Episode 169.0 – Febrile Seizures

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 Download Leave a Comment 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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