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Smile…It’s Monday!

Smile…It’s Monday!. AM Report Monday, July 11, 2011. Febrile Seizures. Definition and Epidemology. Seizure accompanied by fever >/= 100.4 without central nervous system infection

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Smile…It’s Monday!

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  1. Smile…It’s Monday! AM Report Monday, July 11, 2011

  2. Febrile Seizures

  3. Definition and Epidemology • Seizure accompanied by fever >/= 100.4 without central nervous system infection • Does not pertain to children with previous neurologic insults, known CNS abnormalities, or h/o afebrile seizures • Affects 2-5% of infants and children aged 6 to 60 mos (5yrs)

  4. Classification • Simple Febrile Seizure • Primary generalized seizure (no focal component) • Lasts less than 15 min • Does not recur within 24 hours • Complex Febrile Seizure • Seizure with focal component(s) • Prolonged (>15min) • Recurrent within 24 hours

  5. Simple Febrile Seizures Neurodiagnostic Evaluation Long-term Management

  6. Love Those Clinical Practice Guidelines!! • Febrile Seizures: Guideline for the Neurodiagnostic Evaluation of the Child with Simple Febrile Seizure (February 2011-update to the 1996 CPG) • Febrile Seizures: Clinical Practice Guideline for the Long-term Management of a Child with Simple Febrile Seizures (June 2008-update to the 1999 CPG)

  7. What do you want to do to evaluate a simple febrile seizure? • LP? • EEG? • Labs • Which ones? • Neuroimaging • CT or MRI?

  8. Neurodiagnostic Evaluation • Action Statement 1a • A LP should be performed in any child who presents with a seizure and fever and has meningeal signs and symptoms (eg, neck stiffness, Kernig and/or Brudzinski signs) or in any child whose history or examination suggests the presence of meningitis or intracranial infection (Strong Recommendation) • In ~25% of children with meningitis, seizure is the presenting sign of disease • 30-35% of those children (primarily younger than 18 mos) lacked any meningeal signs

  9. Neurodiagnostic Evaluation • Action Statement 1b • In any infant between 6 and 12 months of age who presents with seizure and fever, a LP is an option when the child is considered deficient in Haemophilusinfluenzaetype b (Hib) or Streptococcus pneumoniae immunizations (ie, has not received the immunizations as recommended) or when immunization status cannot be determined, due to an increased risk of bacterial meningitis (Opinion) • Action Statement 1c • A LP is an option in a child who presents with seizure and fever and is pretreated with antibiotics, because antibiotic treatment can mask the signs and symptoms of meningitis (Opinion)

  10. Neurodiagnositic Evaluation • Action Statement 2 • An electroencephaolgram (EEG) should not be performed in the evaluation of a neurologically healthy child with simple febrile seizure (Strong recommendation) • Action Statement 3 • The following tests should not be performed routinely for the sole purpose of identifying the cause of a simple febrile seizure: measurement of serum electrolytes, calcium, phosphorous, magnesium, or blood glucose or complete blood count (Strong Recommendation)

  11. Neurodiagnostic Evaluation • Action Statement 4 • Neuroimaging should not be performed in the routine evaluation of a child with simple febrile seizure (Strong recommendation)

  12. Long Term Management • Four adverse outcomes that theoretically may be altered by an effective therapeutic agent • Decline in IQ • Increased risk of epilepsy • Risk of recurrent febrile seizures • Death

  13. Long Term Management • Decline in IQ • No studies have shown that simple febrile seizures have caused an increased incidence of • Decline in IQ, academic performance, or neurocognitive attention • Behavioral abnormalities • Increased risk of epilepsy • Risk of developing epilepsy is only slightly higher than that of the general population (by age 7, it is the same) • Exceptions • Children with multiple simple febrile seizures • FHx of epilepsy • Pts <12mos at the time of the first febrile seizure

  14. Long Term Management • Increased risk of epilepsy • No study has demonstrated that successful treatment of simple febrile seizures can prevent later development of epilepsy • Risk of recurrent febrile seizures • High rate of recurrence, varies with age • <12 mos at first event: 50% • >12 mos at first event: 30% • Of those that have a second SFS, 50% will go on to have a third • Death • Never has been reported

  15. Long Tern Management • Recommendation • On the basis of risks and benefits of the effective therapies, neither continuous or intermittent anticonvulsant therapy is recommended for children with 1 or more febrile seizures (Recommendation) • Antipyretics are ineffective in preventing febrile-seizure recurrence

  16. Complex Febrile Seizures A Brief word…

  17. No Clinical Practice Guidelines • LP should be considered for febrile status epilepticus • Urgent CT in patients with abnormally large heads, persistently abnormal neurologic exam (particularly with focal features) or signs and symptoms of increased ICP • EEG more likely to be abnormal when convulsions are of long duration or have focal features • Cannot predict the likelihood of recurrent febrile seizures or the development of afebrile seizures

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