Febrile convulsions presented by Dr. Yousef Quda Master degree of Pediatrics.

1. Febrile Convulsions
Dr.
Yousef Mohammed Quda
MSc. Pediatrics
www.facebook.com/dryousefquda

3. What is seizure?
 Is defined as paroxysmal involuntary
disturbance of brain electrical activity.
 Manifested as motor, sensory, behavioral,
or autonomic dysfunction
 With or without impairment or loss of
consciousness
 If seizures manifest as motor act, it is
called convulsions.
 Single motor act = fit.

4. Epilepsy
Epilepsy: recurrent
seizures which are
unrelated to fever or
acute cerebral insult.

5. What Are the causes of
convulsive disorders?

6. Causes of convulsive
disorders
(A) Acute:
1-Febrile convulsions.
2-Intracranial infections: Meningitis,
encephalitis, cerebral abscess.
3-Intracranial hemorrhage: Traumatic or
non-traumatic (hemorrhagic diseases,
rupture of defective vessels or aneurysm).

7. Causes of convulsive
disorders
4-Toxic causes:
a-Drugs: Aminophylline, antihistamines,
phenothiazine, corticosteroids, chlorpromazine.
b- Tetanus.
c- Shigellosis, salmonellosis.
5-Anoxic cause: hypoxic-ischemic
encephalopathy
6-First epileptic fit.

8. Causes of convulsive
disorders
7-Metabolic:
- Hypocalcaemia - Hypomagnesemia
- Hypo & hypernatremia - Hypoglycemia
-Inborn errors of metabolism
(phenylketonuria, pyridoxine deficiency)
8-Acute cerebral edema (hypertensive
encephalopathy).

9. Causes of convulsive
disorders
(B) Chronic or recurrent forms:
1) Epilepsy
2) Epilepsy simulating states
3) Tetany

11. Febrile Convulsions
Definition:
Convulsions in age vulnerable
children due to:
1.Rapid rise of body temperature
2.Due to extracranial causes.

12. Febrile Convulsions
Incidence:
- Affect 4% of children.
- Family history in about 20 % of cases
- Simple febrile seizures is inherited as
autosomal disorder.
- Recurrent in 30-50 % of cases.

13. Febrile Convulsions
Diagnostic criteria:
1- Age: 9 months - 5 years.
2- temperature: Usually ≥ 39ºC,
fits occur within 8-12hrs from onset
of fever.

14. Febrile Convulsions
Diagnostic criteria:
3- No evidence of CNS
infection (meningitis, abscess) the most
important doctor's responsibility.
4- Evidence of extracranial
infection (viral URTI, tonsillitis, otitis
media, roseola infantum infection)

15. Febrile Convulsions
5- Type of convulsions:
Complex
(complicated)
Typical
(simple)
- Focal seizures.
- Last > 15 min
- Recurring during
the same illness
within 24 hours
- Uncommon.
-Generalized tonic-clonic.
- Last < 15 min.
- One fit only in the same
illness.
- the commonest form.

16. Febrile Convulsions
6- Investigations:
- Usually not needed in children with simple
febrile convulsion.
- Complex form may need:-
- Glucose determination, serum electrolytes.
- Lumbar puncture and CSF analysis.
- Neuro-imaging (CT, MRI).
- EEG.

18. Treatment
1- Fever control .
2- Benzodiazepine: diazepam (I.V. or rectal) if fit
last more than 5 minutes.
3- Treat the underlying cause  (antibiotics).
4- Parental advice about fever control.

19. Treatment
Diazepam:
- IV dose: 0.1-0.3 mg/kg (maximum dose is 10
mg/dose) for a maximum of 3 doses.
- Rectal dose: 0.3-0.5 mg/kg diluted in 3 ml NS,
given by syringe and a flexible tube.
- Side effects: Hypotension and respiratory arrest.

20. Treatment
5- Prophylactic anti-convulsants therapy (Na
valproate) may be used for cases carry risk to
develop epilepsy:
- Complex form.
- Pre existing neurologic abnormality
(delayed development milestones).
- Initial febrile seizure developed before 12 m
- Positive family history of epilepsy.

21. Depakine drops : 200mg/ml{0.1: 0.2ml/kg/d}

22. Treatment
However, Short- term or long-
term Prophylaxis is no longer
recommended as many drugs
have no effect on febrile
seizures and may decrease
cognitive function.

23. Treatment
6- At the onset of each febrile
illness oral diazepam (1 mg/kg
divided q8 hours )is given for
for 2-3 days to reduce risk of
recurrence in recurrent cases.

24. Differential diagnosis
Seizures associated with fever
1- Meningitis.
2- Viral meningeo-encephalitis.
3- Brain abscess
4- Epileptic fit precipitated by
associated fever.

25. Prognosis:
1.Recurrence of febrile
seizures : The risk is increased if:
-1st febrile seizure before 12 m or
-Febrile seizure occurs at < 40C.
-Complex features.

26. Prognosis:
- Positive family history of febrile
seizures.
2. Epilepsy: Risk is 1% in
absence of risk factors & 9% in
presence of several risk factors.