Febrile seizures/convulsions

• What are febrile convulsions?


  Seizures associated with fever
• What age group do febrile convulsions normally occur in?


  1 - 5 year olds
• What are some common viral causes of febrile seizures?


  Resp tract infections

  Otitis media

  UTIs

  Influenza

  Human herpes virus 6
• Which virus has the highest implication in febrile convulsions?

  Human herpes virus 6 (HHV-6)
• How many different types of febrile convulsion are there?


  3
• What are the 3 types of febrile convulsion?

  Simple

  Complec

  Febrile status epilepticus
• What is the most common type of febrile seizure?


  Simple
• WHat do simple febrile convulsions present with?


  Generalised tonic-clonic

  Muscle stiffness

  Jerking

  Shaking of limbs

  Breathing difficulties

  Pallor

  Cyanosis

  Loss of consciousness
• How many times does a seizure occur within 24 hours in simple febrile convusions?


  Once
• How long does it take the vast majority to recover from a simple febrile convulsion?


  1 hour
• How long do the seizures last in simple febrile convulsions?


  <10 mins
• How do complex febrile convulsions present?


  Same as simple but with more focal features e.g. Movement on one side fo the body
• How long do complex febrile convulsions last?


  >15 mins
• Do seizures recur within 24 hours with complex febrile convulsions?


  Yes
• What is febrile status epilepticus?


  Seizure lasting longer than 30 mins
• What are some important key features of a seizure to ask about?

  Fever:

  • Onset
  • Peak temp
  • Duration

  Seizure:

  • Characteristics
  • Duration
  • First time?
• What investigations are done for febrile convulsions?


  Typically clinical

  Temp should be checked after seizure

  Assess consciousness

  Lumbar puncture

  EEG

  MRI
• What are some other investigations that may be done if the cause of the fever is uncertain?

  Bloods - FBC, U&Es, ESR, coag, glucose

  Urine culture - <18 months or complex seizure
• Why may a lumbar puncture be done?


  Rule out meningitis
• What are some ddx for febrile convulsions?


  Epileptic seizures

  Viral meningitis

  Bacterial meningitis

  Acute encephalopathy

  Dravet syndrome
• how are febrile convulsions managed?


  Safety netting

  Antipyretics

  Seizure lasts >5mins = ambulance

  Buccal midazolam or rectal diazepam
• When is outpatient referral considered?

  First febrile convulsion

  Diagnostic uncertainty

  <18 months

  Antibiotics (potentially masking meningitis)
• What are some complications following complex febrile seizures?

  Todd's paresis

  Epilepsy

  Febrile status epilepticus
• What is Todd's paresis?


  Transient hemiparesis after a febrile seizure