Febrile Seizures

Paediatric blue call for a twitching hot tot - you either love them, or hate them. As most of the time the child is pretty much back to normal by the time they arrive in the ED, it's easy to get a bit blaze about Febrile Convulsions or Febrile Seizures.

Febrile seizures: Seizure accompanied by a fever in the absence of inter-cranial infection due to bacterial meningitis or viral encephalitis.

They happen in 3% of children, between 6 months and 3- 5 years of age. The peak incidence is 18 months. Only 6-15% of seizures occur after 4 years. They are normally brief, with a 30-40% risk of a further attack.
10% increased risk if child has first degree relative with febrile seizures
A febrile seizure is more likely the younger the child, the shorter the duration, lower the temp at seizure and family history.  1-2% lifetime risk of epilepsy, same as all kids - complex focal have 4-12% risk

Presentation
- Short duration (<15minutes)
- Single seizure
- Brief post-ictal period
- Fever identified
- Prolonged seizure (5 - 10min) more likely to have a recurrence.

Investigations
Minimal evaluation needed
Urinalysis may be indicated - UTI common cause
Lumbar Puncture - only if child is not well looking, fully immunised, presenting with a simple febrile seizure. It
For complex seizure, consider bacterial meningitis as a cause - it can be difficult to clinically rule it out.

Management
As per departmental policy. Example from Manchester on the CEM website here.
If seizing, follow status epilepticus guidelines.
No evidence on duration of observation, although 24 hours has been suggested.

Advice
Normal seizure advice
Antipyretics do not prevent convulsions but may provide comfort. Diazepam also should not be used as prophylaxis.