childhood seizures.

• Febrile seizures do not cause of brain damage or intellectual decline

• The vast majority of febrile seizures do not appear to have any

long-term sequelae.

Risk Factors for Recurrent Febrile Seizures & Epilepsy After a Febrile Seizure

Recurrent Febrile Seizures Epilepsy

DEFINITE RISK FACTOR

Family history of febrile seizures Neurodevelopmental abnormality Age less than 18 months Complex febrile seizure Height of peak temperature Family history of epilepsy Duration of fever

POSSIBLE RISK FACTOR

Family history of epilepsy More than 1 complex feature

Swaiman ,ed 6th

- General risk of recurrent is 30-40%- Less if no risk factor 10%- More if many risk factors >50-60%

- General risk of simple FS is 1-1.5%

- For complex seizure 4-15%- High risk if more risk factor