Summary
Definition
History and exam
Key diagnostic 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
- prenatal exposure to nicotine
- iron deficiency
- complications of pregnancy, labor, and delivery
Diagnostic tests
1st tests to order
- diagnosis is clinical
Tests to avoid
- head CT
Tests to consider
- lumbar puncture
- viral studies
- blood culture
- EEG
- brain MRI
- serum sodium
- CBC
- capillary blood glucose
- 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
Damian Roland, BMedSci, MBBS, FRCPCH, PhD
Honorary Professor and Consultant in Paediatric Emergency Medicine
Paediatric Emergency Medicine Leicester Academic (PEMLA) Group
Children’s Emergency Department
Leicester Royal Infirmary
Leicester
UK
Disclosures
DR declares that he is a previous member of the National Institute for Health and Care Excellence Feverish Illness in Children Guideline Group.
Acknowledgements
Prof Damian Roland would like to gratefully acknowledge Dr Leena Mewasingh, Dr Frances Morrison, Dr John J. Millichap and Dr J. Gordon Millichap, previous contributors to this topic. LM has received funding from drug companies (e.g., Eisai) to attend medical conferences and been invited to an educational symposium (Novartis, LivaNova). FM declares that she has no competing interests. 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
- ACR appropriateness criteria: seizures - child
- Summary of recommendations for the management of infantile seizures: task force report for the ILAE Commission of Pediatrics
More GuidelinesPatient information
Febrile seizures
More Patient informationVideos
Diagnostic lumbar puncture in adults: animated demonstration
Venepuncture and phlebotomy: animated demonstration
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