Febrile convulsions

It is a very common convulsive disorder during childhood with uniformly excellent prognosis. However, it may signify a serious underlying acute infectious disease such as septicemia, so that each child must be carefully examined and appropriately investigated for the cause of the associated fever.

Clinical manifestations

· Age incidence: it occurs between 9 months and 5 years with a peak incidence between 14-18     months.

· There is a positive family history of febrile convulsions in up to 20% of cases.

· Febrile convulsions occur at the onset of rapid rise of body temperature (within 8-12 hours of rise of body temperature). Most affected children have a temperature above 39ºC at the time of convulsions.

•          The convulsive fit in simple febrile convulsions has the following characters: it is generalized tonic-clonic convulsion, brief and usually lasts for few seconds to less than 15 minutes, the post-ictal stupor is short, and there is usually one convulsive fit during the same illness.

· There are no clinical features suggesting CNS infection, meningeal irritation or increased intracranial pressure.

· There is an evidence of extracranial infection as pharyngitis, otitis media, pneumonia or gastroenteritis.

Investigations

1- Lumbar puncture and CSF analysis are not indicated in typical cases. CSF is normal.

2- EEG examination is normal after 2 weeks of the febrile seizure.

Management of febrile convulsions

· Reassurance of the parents.

· Careful search for, and treatment of the cause of fever.

· Active measures to control the fever including the use of antipyretics, cold fomentation and water bath.

· Control of seizures: anticonvulsants e.g. diazepam can be used for the immediate control of febrile convulsions in a dose of 0.2-0.3 mg/kg/dose IV.

Prophylaxis against recurrence of febrile convulsions

Prolonged anti-convulsant prophylaxis for the prevention of recurrent febrile convulsions is

Oral diazepam is an effective and safe method of reducing the risk of recurrence of febrile seizures. diazepam 0.3-mg/kg/8 hr (1mg/kg/24hr) is administered for the duration of illness (usually 2-3 days).

Prognosis of febrile convulsions

Febrile convulsions rarely develop into epilepsy, and usually they spontaneously disappear without specific therapy. The risk factors for development of epilepsy in children as a complication of febrile convulsions include:

a- Positive family history of epilepsy.        

b- Initial febrile seizure prior to 9 mo of age.

c- Prolonged or atypical febrile seizure.                   

d- Frequent seizures.

e- Motor or mental deficits.