Febrile seizure


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    This guideline has been adapted for statewide use with the support of the Victorian Paediatric Clinical Network

  • See also       

    Afebrile seizures 
    Febrile Child    

    Key Points

    1. Most febrile seizures are benign and do not require investigations
    2. Management includes identifying the source of the infection and treating if indicated
    3. Antipyretics have not been shown to reduce the risk of further febrile seizures 

    Background

    • Usually occur between 6 months and 5 years  of age
    • Benign
    • Occur in 3% of healthy children
    • Normally associated with simple viral infections
    • Occur without previous afebrile seizures no significant prior neurological abnormality and no signs of CNS infection
    • Recurrence rate depends on the age of the child; the younger the child at the time of the initial seizure, the greater the risk of a further febrile seizure (1 year old 50%; 2 years old 30%)

    Classification:

    Simple Febrile Seizure Complex Febrile Seizure Afebrile Febrile Seizure
    Fever and all of the following:
    • generalised tonic-clonic seizure
    • duration of less than 10 minutes
    • complete recovery within 1 hour
    • do not recur within the same febrile illness
    Fever and any of the following:
    • focal features at onset or during the seizure  
    • duration greater than 10 minutes  
    • incomplete recovery within 1 hour
    • recurrence within the same febrile illness 
    • Seizures in an acute infectious illness (particularly gastroenteritis) without documented fever
    • Features consistent with simple febrile seizure
     

    Risk factors for developing subsequent epilepsy include:

    • family history of epilepsy
    • any neurodevelopmental problem
    • prolonged or focal febrile seizures
    • febrile status epilepticus

    No risk factors: 1% risk of developing epilepsy (similar to population risk)
    Risk increases with more risk factors, up to 10% 

    Assessment

    In a simple febrile seizure, once the seizure has terminated, the aim of the assessment is to determine the cause of the fever (see Febrile child  guidelines)

    In addition, look for the following risk factors which make simple febrile seizure unlikely:  

    • < 6 months of age (consider CNS infection, see meningitis guideline)
    • > 6 years of age
    • any features of a complex febrile seizure
    • signs of CNS infection
    • previous afebrile seizures 
    • progressive neurological conditions 
    • developmental delay or regression  

    Management

    Investigations

    In a simple febrile seizure, where the focus of infection can be identified clinically,  no investigations are indicated

    There is no role for EEG in simple or complex febrile seizures

    Investigations for the source of fever, including lumbar puncture, should be guided by the nature of the presentation and age of the child. See Febrile child guideline for indications for investigations

    In a prolonged or focal febrile seizure, consider CNS imaging after consultation with a senior doctor 

    Treatment

    Treat the seizure when necessary as per the  Afebrile seizures guideline

    Manage the underlying cause of the fever (see Febrile child guideline)

    Consider consultation with local paediatric team when:

    • Seizures unable to be controlled  
    • Complex febrile seizure
    • Child does not return to normal mental state within 1 hour  
    • Child clinically unwell 
    • Ongoing concern regarding the nature of the febrile illness
    • Frequent seizures (for consideration of anticonvulsants if indicated) 

    Consider transfer when:

    • Respiratory or haemodynamic compromise  
    • Children requiring care above the level of comfort of the local hospital  

    For emergency advice and paediatric or neonatal ICU transfers, call the Paediatric Infant Perinatal Emergency Retrieval (PIPER) Service: 1300 137 650.

    Consider discharge when:

    • Return to normal neurological state following simple febrile convulsion
    • Serious bacterial infection excluded or adequately treated
    • Underlying illness managed appropriately
    • Parents aware of first aid advice and management of possible subsequent convulsions 

    Discharge information:

    Parent information

    Kids Health Info

    Febrile seizures  
    Fever in children
     

    Last update August, 2019