Febrile convulsion Pediatric group of Emergency department ChungGang

Febrile convulsion Pediatric group of Emergency department Chung-Gang Memorial Hospital Chen, Kuan-fu M. D.

Case presentation ¡ 3 y/o male p’t brought to ER with fever. Family claimed jerking just noted today with chills. ¡ Triage: T: 38. 6, P: 179, R: 30, BP: 150/60 ¡ PH: no seizure history

Case presentation ¡ At ER, again an episode of GTC attack ¡ Valium was given through anus ¡ Nurse asks you: Do you want the CT? Do you want some electrolyte check? Do you want the AED (Anti-Epileptic Drug)? ¡ Family asks you: Do you want to admit him Will he have another episode? Will he have epilepsy in the future?

Epidemiology ¡ Incidence: 2 -4% ¡ Most common cause of convulsions in young children ¡ Age: 6 m/o-6 y/o, peak: 12 -18 m/o ¡ Etiology: infection, immunization, genetic factor, hippocampal lesions

Criteria ¡ BT > 38ºC ¡ Age < 6 y/o ¡ No CNS infecton or inflammation ¡ No acute systemic metabolic abnormality ¡ No history of previous afebrile seizures

Category Simple(benigh) Complex Duration < 15 mins Duration > 15 mins No NE finding NE focal finding or post-ictal paresis No recurrence during 24 hrs (total duration < 30 mins if in series) Series, total duration > 30 mins

Symptoms & Signs ¡ Most common: simple type ¡ General clonic most common, but can be atonic or tonic spells ¡ Degree of fever doesn’t matter

Differential diagnosis ¡ Shaking chills ¡ Metabolic disorder: rare ¡ Meningitis & encephalitis Younger p’t doesn’t have meningeal sign (<2 y/o) Status Epilepticus with fever more

Diagnosis ¡ Lumbar puncture? AAP (American Academy of Pediatrics ) suggeston: ¡ First seizure + fever in < 12 m/o ¡ Occur in 2 nd day of illness ¡ Routine check of electrolytes? Very low yield Indicated in hx of vomiting, diarrhea, and abnormal fluid intake or PE finding ¡ Routine CT? Large head, abnormal NE finding, focal features, IICP ¡ Routine EEG? Not warranted

Treatment ¡ > 5 minutes: Lorazepam (0. 05 to 0. 1 mg/kg) iv Diazepam rectal gel (0. 5 mg/kg) ¡ Persistence: rare phenytoin (15 to 20 mg/kg IV) ¡ Fever: Treated while seizure controlled

Treatment ¡ AED (Anti-Epileptic Drug) Controversial AAP: ¡Simple type, no matter one or recurrent, Not recommended ¡No matter continuous or intermittent ¡ Antipyresis not affect recurrence rate

Prognosis ¡ Recurrence rate: Overall: 1/3 < 2 y/o: 50 -65% Older: 20% ¡ Increased recurrence risk Young age at onset History of febrile seizures in a first-degree relative Low degree of fever while in ED Brief duration between the onset of fever and the initial seizure.