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					Febrile seizures
          Introduction
Febrile seizures are usually defined
as epileptic seizures precipitated by
fever ( usually defined as above 38 º
C ) , not due to intracranial infection
or other definable CNS cause and not
preceded by afebrile seizures.
Febrile seizures are common
causes of pediatric admission and
parental concern ; their incidene
varies from 0.5 – 1.5 % in China
2.2 % in North America to 8.8 % in
Japan.
Febrile seizures are age dependent
and are rare before 9 months and
after 5 years of age. The peak age
of onset is 14-18 month .
Although the occurrence of febrile
seizures in childhood is is quite
common they can be extremely
frightening , emotionally traumatic
and anxiety provoking when
witnessed by parents.
During the seizure the parents may
percieve that their child is dying ,
but fortunately the vast majority of
febrile seizures are benign. Rarely
have febrile seizures caused brain
damage and with the exception of
developing countries , there are no
documented cases of febrile
seizure-related deaths on record.
The commonest type of febrile
seizures ( known as simple febrile
seizures ) is generalized tonic-clnic
in nature , lasts a few seconds and
rarely up to 15 minutes , is followed
by brief postictal period of
drowsiness and occurs only once in
24 hours .
A febrile seizure is described as
complex or complicated when the
duration is more than 15 minutes ,
when repeated attacks occur within
24 hours or when focal seizure
activity or focal findings are present
during the post-ictal period .
 Febrile seizures tend to occur in
families ; in child with febrile
seizure , the risk of febrile seizures
is 10 % for the sibling and almost
50 % for the sibling if a parent has
febrile seizures as well .Although
clear evidence exists for a genetic
basis of febrile seizures , the mode
of inheritance is unclear.
One third of chidren with febrile
seizures will have another febrile
seizure with a subsequent fever .
Of those who do , about 12 will
have a 3rd seizure. If there is a
family history , if the first seizure
happened with a fever below 38.5 º
C , a child is more likely to have
more than one febrile seizure.
Despite that febrile seizures are
benign in nature , persons with a
history of febrile seizures had a
higher rate of epilepsy that lasted
into adult life , but less than 7 % of
children with febrile seizures
developed epilepsy duing 23 years
of follow up . The risk is higher for
those who had a family history of
epilepsy , cerebral palsy or low
Apgar score at 5 minutes.
Pathophysiology of febrile
       seizures :

Febrile seizures occur in young children
at a time in their development when
seizure threshold is low.
This is a time when young children are
susceptible to frequent childhood
infections such as upper respiratory
infections , otitis media , viral syndrome
, and they respond with comparably
higer temperatures.
Preliminary studies in children
appear to support the hypothesis
that the cytokine network is
activated and may have a role in
the pathogenesis of febrile seizures
, but the precise clinical and
pathological significance of these
observations are not yet clear.
The occurrence of a child's first (
initial ) febrile seizures has been
associated with : first or second
degree relative with history of febrile
and afebrile seizures , developmental
delay , viral infections and iron
deficiency anemia.
Other exogenous circumstances
that have been identified as
predicing an increased risk of initial
febrile seizures inclde difficult birth ,
neonatal asphyxia and coiling of
the umbilical cord.
    The sisk has also been
postulated to increase after receipt
of pediatric vaccinations such as
DTP and MMR.
Viral infections has been hypothesized
to be one of the imporant causative
factors. Different viral infctions were
shown to be present in at least 40 % of
children with febrile seizures in early
clinical studies.
   More recently some viruses are
postulated to be more " neurotropic "
and more important in the causation of
febrile seizures ; Human herpesvirus 6
was found in one third of patients with
febrile seizures .
Chiu et al., have shown that the risk
of febrile seizures following
influenza Avinfection was higher
copmared to other respiratory
viruses and was associated with
repeated seizures in the same
febrile episode .
    Parainfluenza , adenovirus ,
respiratory syncytial virus and rota
virus are also associated with the
occurrence of febrile seizures in
children.
On the other hand , childhood and
infantle fevers caused by bacterial
causes are not likely to cause febrile
seizures
                              Management of febrile
                                   seizures



      Is it febrile?              Why not others?           DD from other
Documented core temperature      Put other possibities   abnormal movements
                                                              or rigors
It is febrile sizures what to do?
         During the attack:
    i- Put the child on his side.
ii- gentle removal of secretions
              then……
                 Watch the
                    watch
               For 15 minutes


 If continued
                                If stopped
Hospital or rectal
                                 Nothing
   diazepam
Prophlaxis in case of fever
 No role of antipyretics
 Oral diazepam 0.3 mg / kg /day
in 3 doses for 3 days
Case- based pitfalls in
  febrile seizures
1- A 4 years old child presented to yje
casuality with first attack of febrile
seizures , the attack begins suddenly
after 2 days from the onset of
follicular tonsillitis that doesn't seem
to respond to antibiotic treatment.
Age of 1st attack
Onset of the attack
Aetiology
2- A 3 years old child with known febrile
seizure has suffered a new attack that
lasted 3 minutes and stopped only after
emersing him in a cold bath, the child
was rapidly to the casuality and
received an intravenous injection of 1.5
mg diazepam then admitted to complete
treatment in usual hospital ward.
Cold bath
Casuality
Diazepam
Admission
3- A 2 years old child was admitted to
the causality after suffering from partial
seizure attack lasting 20 minutes , the
attack was interrupted but recurred 2
hours later and followed by disturbed
consciousness . The temperature after
admission was 37.7 , febrile seizures
were excluded and LP was done.
Why not febrile?
Why LP?
What to do then?

				
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posted:8/15/2010
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