Review of Febrile Convulsions

This set of flashcards covers key concepts related to febrile convulsions, including definitions, characteristics, risk factors, genetic factors, treatment options, and clinical recommendations.

What are febrile seizures?

Seizures that occur between the ages of 6 and 60 months (5 years) due to fever not resulting from central nervous system infection.

What is the incidence of febrile seizures in children under 5 years of age?

2-4% of children, with incidence as high as 15% in some populations.

What are the characteristics of a simple febrile seizure?

Lasts less than 15 minutes, occurs once in 24 hours, is generalized, and the patient has no previous neurologic problems.

What differentiates a complex febrile seizure from a simple febrile seizure?

A complex febrile seizure lasts 15 minutes or longer, occurs more than once in 24 hours, and may involve focal features; the patient may have known neurologic problems.

What is febrile status epilepticus?

A febrile seizure lasting longer than 30 minutes.

What percentage of children experience recurrence of febrile seizures after the first episode?

Approximately 30%.

What are the major risk factors for recurrence of febrile seizures?

Age less than 1 year, duration of fever less than 24 hours, and fever between 38-39°C.

What is the recurrence rate of febrile seizures with no risk factors?

12%.

What genetic factors are associated with febrile seizures?

Positive family history for febrile seizures, with many cases appearing to be inherited as an autosomal dominant trait.

What conditions can be preceded by febrile seizures?

Generalized epilepsy with febrile seizures plus (GEFS+), severe myoclonic epilepsy of infancy (Dravet syndrome), and temporal lobe epilepsy secondary to mesial temporal sclerosis.

What are the initial symptoms of Dravet syndrome?

Febrile and afebrile unilateral clonic seizures recurring every 1 or 2 months starting in the first year of life.

What is the recommended follow-up for a child under 12 months of age after a febrile seizure?

A lumbar puncture is recommended to rule out meningitis, especially if prior antibiotics were administered.

When should lumbar puncture be considered in children between 12 and 18 months?

If clinical symptoms suggest meningitis, as symptoms may be subtle in this age group.

What should be determined in blood studies for a child with a first simple febrile seizure?

Blood glucose should be determined.

What is recommended for children with complex febrile seizures?

Individualized work-up including EEG and neuroimaging if the child is neurologically abnormal.

What is the first-line treatment for a seizure lasting more than 5 minutes?

Acute treatment with diazepam, lorazepam, or midazolam.

What is the typical acute treatment prescribed for recurrent febrile seizures?

Rectal diazepam is often prescribed to be administered if febrile seizure lasts more than 5 minutes.

What are alternative therapies for managing febrile seizures?

Intermittent diazepam prophylaxis, phenobarbital, and valproate.