Episode 169.0 – Febrile Seizures - a podcast by Core EM

A look at the most common type of seizures in the young pediatric population.

Hosts:

Brian Gilberti, MD

Audrey Bree Tse, MD







https://media.blubrry.com/coreem/content.blubrry.com/coreem/Febrile_Seizures.mp3







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Tags: Pediatrics











Show Notes

Background



* The most common type of seizure in children under 5 years of age

* Occur in 2-5% of children

* In children with a fever, aged 6 months to 5 years of age, and without a CNS infection

* Risk Factors



* 4 times more likely to have a febrile seizure if parent had one

* Also increase in risk if siblings or nieces / nephews had one





* Common associated infections



* Human Herpesvirus 6

* Human Herpesvirus 7

* Influenza A & B





* Simple Febrile Seizure



* Generalized tonic-clonic activity lasting less than 15 minutes in a child 6 months to 5 years of age





* Complex Febrile Seizure



* Lasts longer than 15 minutes, occurs in a child outside of this age range, are focal, or that recur within a 24-hour period.







Diagnostics / Workup



* Gather thorough history and perform thorough physical exam

* Most cases will not require labs, imaging or EEG

* If e/o meningitis, perform LP

* AAP suggests considering LP in:



* Children 6-12 months who are not immunized for H flu type B or strep pneumo

* Children who had been on antibiotics





* For complex seizures, clinician may have a lower threshold for obtaining labs



* Hyponatremia is more common in this group than in the general population.

* LPs are more commonly done by providers, but these are low yield with one study showing bacterial meningitis being diagnosed in just 0.9% (Kimia 2010), all of whom did not have a normal exam or negative cultures.

* Neuroimaging is also exceedingly low yield if the patient returns to baseline (Teng 2006)

* One study that showed that the duration of complex febrile seizure, being greater than 30 minutes, was associated with a higher incidence of bacterial meningitis. (Chin 2005)

* Of they have history and exam concerning for meningitis, they should get an LP

* If they look dehydrated or edematous, you would have more of a reason to get a chemistry







Treatment



* Benzodiazepine if seizure lasted for >5 minutes, either IV or IN

* Supportive care



* Tylenol or motrin if febrile

* Fluids if signs of dehydration





* Antipyretics “around the clock”



* A majority of data show no benefit in preventing recurrence of seizure

* One study (Murata 2018) found that giving tylenol q6h at 10 mg/kg for the first 24 hours following the initial seizure decreased the rate of recurrence when compared to children who did not receive antipyretics.



* NNT here was 7

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