1. Febrile Convulsion

2. Definition
Brief (<15 min), generalized, tonic- clonic seizure associated with a febrile illness≥39°C, but without any CNS infection, severe metabolic disturbance, or other known neurological cause
The most common seizure disorder during childhood

3. Introduction Age: 6 m ~ 5 y Incidence:3% ~ 4% in children <5 y
Peak age of onset: 18 ~ 22 m
Sex: male > female

4. Genetics
Strong family history in siblings and parents: increase risk one-third of cases.

5. Common Causes viral infection is commonest >85% of casess:
Viral URI
Reseola
Acute otitis media
And may occur with pneumonia, gastroenteritis & UTI.
May also occur following immunization especially with pertussis or measles immunization.

6. Differential diagnosis
CNS infection
Eletrolyte disturbance
Inborn errors of metabolism
Intracranial mass
Ofcourse the Diagnosis Accourding by history and exclusion.

7. Clinical Presentation
Typical - simple
Atypical - complex

9. Atypical Presentation
Age < 6 m or >5 y
Onset >24 hrs after fever onset
Duration >15 min
Focal(unilateral)or generalized.
Occur more than once in 24 hrs.
Focal motor manifestations.
Abnormal neurological examination.

10. Investigation Typical: not required Atypical: required EEG
Toxicology screening
Assessment of electrolytes
CT or MRI

11. CSF Study To rule out meningitis When CNS infection was suspected
Atypical febrile convulsion
Age < 1yr

12. Treatment Routine treatment: Search for the cause of fever
Control fever (avoid excessive clothing, encourage fluids, tepid sponge bath, and antipyretics)
Prophylactic anticonvulsants are not indicated for typical febrile convulsion.

13. Don’t forget:
Counseling of parents as emergency resuscitation they can do it at home:
Put in semi-prone position.
Extend the neck,elevate the jaw.
Remove tight cloth,don’t restrain.
Nothing per mouth (spoon handle!)
No mouth to mouth breathing.
No water on the face.

14. Prognosis Excellent prognosis in most children Risk of recurrence:
Onset < 1 y or with family history: 50%
Onset > 1 y: 30 % up to the age of 5 yr
After second episode: 50 %
Age > 5 y: near zero

15. Prognosis Risk of epilepsy development: 1~2% in the general population
increase up to 9% when two or more risk factors are present

16. Prognosis Risk factors for epilepsy development:
Positive family history of epilepsy
Atypical febrile convulsion
Previous abnormal development or neurological disorder

17. Recurrence Prevention
Phenobarbital: ineffective and may decrease cognitive function
Carbamazepine: ineffective
Phenytoin: ineffective
Valpronic acid: effective, but with potential risk of fatal hepatotoxicity, thrombocytopenia, GI disturbances, and pancretitis

18. Recurrence Prevention
Antipyretic agents: ineffective
Diazepam: effective and safe
Oral or rectal form
For patients with frequent febrile convulsion or significant parental anxiety
Dose: 0.3 mg/kg q8h PO (1 mg/kg/dl) for the duration of the illness (2~3 days)
Side effects: lethargy, irritable, ataxia

19. أي سؤال ياشباب؟

20. 8years male brought to the emergency room by his mother c/o feeding dificulty , contraction of lims , arching of the back while feeding , the contraction were symmetrical in both limbs mainly in extension manners that ends whithin few seconds this repeated several times per day especially after wake up from sleep ,

21. and no significants family history or history of birth trauma or perinatal infection . CBC serum,electroltes & glucose all within normal.

22. What is the investigation of choice?
What is the abnormality in the investigation?
What is the treatment of choice?
What is the long term sequelae?

23. An 18 mounth male was brought to emergency center by his parents after having agenaralized tonic clonic seizures that last approximately 5 minites the parents say the child has been previously well but developed cold symtomes earlier today with a temperature of 39C.

24. What is your diagnosis?
Other point significant in the history?
When called atypical febrile convulsion?
It is associated with high risk of epilepsy?
Out lines of breif manegment of such condition?

25. An 8years old girl brought to emergency unit of the school by her teachers because she developed generalized tonic clonic convulsion 2hrs ago at class room at break time.they said she was convulsing her eyes rolled up , tongue bitting,loss of bladder control .& loss of consciousness for few minutes after which regained her convulsion but was drawsy.

26. What other questions you will ask in the history?
If she had previous attacks what is your diagnosis?
What is the drug of choice?

27. Thank You for Your Attention !
Bibliography
Provisional committee on quality improvement, subcommittee on febrile seizures. Practice parameter: the neurodiagnostic evaluation of the child with a first simple febrile seizure. Pediatrics 1996;97:769.
Shinnar S and Glauser TA. Febrile seizures. J Child Neurol 2002;17:S44-52.
Thomas KE et al. The diagnostic accuracy of Kernig’s sign, Brudzinski’s sign, and nuchal rigidity in adults with suspected meningitis. Clin Inf Dis 2002;35:46.
Warden CR et al. Evaluation and management of febrile seizures in the out-of-hospital and emergency department settings. Ann Emerg Med 2003;41:215.