Febrile seizure
Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- febrile illness
- seizure
Other diagnostic factors
- normal postictal exam
Risk factors
- temperature elevation
- young age
- male sex
- family history of febrile seizures
- viral or bacterial infection outside the central nervous system
- vaccinations
- antenatal exposure to nicotine
- iron deficiency
- complications of pregnancy, labour, and delivery
Diagnostic investigations
1st investigations to order
- diagnosis is clinical
Investigations to consider
- lumbar puncture
- viral studies
- blood culture
- EEG
- brain MRI
- serum sodium
- FBC
- serum glucose
- iron studies
Treatment algorithm
febrile status epilepticus
first simple febrile seizure
first complex seizure
febrile illness with prior history of simple seizure or 1 complex seizure
history of 2 or more complex febrile seizures with ineffective diazepam treatment
Contributors
Authors
Leena Mewasingh, MBChB, MSc
Consultant Paediatric Neurologist
St Mary’s Hospital
Imperial College Healthcare NHS Trust
London
UK
Disclosures
LM has received funding from drug companies (e.g., Eisai) to attend medical conferences and been invited to an educational symposium (Novartis, LivaNova).
Frances Morrison, MBChB, DCH, MRCPCH
Paediatric Specialist Trainee
St Mary’s Hospital
Imperial College Healthcare NHS Trust
London
UK
Disclosures
FM declares that she has no competing interests.
Acknowledgements
Dr Leena Mewasingh and Dr Frances Morrison wish to gratefully acknowledge Dr John J. Millichap and Dr J. Gordon Millichap, previous contributors to this topic. JJM serves as an Associate Editor of Neurology and serves on the editorial board of Pediatric Neurology Briefs; volunteers on the medical advisory board of The Jack Pribaz Foundation (KCNQ2.org); received speaker honoraria from Invitae; received royalties for online monographs from Up-To-Date; served on the scientific advisory board for Mallinckrodt; is principal investigator for a clinical trial funded by UCB Pharma; and is the principal investigator for research grants from Citizens United for Research in Epilepsy and the Thrasher Research Fund. JJM is an author of a number of references cited in this topic. JGM is an author of a number of references cited in this topic.
Peer reviewers
Robert S. Rust, Jr., MA, MD
Professor
Department of Neurology
University of Virginia Health System
Charlottesville
VA
Disclosures
RSR declares that he has no competing interests.
Differentials
- Acute bacterial meningitis
- Viral meningitis
- Viral encephalitis
More DifferentialsGuidelines
- Fever in under 5s: assessment and initial management
- Summary of recommendations for the management of infantile seizures: task force report for the ILAE Commission of Pediatrics
More GuidelinesPatient leaflets
Febrile seizures
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