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Homepage: EMNote.org ■ 🚩Membership: https://tinyurl.com/joinemnote 🚩ACLS Lecture: https://tinyurl.com/emnoteacls Febrile Seizures Febrile Seizures Definition of Febrile Seizures Seizure accompanied by fever greater than or equal to 100.4°F (38°C) No central nervous system infection Age Range Occurs in children aged 6–60 months Perception by Caregivers Often perceived as life-threatening Frequent reason for emergency department visits Epidemiology Incidence Rates 2%–5% in the U.S. and Western Europe 8%–10% in some Asian populations Peak Age Most common in the second year of life 90% occur by age 3 years Seasonality More frequent in winter months Recurrence Risk Single febrile seizure may recur Etiology Genetic Factors One-third to one-half have a family history Common Viral Infections Influenza, adenovirus, parainfluenza, herpesvirus-6 Bacterial Causes Otitis media is most common Vaccines Measles, DTP, PCV 13, influenza vaccines may trigger febrile seizures Fever Height Risk doubles with each degree above 101°F Clinical Manifestations Timing Occurs within 24 hours of illness onset 25%–50% present as the first sign of fever Duration Average: 4–7 minutes 10%–15% last greater than 10 minutes Signs and Symptoms High fever (average 39.4°C) Loss of consciousness, irregular breathing, pallor/cyanosis Foaming at mouth, eyes rolling back, twitching/jerking Postictal Period Drowsiness, fussiness, confusion lasting up to 30 minutes Postictal palsy (Todd’s paralysis) may occur Classifications Simple Febrile Seizures Generalized, no focal features Last less than 15 minutes Do not recur within 24 hours 70% of cases Complex Febrile Seizures Focal features, last greater than 15 minutes Recur within 24 hours Occur in children with neurologic abnormalities 25% of cases Febrile Status Epilepticus Lasts greater than 30 minutes Brief serial seizures without regaining consciousness 5% of cases Evaluation Initial Steps History and physical examination to determine fever cause Key details: seizure description, duration, recent illnesses/vaccinations Physical Exam Look for signs of meningitis Assess finger stick glucose level Neuroimaging Not routine for simple febrile seizures Consider MRI after febrile status epilepticus Lumbar Puncture Indicated if meningitis suspected Recommended for children with incomplete immunization or febrile status epilepticus Management Spontaneous Resolution Most resolve before reaching the ED Ongoing Seizures Treat if tonic-clonic seizures last greater than 5 minutes First-line: Lorazepam (0.1 mg/kg) or diazepam (0.2 mg/kg) Alternatives: Midazolam or rectal diazepam Second-Line Medications Levetiracetam, fosphenytoin, valproate, phenobarbital Repeat Doses Benzodiazepines can be repeated after 5 minutes Prevention Medications Phenobarbital and intermittent diazepam reduce recurrence but have adverse effects in 30% AAP advises against routine prophylactic antiseizure drugs Antipyretics Improve comfort but do not prevent recurrence Prophylactic use not supported by studies Prognosis Neurologic Sequelae No clear association with long-term neurologic or cognitive defects Recurrence Risk One-third of children will have another episode Higher risk: Age less than 1 year, low-grade fever, family history Epilepsy Risk 1%–2% after simple febrile seizures 6%–8% after complex febrile seizures Risk factors: Complex seizure, neurodevelopmental abnormalities, family history Indications for Admission Discharge Criteria Safe after 2–4 hours of observation if child returns to baseline Hospitalization for parental reassurance not beneficial Admission Required All children undergoing lumbar puncture in the ED Future Considerations Emerging Research Role of cytokines, iron deficiency anemia, vitamin D deficiency Biomarkers for distinguishing febrile seizures from non-ictal events Impact of Vaccines Vaccines against Haemophilus influenzae type B and Streptococcus pneumoniae have reduced evaluation needs Key Takeaways Febrile seizures are the most common seizure type in preschool-age children Understanding classification guides management and prognosis Vaccines have significantly altered evaluation protocols