Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ Key Features +++ Essentials of Diagnosis ++ Criteria for febrile seizures Age 3 months to 6 years (most occur between ages 6 and 18 months) Fever > 38.8°C Non–central nervous system (CNS) infection More than 90% of febrile seizures are generalized, last less than 5 minutes, and occur early in the illness causing the fever +++ General Considerations ++ Occur in 2–3% of children Rarely (1–3%) evolve to recurrent unprovoked seizures (epilepsy) in later childhood and adult life If the following complex features are present, the chance of epilepsy developing later is higher Duration longer than 15 minutes More than one seizure in the same day Focal features Other predictive factors Abnormal neurologic status preceding the seizures (eg, cerebral palsy or mental retardation) Early onset of febrile seizure (before age 1 year) Family history of epilepsy Recurrent febrile seizures occur in 30–50% of cases +++ Clinical Findings ++ Acute respiratory illnesses are most commonly associated with febrile seizures Gastroenteritis, especially when caused by Shigella or Campylobacter, and urinary tract infections are less common causes Roseola infantum is a rare but classic cause One study implicated viral causes in 86% of cases HHV-6 and HHV-7 are common causes for febrile status epilepticus, both accounting for one-third of cases Meningitis and encephalitis must be considered Signs of meningitis (eg, bulging fontanelle, stiff neck, stupor, and irritability) may be absent, especially in a child younger than age 18 months +++ Diagnosis +++ Laboratory Findings and Imaging ++ Routine studies such as serum electrolytes, glucose, calcium, skull radiographs, or brain imaging studies are seldom helpful unless warranted based on clinical history A white blood cell count above 20,000/μL or an extreme left shift may correlate with bacteremia Complete blood cell count and blood cultures may be appropriate Serum sodium is often slightly low but not low enough to require treatment or to cause the seizure +++ Diagnostic Procedures ++ Lumbar puncture Although the yield is low, should be considered if the child is younger than age 18 months, and has been pretreated with antibiotics or is underimmunized Any child with meningeal signs, fever, and seizure should undergo cerebrospinal fluid examination EEG Rarely useful May be considered if the febrile seizure is complicated, focal, or otherwise unusual +++ Treatment ++ Measures to control fever such as sponging or tepid baths, antipyretics, and the administration of antibiotics for proven bacterial illness are reasonable but unproven to prevent recurrent febrile seizures Diazepam,0.5 mg/kg two or three times per day orally or rectally Started at the first onset of fever for the duration of the febrile illness may be effective However, will sedate a child and possibly complicate the evaluation for a source of the fever +++ Outcome +... Your Access profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth