The majority of seizures in childre...

The majority of seizures in children younger than five years are febrile seizures, and children with a positive family history have a higher incidence. A febrile seizure is defined as any seizure occurring in a child who is six month to five years of age accompanied by dint of a current or recent agitation (at least 38[degrees]C [100.4[degrees]F]) and without previous seizure or neurologic adventures Febrile seizures can be classified as simple or compages Simple febrile seizures are characteristically generalized, usually last les than 15 minutes, and flash on the mind only once in a 24-hour period. tangled skein febrile seizures may have focal features, last longer than 15 minutes, and run in the mind within a 24-hour period. excitement and seizure can occur at the same time and be unrelated, as it was as in patients with underlying seizure disorder, patients who are on the outside of the febrile seizure age range, or patients who have a central nervous rule infection.

Warden and associates searched the clinical literature to review the evaluation and management of febrile seizures in children. Viral infections are oftentimes present with febrile seizures, with human herpes virus 6 and 7 and influenza A and B being important pathogens. There also is a significant increased risk of febrile seizures within 24 hours of receiving vaccination for diphtheria and tetanus toxoids and whole-cell pertussis, and within eight to 14 days of receiving a measles, mump and rubella vaccination. The risk of returning febrile seizures is increased in patients whose initial febrile seizure occurr at les than 12 month of age, patients with a lower rectal temperature at first seizure (les than 40[degrees]C [104[degrees]F]) patients with shorter duration of ferment before their first seizure (les than 24 hours), patients with a family history of febrile seizures, and patients with mixed features with the first febrile seizure. The risk of unfolding of epilepsy is slightly increased among somebodys having simple febrile seizures however is significantly increased among those who have united or more complex febrile seizures.

Initial evaluation of children with febrile seizure includes airway and circulatory support, ideally with noninvasive measures until the postictal state unravels Patients are best evaluated in the hospital setting. A thorough medical history that includes past seizures and other neurologic conditions, front to medications or toxins, allergies, or trauma may point to a specific seizure cause. Treatment with antipyretics is rarely necessary in the typical seizure case. Patients with seizures that last longer than five minutes should receive a benzodiazepine. After the seizure cessations the physician should conduct a mental status examination and a physical evaluation. Routine laboratory studies include simply a blood glucose test; an electrolyte standard may be appropriate if a metabolic abnormality is being considered. No further work-up is necessary, still lumbar puncture is indicated in patients with suspected meningitis.

A lumbar small hole should be considered in children younger than 18 month who have a febrile seizure with the following: (1) a history of irritability, decreased feeding, or lethargy; (2) an abnormal appearance or mental state upon initial observation after the postictal period; (3) any physical examination evidence of meningitis; (4) any mixed features; (5) any slow postictal clearing of mentation; or (6) pretreatment with antibiotics. Neuroimaging simply is appropriate in patients at risk of cerebral abscess, in those who have clinical evidence of increased intracranial press in patients who have evidence of trauma, or in patients who have status epilepticus or have had a tangled skein seizure. Children with simple febrile seizures can be cared for at domicile after providing parental education and making plans to succeed up with the family.

The authors finish that evaluation and management of simple febrile seizures can be managed in an outpatient pass setting and the child can be sent to one's home for further care (see accompanying table). Children with intricate web seizures might require hospitalization for evaluation. Routine prophylaxis using phenobarbital, valproic acid, oral diazepam, or antipyretics is controversial and not indicated.

Evaluation and Management of Simple Febrile Seizures

History and physical examination

life-current glucose testing

Supportive care

Treatment of any infectious causes

Reassurance and anticipatory guidance to parents

Warden CR et al. Evaluation and management of febrile seizures in the out-of-hospital and conjuncture department settings. Ann Emerg M February 2003;41:215-22

COPYRIGHT 2003 American Academy of Family Physicians

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