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Febrile seusers
- 1. Emergency room 3y o child arrived by ambulance, In a room with the father ……….”my child had bubbles coming out of the mouth this morning, and was shaking really bad ! I am scared doctor!” “ Oh my ….. Doctor - I thought my baby girl was dying, I did not knew what to do !!!! I just held her while I called the ambulance, thank God they were there in 10 min……..” “ Will my child have the brain damage now ?”
- 2. Emergency room What do you do next ?
- 3. Quick assessment 3 y old girl is resting comfortably on fathers arms as he is holding on to her. He is upset and nervous, Next step – start history and physical What questions do we want to ask? What questions are more important ?
- 4. History and Physical Very important to take a very detailed history Questions that would make difference in treatment: How long did the seizures last? Were there multiple seizures lasting longer then 15 min ?
- 5. Our Patient That was a first episode , Lasted for 7 min Postictal state for 1 hour after Viral cold for the past week Never registered a fever, but “felt warm”
- 6. Febrile Seizures Not associated with any specific illness Related to fever Used to be thought: – Related to the degree of the temperature – Related to the rate of rise or decline of fever
- 7. Quoting Dr Keller New understanding of febrile seizures : Not related to the degree of temperature Not related to the degree of rise or decline Can happen even if the temperature is 99
- 8. Febrile Seizures 2-4 % of all children 6months- 5 years old, Peak incidence 18 months Genetic predisposition – 25% To diagnose child must be free of any past febrile seizures or free of identified brain disease
- 9. Febrile Seizures Simple – last less then 15 min, manifest in generalized tonic- clonic activity Complex- focal or last more then 15 min, or multiple with in same illness 25% are complex, 75%- simple
- 10. Febrile Seizures Laboratory values non specific Leukocytosis could be from seizures or underlying illness EEG- non specific Csf – normal Sometimes transient hyperglycemia
- 11. Febrile Seizures What is your differential diagnosis ?
- 12. Febrile Seizures Meningitis Toxin from infection Drug reaction- anticholinergics, theophyline, salicylates, amphetamine, cocaine Metabolic disturbance- hypoglycemia, hypocalcemia
- 13. Febrile Seizures Treatment: Simple – watchful waiting, observing Complex – longer then 10 min activity- Antiepileptic drugs, Lorazepam- 0.05- 0.1 mg/kg Diazepam- o.2-0.4 mg/kg Phenobarbital- 20 mg/kg Phenytoin- 20 mg/kg
- 14. Febrile Seizures Support respiration – all drugs cause decrease in respiratory rate Antipyretic – acetaminophen – 10-15 mg/kg per rectum or po q 4-6 hours Treat underlying infection Reassure family – most think child will die or have permanent brain damage .
- 15. Febrile Seizures Complications None No epilepsy risk No brain damage No neurologic deficits No mental retardation No learning disorders
- 16. Febrile Seizures Prevention- not advised, due to the possible overuse of the medications and possible allergic reaction to medications Anticipatory guidance and parent education is absolutely a must
- 17. Febrile Seizures What is important for parents to know : Inherited trait Outgrow by age of 5 if not sooner Recurrence risk -35% over childs life time , 25% over next 12 months
- 18. Febrile Seizures When to refer: If child has neurologic deficits after seizure – refer to the pediatric neurologist. If parents frightened or insist on prophylactic treatments – refer them to specialist to help them better understand benign nature .