Febrile Convulsions and Their Management
Febrile convulsion may be defined as a brief generalized convulsion occurring during fever in children in the age groups between 6 months and 5 years without pre-existing or concurrent neurological abnormalities.
About 70% of febrile convulsions occur in the age group 6 months to 18 months.
The convulsions usually last for a few seconds, but may extend up to 15 minutes.
At least 5% of children have one febrile fit before the age of 5 years.
A strong family history of febrile fits is evident in many cases.
The fits occur when the rectal temperature rises above 39 degrees.
Generally, the temperature drops after the fits.
A child who gets a febrile convulsion runs the risk of recurrence during future febrile episodes but the risk progressively diminished with age.
About 4-20% cases may develop afebrile convulsions also.
Though the risk of developing epilepsy in such children is still low (about 2%), however, higher than in the general population.
The risk of developing epilepsy is increased in the following groups.
1.
The first febrile convulsion is complicated, i.
e, prolonged and lateralized seizures or multiple seizures in 24 hours.
2.
Presence of neurological abnormalities before the onset of convulsions.
3.
Positive family history of febrile convulsions.
In general, the intellectual performance of children who had febrile convulsions does not differ from normals, but prolonged convulsions can lead to brain edema.
Medial temporal sclerosis has been described as a sequel.
Management An acute attack can be controlled by diazepam in a dose of 0.
08-0.
3 mg/Kg body weight given parenterally.
The temperature should be brought down by the administration of aspirin in a dose of 30 mg/Kg body weight and tepid sponging.
Further convulsion can be prevented by the administration of phenobarbitone in a dose of 15 mg/Kg, given intramuscularly or orally 30 mg/6 hours.
In children below the age of 18 months, since a febrile convulsion may be the presenting feature of meningitis lumbar puncture is indicated, so also in children showing complex or laterised seizures.
Prophylactic administration of oral phenobarbitone or diazepam at the onset of fever is useful in preventing recurrence.
Prolonged phenobarbitone prophylaxis is indicated for children who show: 1.
Complicated and prolonged convulsions or focal seizures 2.
Frequent recurrence.
3.
Abnormal birth history or neuro-developmental abnormalities.
4.
Onset before 6 months or after 4 years of age.
5.
Presence of inter-ictal EEG abnormality.
About 70% of febrile convulsions occur in the age group 6 months to 18 months.
The convulsions usually last for a few seconds, but may extend up to 15 minutes.
At least 5% of children have one febrile fit before the age of 5 years.
A strong family history of febrile fits is evident in many cases.
The fits occur when the rectal temperature rises above 39 degrees.
Generally, the temperature drops after the fits.
A child who gets a febrile convulsion runs the risk of recurrence during future febrile episodes but the risk progressively diminished with age.
About 4-20% cases may develop afebrile convulsions also.
Though the risk of developing epilepsy in such children is still low (about 2%), however, higher than in the general population.
The risk of developing epilepsy is increased in the following groups.
1.
The first febrile convulsion is complicated, i.
e, prolonged and lateralized seizures or multiple seizures in 24 hours.
2.
Presence of neurological abnormalities before the onset of convulsions.
3.
Positive family history of febrile convulsions.
In general, the intellectual performance of children who had febrile convulsions does not differ from normals, but prolonged convulsions can lead to brain edema.
Medial temporal sclerosis has been described as a sequel.
Management An acute attack can be controlled by diazepam in a dose of 0.
08-0.
3 mg/Kg body weight given parenterally.
The temperature should be brought down by the administration of aspirin in a dose of 30 mg/Kg body weight and tepid sponging.
Further convulsion can be prevented by the administration of phenobarbitone in a dose of 15 mg/Kg, given intramuscularly or orally 30 mg/6 hours.
In children below the age of 18 months, since a febrile convulsion may be the presenting feature of meningitis lumbar puncture is indicated, so also in children showing complex or laterised seizures.
Prophylactic administration of oral phenobarbitone or diazepam at the onset of fever is useful in preventing recurrence.
Prolonged phenobarbitone prophylaxis is indicated for children who show: 1.
Complicated and prolonged convulsions or focal seizures 2.
Frequent recurrence.
3.
Abnormal birth history or neuro-developmental abnormalities.
4.
Onset before 6 months or after 4 years of age.
5.
Presence of inter-ictal EEG abnormality.
