Febrile Seizure 04.25.2011

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Febrile Seizure

By Hillary Crandall

April 25, 2011


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Febrile Seizure

Children aged 6 to 60 months Simple (All)

15 minutes, >1 seizure or >24 hours after fever

Focal

Beginning on one side, eye deviation, loss of muscle tone

Postictal


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Evaluation of Simple Febrile Seizure

EEG: NO Neuroimaging: NO

Labs: NO

electrolytes, calcium, phosphorus, magnesium,

glucose, CBC Lumbar puncture: NO except

Clinical symptoms of meningitis

Unvaccinated and 6-12 months Prevalence of acute bacterial meningitis - 2.4%

Simple - 0.86%

Complex - 4.81%

Pretreated with antibiotics


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Evaluation of Complex Febrile Seizure

EEG: NO Labs: ?

No data, no recommendations

Neuroimaging: Maybe

Otherwise well : probably not

6 studies, 200 patients, no NS interventions

Ill-appearing : YES


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Evaluation of Complex Febrile Seizure Lumbar puncture: Maybe

526 patients with CFS 64% underwent lumbar puncture

0.9% acute bacterial meningitis

1 non-responsive, 1 bulging fontanel/apnea, 1 failed LP/bacteremia

390 patients with CFS (19% referred) 37% underwent LP

1.5% acute bacterial meningitis

6 altered mental status

0.3% HSV meningitis

1 altered mental status

YES: clinical symptoms of meningitis/altered mental status

unvaccinated pretreated with antibiotics

Harriet Lane says: strongly recommend


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Clinical Features of Meningitis(Likelihood Ratios)

Petechiae - 37x Bulging Fontanel - 8x

Neck Stiffness - 7.7x

Toxic 5.8x

Kernig 3.5x

Fever (>40 C) 2.9x

Brudzinski 2.5x

Decreased feeding 2x

Seizure Complex 2x

Multiple 1.5x

Other 1.4x

Abnormal cry 1.8x Lethargy 1.9x

Comatose 1.8x

Irritability 1.3x


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References

1. Neurodiagnostic evaluation of the child with a simple febrile seizure. Pediatrics. 2011Feb;127(2):389-94.

2. Batra P et al. Predictors of meningitis in children presenting with first febrile seizures.Pediatr Neurol. 2011 Jan;44(1):35-9.

3. Teng D, Dayan P, Tyler S, et al. Risk of intracranial pathologic conditions requiring

emergency intervention after a first complex febrile seizure episode among children.Pediatrics. 2006;117:304308

4.Seltz LB, Cohen E, Weinstein M. Risk of bacterial or herpes simplex virusmeningitis/encephalitis in children with complex febrile seizures. Pediatr Emerg Care.2009 Aug;25(8):494-7.

5. Kimia et al. Yield of lumbar puncture among children who present with their first

complex febrile seizure. Pediatrics. 2010 Jul;126(1):62-96.Kimia et al. Utility of lumbar puncture for first simple febrile seizure among children 6 to

18 months of age. Pediatrics. 2009 Jan;123(1):6-12.

7. Curtis et al. Clinical features suggestive of meningitis in children: a systematic review ofprospective data. Pediatrics.

Febrile Seizure 04.25.2011

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