Diagnosis

Febrile seizure

Etiology

Cause [2es]

• Genetic predisposition

• Immaturity

• Vulnerability of the central nervous system

• Environmental factors:

  • Fever

  • Viral infection such as Roseolovirus, HHV-7, coronavirus, adenovirus, RSV, cytomegalovirus, shigella, herpes simplex virus

  • Bacterial infections

  • Vaccine

Pathophysiology

1. Seizure threshold is low at the time of brain development [children)

2. Frequent childhood infections: upper respiratory infection, otitis media, viral syndrome

3. Children respond with comparably higher temperatures

Classification [t5u]

• Simple febrile seizures: generalized, last < 15 min and do not recur within 24 h

• Complex febrile seizures: focal, prolonged, recur more than once in 24 h, may indicate a more serious disease process (meningitis, abscess, or encephalitis)

• Febrile status epilepticus: a single seizure or series of seizures without interim recovery lasting at least 30 minutes

Febrile seizure risk factors [2es]

• Existing neurologic impairment

• Viral infection,

• Family history of seizure

• Developmental delay

• Decreased serum zinc and iron levels

• Maternal smoking and stress

Complications [2es]

• Unexpected death

• Subsequent epilepsy

• Encephalopathy 

• Autism spectrum disorder

• Intellectual disability

• Attention-deficit/hyperactivity disorder

• Tourette syndrome

• Allergic rhinitis

• Asthma

Epidemiology

Incidence per 100.000 [uym][rfq][giv]

Approach

• Blood test

• Blood gas

• CT caput when complex febrile seizures

• Lumbar puncture

• EEG if recurring seizures

Treatment

1. Most febrile seizures resolve spontaneously without associated complications

2. Supportive care:

   • Airway management

   • High-flow oxygen

   • Anticonvulsants if necessary

   • Antipyretics as appropriate

Differential diagnoses

Acute disseminated encephalomyelitis, Basilar artery thrombosis, Brain abscess, Encephalitis, Epidural hematoma, Epilepsy, Meningitis, Otitis media, Pharyngitis, Sepsis, Stroke