CRS: Febrile Seizure

Explanation

Given the clear history of a fever preceding the event and the clear history that this was a seizure, the most likely diagnosis is a simple febrile seizure. Seizures are diagnosed based on the history. Felix did not respond when his father called his name and he was limp with his eyes rolled back so it is clear that Felix lost consciousness.

The jerking movements of his limbs are also most consistent with a seizure. Rigors or shivers from high or low temperatures are fine movements rather than large jerky movements. Twitches or tics do not occur when the child is unconscious. Given that the event is a seizure the next important question is whether or not there is a fever. If the fever is only documented AFTER the event, you must be careful drawing the conclusion that it is a febrile seizure as the act of having a seizure can increase the body temperature. Children with epilepsy having prolonged seizures can have low grade temperatures.

It seems unlikely this episode represents a breath-holding or syncopal episode. There was sustained rhythmic jerking of Felix's limbs. The decreased appetite and runny nose suggest Felix may have been feeling unwell with a cold. We do not know if he had a fever at the time. Given the acute nature of his collapse, with only minor prodromal symptoms, sepsis would be unlikely.

The past and family history offers no additional information to suggest Felix has an underlying cause other than fever for his seizure. There has been no developmental regression or deterioration in neurological function. There is nothing in the history to suggest a focal lesion.

Explanation

Simple febrile seizures are usually not associated with any specific findings on examination. If the child is not tracking well in terms of their growth, in particular if the head circumference is not in keeping with the other growth parameters, you should consider another diagnosis, such as a genetic or metabolic disorder. Neurocutaneous stigmata can be a normal finding but should be a red flag to clinicians to consider neurogenetic disorders.

Simple febrile seizures by definition are generalized (not focal), last less than 15 minutes and occur once during an illness. 60-70% of febrile seizures are simple while 30-40% are complex febrile seizures that are either focal, or prolonged (>15 min), or repeated in the same illness. It is possible to have focal features on history or physical examination in children who have had febrile convulsions when other diagnoses may have to be excluded, in particular by cranial imaging to exclude intracranial pathology such as tumours, abscesses and congenital brain or vascular malformation.