PEDIATRICS
SYMPTOMS/EXAM
■ May be postictal
■ Febrile seizures usually occur early in the course of a febrile illness, so no
specific signs or symptoms of infection may be found. Sometimes patients
may have a clear source of infection, such as URI, pharyngitis, or otitis
media.
■ Signs not consistent with febrile seizures include: Bulging fontanelle,
petechiae, meningismus, and unusually large head circumference (in infants).DIFFERENTIAL
■ CNS infection (meningitis, encephalitis)
■ Head trauma
■ Medication exposure (intentional or accidental)
■ Hypoglycemia
■ Dehydration leading to electrolyte abnormalities
■ Other infections associated with seizures (Shigella, roseola)DIAGNOSIS
The diagnosis of febrile seizures is a clinical one, with additional studies used
to exclude other causes of seizures. Serum glucose should be checked in all
children suspected of having a febrile seizure. If the history supports possible
dehydration, serum electrolytes should also be checked. Additional serum
studies, blood cultures, and urine studies should be sent if there is concern for
SBI. Routine CT or MRI of the brain is not indicated to rule in febrile
seizures, but may be useful if there is concern for other causes of seizure.
Routine EEG is not indicated.TREATMENT
Actively seizing:
■ Stabilize airway.
■ Lorazepam 0.05–0.1 mg/kg IV (max dose 2 mg)Postictal:
■ Observe for 2–4 hours, and discharge when mental status normal.
■ Reassure parents about benign nature of febrile seizure.
■ Educate parents: Up to 15% of children will have a recurrent febrile
seizure within 24 hours of the initial seizure.
■ Follow-up with pediatrician
■ Consider admission if child required lorazepam, diagnosis is unclear,
social situation for child is unstable, or follow-up is not available.COMPLICATIONS
■ 33% of children will have recurrent febrile seizures.
■ 75% of recurrent febrile seizures occur <1 year after initial febrile
seizure.
■ Epilepsy (recurrent seizures not associated with fever) rarely develops in
children with febrile seizures: <2% of children who have a febrile seizure
will develop epilepsy. Children with complex febrile seizures are at greater
risk for developing epilepsy.Have a low threshold for
performing an LP to exclude
meningitis, particularly in
younger children or those
already taking antibiotics.