Bushrah Khadim Anu Dhaliwal HDR presentation February 2016
-20 Months old Joey was discharged from Paediatric Ward 4 days ago after a febrile convulsion. -Mum wants to ask her GP some questions as she does not fully understand what happened.
Febrile convulsions are benign, generalised convulsions or fits occurring in children aged 6 months to 5 years associated with fever and without any underlying cause. Axillary temperature >37.8 or Clinical hx and examination indicative of febrile seizure
2% to 5% of European children Atypical occurrences outside age range Simple febrile seizure type most common 20% complex febrile seizures 5% status epilepticus Multifactorial polygenic mode of inheritance with a maternal preponderance in transmission
Mechanism unknown Degree of fever or Rate of rise of temperature Genetic factors – strong family history
Common causes are common Viral illness Otitis media Tonsilitis Gastroenteritis Post immunisations
Eyewitness account Blood glucose If the child has not yet recovered it is necessary to exclude more serious causes of convulsions such as meningitis or urinary tract infection. An EEG is only indicated if there are repeated convulsions over a period of time, or a single atypical convulsion persistent resultant neurological abnormality, convulsion lasted more than 20 minutes NICE – traffic light system
Antipyretics Avoid tepid sponging and excessive cooling If a convulsion occurs place child in recovery position, do not put anything in their mouth. Call for help if seizure lasting >5minutes Repeated convulsions may be treated with rectal diazepam. Advise for parents
First febrile convulsion Serious illness not excluded Previous hx of febrile seizure with: Child <18 months of age Diagnostic uncertainty Complex seizure – more likely to recur or due to intracranial infection
The prognosis of febrile convulsions is good: 30% risk of recurrent febrile convulsions 10% risk of recurrence within the first 24 hours the risk of long term epilepsy is 2-7% Intellect not affected