Febrile seizures are exactly what they sound like – seizures associated with fever, but in the absence of infection. Exact pathophysiology is unknown but is likely related to process involving cytokines, not too clinically important.
Occurs between 6 months and 5 years, with peak incidence in 2 year old children
There are 2 main types of febrile seizures
- Simple febrile seizure
- Duration <15 mins
- Max of 1 seizure within 24 hrs
- Generalized seizure
- Complex febrile seizure
- Duration > 15 mins
- More than 1 seizure within 24 hours is possible
- Focal onset
Post-ictal phase (period after seizure) for either type is short.
Diagnosis
- Any work-up is typically focused on determining what caused the fever (CBC, urinalysis, glucose, toxicology, lumbar puncture to rule out meningitis etc.)
- If the seizure is complex, further work-up involving an EEG and imaging may be considered as complex febrile seizures have a higher risk of developing into epilepsy
Treatment
- If the seizure is simple and short, no abortive therapy is required, but if the seizure is longer than 5 mins provide abortive therapy (which is typically a benzodiazepine)
- IV lorazepam
- Bucal/intranasal midazolam if IV access is not available
- NSAIDs cannot be given during a fever in order to prevent a seizure since the seizure typically occurs as the fever is developing and as the temperature is rising, rather than at the peak temperature
- NSAIDs can be given however after a seizure in order to decrease body temperature but typically will not affect the seizure itself