CRS Febrile Seizure

Explanation

Febrile seizures are very common. Approximately 3-5% of children will have a febrile seizure at some stage in their childhood.

Explanation

Febrile seizures can occur in children from the age of 6 months to 6 years. It is important to exclude other diagnoses in all children, but particularly in children outside this range as it is unlikely for children outside this range to present with their first febrile seizure. Other diagnoses, particularly meningitis, need to be considered in children younger than 6 months or older than 6 years.

Explanation

A family history of febrile seizures may be found in 10 to 20% of parents and siblings. The history of febrile seizures in a first degree or second degree relative. eEach contributes to a 6-10% risk for a first febrile seizure. Monozygotic twins have a much higher concordance rate than do dizygotic twins, in whom the rate is similar to that of other siblings.

Other factors that predict a first febrile seizure are: delayed neonatal hospital discharge, slow neurologic development and attendance at daycare. (Forsgren et al., 1991; Bethune et al., 1993; van Esch et al., 1998). There is no definite genetic locus or inheritance pattern yet identified for simple febrile seizures.

Explanation

Demonstration of paroxysmal discharges on EEG during a clinical seizure is diagnostic of a seizure but this does not occur frequently. Seizures can only be suggested by history or by direct observation of the event by a trained healthcare professional. The presence of abnormalities on an EEG does not mean that the event witnessed and reported by the parents was in fact a seizure.

Sometimes, children and adolescents with an underlying seizure disorder with abnormalities on EEG will have pseudoseizures. When in doubt, a video-EEG or prolonged EEG may be helpful. An inter-ictal EEG cannot be relied upon to make the diagnosis (inter-ictal means an EEG performed in between seizures. Up to 40% of children with definite seizures based on history or direct observation of an event will have normal inter-ictal EEGs. Physical examination and brain imaging is normal in the vast majority of children with seizures and if abnormal would indicate a diagnosis other than febrile seizures.

Explanation

Seizures can occur anywhere and you may not have first aid equipment available. The most important first aid measure is to ensure that the child is not in immediate danger from fire, water or heights. Place the child in a safe environment (e.g., on the floor or on the bed) away from sharp objects such as table legs and away from water (e.g., the bath) or heights (e.g., stairs).

Do not put anything into the mouth, until the child is conscious as you may have your fingers bitten or you may push an object into the airway. You should not put the child in the car and drive to ED as you cannot watch your child and drive at the same time. If the seizure lasts longer than 5 minutes call the ambulance rather than drive.

More information can be found in the following fact sheets:

Royal Children’s Hospital Melbourne

Febrile convulsions - parent fact sheet

Sydney Children’s Hospitals Network

Febrile Convulsions - parent fact sheet

Explanation

The correct answer is 'Blood sugar level'. For simple febrile seizures in children older than 6 months, there is no reason to perform a lumbar puncture to exclude meningitis, unless there are specific features of meningitis such as neck stiffness or severe photophobia. Urine metabolic screening is very unlikely to provide useful information unless there are other features of metabolic illnesses (such as parental consanguinity, or abnormalities on physical examination).