Febrile Convulsions

Febrile convulsions can be defined as fever associated with convulsion in children aged 6months to 5years after excluding intracranial and metabolic causes.

Etiology

Disease conditions that lead to convulsions are:

• Uncomplicated malaria
• Otitis media
• Urinary tract infections
• Acute gastroenteritis
• Typhoid fever
• Pneumonia
• Pharyngotonsillitis
• Pharyngitis
• Other upper and lower respiratory tract infections.

Types

There are two types of febrile convulsions: simple and complex

Simple febrile convulsions

• It is characterized by generalized tonic-clonic convulsions
• The duration of convulsion is 15secs or less
• The frequency of one episode of convulsion in a 24hours period
• There is usually no family history
• Neurological sequel is also absent.

Complex febrile convulsions

• It is characterized by focal seizures
• The duration of each convulsion is greater than 15secs
• The frequency of more than one episode in 24 hours
• There is a positive family history of febrile convulsion
• Neurological sequel is present and the EEG finds are abnormal.

Management

This involves a good history, investigations and treatment.

History: a good history should be taken to

• Know the onset of the fever, character of the fever and grade
• rule out the cause of the fever
• ask for family history of febrile convulsion
• know the interventions given; cow urine, pouring of salt into the mouth, mother urinating in the child’s mouth, forceful spoon insertion into the mouth.

Investigations

• Lumbar puncture: for cerebrospinal fluid M/C/S infections in the CNS
• Electrolytes, urea and creatinine: to rule out metabolic causes
• Random blood glucose: to rule out metabolic causes
• Full blood count (FBC)
• Urinalysis
• Urine M/C/S : to rule out urinary tract infection.
• Chest Xray : to rule out pneumonia.
• Blood film for malaria parasite.

Treatment

The principles of treatment are;

1. Control fever
2. Non-pharmacological methods are: tepid sponging with lukewarm water, expose the child, cold saline lavage
3. Pharmacological : administer paracetamol, ibuprofen
4. Abort seizures: using I.M paraldehyde (1ml/year of life, max. 5ml) , or rectal or IV diazepam( 0.3- 0.5mg/kg)
5. Treat underlying cause: give antibiotics for infections, Anti-malarial for malaria
6. Counselling: counsel the mother against harmful intervention during convulsions. Tell her to place the child on left lateral position during convulsions and clear surrounding of harmful substances. Tell her that if the child has a fever she should administer rectal diazepam or paracetamol and bring the child immediately to the hospital.

Risk factors for recurrent febrile convulsion

1. Fever of 38-39⁰C
2. Age >1year
3. Fever < 24hours
4. Family history of febrile convulsion
5. 30% chance of recurrence after first episode
6. 50% chance of recurrence after 2 or more episodes.

Risk factors for developing epilepsy later on.

1. Presence of an underlying neurodevelopmental disorder.
2. Complex febrile convulsions
3. Family history of epilepsy.