febrile seizure 04.25.2011
TRANSCRIPT
-
8/7/2019 Febrile Seizure 04.25.2011
1/7
Febrile Seizure
By Hillary Crandall
April 25, 2011
-
8/7/2019 Febrile Seizure 04.25.2011
2/7
Febrile Seizure
Children aged 6 to 60 months Simple (All)
15 minutes, >1 seizure or >24 hours after fever
Focal
Beginning on one side, eye deviation, loss of muscle tone
Postictal
-
8/7/2019 Febrile Seizure 04.25.2011
3/7
Evaluation of Simple Febrile Seizure
EEG: NO Neuroimaging: NO
Labs: NO
electrolytes, calcium, phosphorus, magnesium,
glucose, CBC Lumbar puncture: NO except
Clinical symptoms of meningitis
Unvaccinated and 6-12 months Prevalence of acute bacterial meningitis - 2.4%
Simple - 0.86%
Complex - 4.81%
Pretreated with antibiotics
-
8/7/2019 Febrile Seizure 04.25.2011
4/7
Evaluation of Complex Febrile Seizure
EEG: NO Labs: ?
No data, no recommendations
Neuroimaging: Maybe
Otherwise well : probably not
6 studies, 200 patients, no NS interventions
Ill-appearing : YES
-
8/7/2019 Febrile Seizure 04.25.2011
5/7
Evaluation of Complex Febrile Seizure Lumbar puncture: Maybe
526 patients with CFS 64% underwent lumbar puncture
0.9% acute bacterial meningitis
1 non-responsive, 1 bulging fontanel/apnea, 1 failed LP/bacteremia
390 patients with CFS (19% referred) 37% underwent LP
1.5% acute bacterial meningitis
6 altered mental status
0.3% HSV meningitis
1 altered mental status
YES: clinical symptoms of meningitis/altered mental status
unvaccinated pretreated with antibiotics
Harriet Lane says: strongly recommend
-
8/7/2019 Febrile Seizure 04.25.2011
6/7
Clinical Features of Meningitis(Likelihood Ratios)
Petechiae - 37x Bulging Fontanel - 8x
Neck Stiffness - 7.7x
Toxic 5.8x
Kernig 3.5x
Fever (>40 C) 2.9x
Brudzinski 2.5x
Decreased feeding 2x
Seizure Complex 2x
Multiple 1.5x
Other 1.4x
Abnormal cry 1.8x Lethargy 1.9x
Comatose 1.8x
Irritability 1.3x
-
8/7/2019 Febrile Seizure 04.25.2011
7/7
References
1. Neurodiagnostic evaluation of the child with a simple febrile seizure. Pediatrics. 2011Feb;127(2):389-94.
2. Batra P et al. Predictors of meningitis in children presenting with first febrile seizures.Pediatr Neurol. 2011 Jan;44(1):35-9.
3. Teng D, Dayan P, Tyler S, et al. Risk of intracranial pathologic conditions requiring
emergency intervention after a first complex febrile seizure episode among children.Pediatrics. 2006;117:304308
4.Seltz LB, Cohen E, Weinstein M. Risk of bacterial or herpes simplex virusmeningitis/encephalitis in children with complex febrile seizures. Pediatr Emerg Care.2009 Aug;25(8):494-7.
5. Kimia et al. Yield of lumbar puncture among children who present with their first
complex febrile seizure. Pediatrics. 2010 Jul;126(1):62-96.Kimia et al. Utility of lumbar puncture for first simple febrile seizure among children 6 to
18 months of age. Pediatrics. 2009 Jan;123(1):6-12.
7. Curtis et al. Clinical features suggestive of meningitis in children: a systematic review ofprospective data. Pediatrics.