Overview

• Seizures provoked by fever in otherwise normal children.
  • Roseola Infantum (caused by human herpes virus 6), can cause a maculopapular rash and febrile convulsions.
• Only occur between 6 months - 6 years old. MOST COMMON CAUSE OF SEIZURES IN CHILDREN (occur in 3% of children).

Making Diagnosis

Clinical Features

• Simple Febrile Convulsions ⇒
  • Generalised, tonic-clonic seizures.
  • Last <15 minutes.
  • Only occur once during single febrile illness.
• Complex Febrile Convulsions ⇒
  • Focal seizures.
  • Last >15 minutes.
  • Occur multiple times during same febrile illness.

Investigations

• Exclude other Neurological Pathology → epilepsy, meningitis, encephalitis, intracranial SOL.

Management Plan

• Admission → first febrile seizure, uncertain focus of infection, age <18m, complex seizure (>15 mins or multiple times in same illness), taking antibiotics, residual focal neurological deficits.
• Advise parents on managing further episode → call ambulance if seizure lasts >5 mins (and no drugs available).
  • Protect from injury → cushion their head, remove nearby objects, do not restrain (don’t place in recovery position).
  • Give rescue medication (PRESCRIBED BY SPECIALIST) → buccal midazolam or rectal diazepam.
    • If seizure persists for >10 mins after first dose of benzodiazepine, call ambulance and rescue therapy can be repeated.
  • Managing Fever → adequate fluid intake, regular paracetamol + ibruprofen, seek advice if prolonged fever.

Complications →

Prognosis → 30-40% risk of another febrile convulsion. 2.5% risk of developing epilepsy (factors increasing risk = FH of epilepsy, complex febrile seizure (multiple within same illness or prolonged seizures, background of neurodevelopmental disorder).