Febrile seizures are common in young children under 6 years old, occurring in 2-4% of children. They are convulsions associated with a fever over 38°C without an infection of the brain or metabolic abnormality. Febrile seizures are categorized as simple or complex based on duration and features. Treatment involves antipyretics to reduce fever along with anticonvulsants if seizures last more than 5 minutes. While concerning for parents, febrile seizures are generally benign and do not require long-term anticonvulsant treatment in otherwise healthy children with simple febrile seizures.

1. Azza Zohdy
MD-FRCPCH (Uk) –
MRCPCH( UK)- M Sc.

2. Febrile seizures are common cause of convulsions in
young children.
They occur in 2 to 4% of children younger than five years
of age ( between 6 months and 6 years).
The majority occur between 12 and 18 months of age.
In some populations it may be as high as 15%.

3. Accepted Criteria
-- A convulsion associated with an elevated temperature
more than 38 ⁰ C.
-- A child younger than 6 years of age.
-- No central nervous system infection or inflammation.
-- No acute systemic metabolic abnormality that may
produce convulsions.
-- No history of previous afebrile seizure.

4. Categories
A-Simple ( benign)
- The most common.
- Seizures last less than 15 minutes.
No focal features.
- Occur in series with a total duration less than 30
minutes.

5. B -Complex.
- Episodes last more than 15 minutes.
- Focal features.
- Post ictal paresis.
- Series with total duration more than 30 minutes.

6. Etiology and pathogenesis
- Not well known.
- Fever induced factors( interleukin----)
- Genetic susceptibility.
- Fever associated neuronal activity.
- Hyperthermia induced alkalosis.

7. - Infections: bacterial and viral infections.
- Immunizations: DPT ( in the same day)
- MMR( in 8-14 days).

8. Predisposing factors
-Reduced levels of GABA in the CSF.
-Increased concentrations of neopetrin in the CSF.
- Low iron and ferritin levels.
- Genetic susceptibility:
- Genetic loci.
- Nonmendelian forms.
- Syndromes.
- Hippocampus malformation.

9. Clinical Features
A- Simple febrile:
- Generalized clonic
- atonic
- tonic spells.
- -Facial and respiratory muscles are commonly involved.
- - Mostly in the first day of illness.
- - In 25% of cases it occurs between 38⁰C – 39⁰C.
- - It is often seen as the temperature is increasing rapidly,
- but may develop as the fever is declining.

10.  B- Complex febrile:
- Focal
- Longer than 15 minutes.
- Multiple episodes within 24 hours.

11.  C- Febrile status epilepticus:
- Continuous seizures.
- Intermittent seizures without neurologic recovery.
- Lasting for a period of 30 minutes or more.

12.  D:- Recurrent febrile seizures
 30%
 Young age of onset
 History of febrile seizure in a first degree relative.
 Low degree of fever while in the ER.
 Brief duration between the onset of fever and the initial
seizure.

13. Differential Diagnosis
 - Shaking chills.
 - Metabolic disorders.
 - Meningitis and encephalitis.
 - Epilepsy.

14. Treatment
They always last less than 5 minutes.
- Airway, respiratory status and circulation are continuously
assessed during seizure.
- Collect blood for glucose and electrolytes.
- Antiepileptic drugs :
- 1) Lorazepam ( 0.05- 0.1 mg/kg IV)
- 2) Additional dose.
- 3) Fosphenytoin( 15- 20 mg/kg IV)
- 4) Diazepam rectal ( 0.5 mg/kg)

15. Fever

18.  Acetaminophen
 10 -15 mg/kg/dose/4-6 hours ( maximum 800 mg)
 Ibuprofen
 10mg/kg/dose/6hours ( maximum 40mg/kg)
Switch from one drug to another.
Do not combine them together.

19. External Cooling
 External cooling may be used as an adjunct to antipyretic
therapy for children in whom you need rapid reduction
of body temperature.
 Antipyretic agents should be administered 30 minutes
before external cooling.
 Antipyretic agents are necessary to reset the
thermoregulatory set point, without which external
cooling will result in an increase in heat production.

20. Diagnostic Evaluation
 Lumbar puncture:
 When there are signs or symptoms of meningitis or CNS
infection.
 For infants between 6 and 12 months not immunized for
Haemophilus influenzae.
 The patient was on antibiotics before the convulsions.
 If the febrile seizure ocurrs after the second day of illness.
 In febrile status epilepticus.

21.  Complete blood count, electrolytes, blood sugar, urea
nitrogen are indicated for diagnosis of the disease only.
 Neuroimaging is not indicated for simple febrile seizures.
 EEG is not warranted in the setting of simple seizures.

22. Preventive Therapy
Based on the risk and benefits of effective therapies,
neither continuous nor intermittent anticonvulsive
therapy is recommended for children with one or more
simple febrile seizures.
Recurrent episodes of febrile seizures can create anxiety in
some parents and their children , and as such appropriate
educational and emotional support should be provided.

23. Patient Information
 Home treatment:
 Place the child on their side but do not try to stop their
movement or convulsions.
 Do not put any thing in the child′s mouth.
 Keep an eye on the time, seizures that last for more than
5 minutes require immediate treatment.

26. Fever
3- 36 months:
Rectal temperature ≥ 38⁰C .
Older children:
Oral temprature ≥ 37.8⁰C.

27.  There is no evidence to support that fever ≥ 40⁰ C is
associated with increased risk of adverse outcome ( eg.
Brain damage) although this belief is held by many
caregivers and clinicians.

28. Anticipatory guides:
• Fever is not an illness , but a physiologic response.
• In otherwise healthy children, most fevers are self limited
• Provided that the cause is known and fluid loss is
replaced, fever does not cause brain damage.
• There is no evidence that fever makes the illness worse.
• The initial measures to reduce the childs temprature
include provision of extra fluids and reduced activity

29.  Children with temperature elevation and possibility of
hyperthermia require treatment, but the treatment of
hyperthermia differs from that of fever.
 Antipyretic medications are ineffective in children with
heat stroke and may exacerbate liver injury and
coagulopathy.

30.  External cooling is the treatment of choice for heat stroke and
other forms of heat illness in which rapid cooling is necessary
to prevent end organ failure.
 Indications for concomitant antipyretic adminestration and
mechanical cooling include:
-Uncertainty about the cause of elevated temperature
( heat illness versus fever)
- fever combined with a component of heat illness( over-
rapping, hypovolemia. Drugs.
- underlying neurologic disorder, in which the child may have
abnormal temperature control.

31.  When mechanical cooling is necessary , sponging with
warm water ( 30⁰ C ) or tepid sponge is recommended.
 Cooling blankets can be useful in hospitalized children
who are critically ill or who have problems with neat
control( head injury)