Febrile Seizures

Febrile seizures are diagnosed in children <6 years of age with a body temperature of> 38 ° C and no previous afebrile seizures when no cause can be identified and no underlying developmental or neurological problem. The diagnosis is made clinically by the exclusion of other causes. The treatment of a seizure <15 min is symptomatic. Seizures that last longer ? 15 min, i.v. with lorazepam, diazepam rectal or intranasal midazolam and, if persistent, i.v. with fosphenytoin, phenobarbital treated, or Valproate Levetiracetam. A permanent medical treatment is not usually necessary.

The fever attacks occur in about 2-5% of children from <6 years, most aged 6-36 months. Febrile seizures can be simple or complex:

Febrile seizures are diagnosed in children <6 years of age with a body temperature of> 38 ° C and no previous afebrile seizures when no cause can be identified and no underlying developmental or neurological problem. The diagnosis is made clinically by the exclusion of other causes. The treatment of a seizure <15 min is symptomatic. Seizures that last longer ? 15 min, i.v. with lorazepam, diazepam rectal or intranasal midazolam and, if persistent, i.v. with fosphenytoin, phenobarbital treated, or Valproate Levetiracetam. A permanent medical treatment is not usually necessary. The fever attacks occur in about 2-5% of children from <6 years, most aged 6-36 months. Febrile seizures can be simple or complex: Simple febrile seizures last <15 minutes and have no focal symptoms. Complex febrile seizures last for ? 15 min, either continuously or with breaks, have focal symptoms or relapse within 24 hours. In most cases, there are simple febrile seizures (> 90%). Febrile seizures occur in bacterial or viral diseases. They can also occur after some vaccines such as measles, mumps and rubella. There are genetic and familial factors that appear to increase susceptibility to febrile seizures. Monozygotic twins have a much higher concordance rate than dizygotic twins. Several genes that are associated with febrile seizures have been identified. Symptoms and complaints Often a febrile seizure occurs in the initial phase of a rapid increase in body temperature and most orders ship within 24 hours after fever onset. The seizures are typically generalized and mostly clonic; but some also show a atonic or tonic attitude. A postictal period of a few minutes is common, but can last for up to a few hours. If the postictal period lasts longer than an hour or if the children during this phase focal symptoms (eg. As decreased movement on one side), it is important to check directly to an underlying acute CNS disorder. Febrile status epilepticus are continuous or intermittent spasms that last ? 20 min without appearing between them neurological recovery. (Clinical or sometimes by testing) The seizures are diagnosed diagnostic exclusion of other causes as fevers after exclusion of other causes. A fever can trigger seizures in children who had afebrile seizures before. These seizures are not designated as febrile seizures, as these children have already shown a tendency to seizures. A routine testing, apart from the search for the cause of the fever is not required for simple febrile seizures, but if the children have complex seizures, neurologic deficits or signs of a serious underlying disease (eg. As meningitis, metabolic disorders), tests should be performed , Tests to rule out other disorders are clinically determined: CSF analysis to have meningitis and Enzephalitisauszuschließen when children are <6 months old and have meningeal signs or symptoms of CNS depression or seizures after several days of febrile illness; and possibly cerebrospinal fluid when the children are not fully immunized or take antibiotics serum glucose, Sodium, -Kalzium, -magnesium, phosphate and liver and kidney function in order to prevent metabolic disorders when, diarrhea or impair a history of vomiting hydration occur or are found signs of dehydration or edema when complex febrile seizures are present. MRI of the brain when the neurological examination is focal abnormalities or when focal symptoms during the seizure or postictal occur EEG when the febrile seizures have focal symptoms or relapse A diagnostic evaluation based on the underlying condition, when the children an already identified development or neurological disorder have (usually the term febrile seizure in such cases not used) the EEG usually shows no specific abnormalities still helps it to predict seizures. In children with a normal neurological examination, it is not recommended right after the first attack of fever. Prognosis recurrence and later epilepsy The general repetition rate of febrile seizures is 35%. The risk of recurrence increases when the children are <1 year old at the occurrence of the first febrile seizure or if they have first-degree relatives with febrile seizures. to develop a afebriles seizures after ? 1 simple febrile seizures The risk is about 2 to 5%, which is slightly higher than the baseline risk of developing epilepsy (about 2%). Most of the increased risks occur in children who have additional risk factors (eg. As complex febrile seizures, family members with seizures, developmental delay). These Kinderns the risk is increased up to 10%. It is not clear whether the occurrence of febrile seizure itself can lower the seizure threshold permanently or whether some underlying factors children both febrile and afebrile seizures prädisponieren.Neurologische consequences It is not believed that simple febrile seizures themselves cause neurological abnormalities. Some children with an undiagnosed neurological disorder, however, a febrile seizure may be the first manifestation may; Signs of the disorder can be identified may subsequently occur or later. In both cases, it is not assumed that the febrile seizure is causal. Prolonged febrile status epilepticus can with damage to sensitive parts of the brain such as the hippocampus, may be connected. Treating fever-lowering therapy Supportive therapy if seizures <15 min continue antiepileptic drugs and sometimes intubation if seizures ? 15 min persist All children need an antipyretic therapy; lowering the temperature can help to prevent further febrile seizure during the immediate disease and makes it easier to stop febrile status epilepticus. Treatment is symptomatic when the seizures <15 min persist. When seizures that last for ? 15 min, possibly drugs must be given to interrupt them. Circulation and respiration should thereby be observed. Intubation is necessary if the child does not respond and persist the seizures. The drugs are usually administered i.v. administered. Using short-acting benzodiazepines (z. B. lorazepam 0.05-0.1 mg / kg i.v. every 5 min up to 3 times). Fosphenytoin 15-20 mg PE (phenytoin equivalent) / kg IV over 15 to 30 minutes can be given if an attack in progress. Diazepam 10 mg may rectiole until the age of 6 years once given in children and after 20 minutes to be repeated if not lorazepam iv may be administered. Phenobarbital, valproate or levetiracetam may also be used to treat a sustained attack. Prevention The parents of a child who has had a febrile seizure should be instructed to monitor the temperature of their child during diseases carefully and to administer antipyretics, when the temperature is increased (even if controlled studies have not shown that Tthis treatment recurrence febrile seizures prevented). A maintenance medication with anticonvulsant drugs for the prevention of febrile convulsions or developing afebrile seizures is not indicated unless there are multiple and prolonged episodes ago. Some doctors prescribe from a prolonged febrile seizure at home rectal diazepam, which is given by the parents. Important points Febrile seizures are seizures that <6 years with a body temperature of> occur in neurologically normal children 38 ° C and without previous afebrile seizures, and who have no identifiable cause. Simple febrile seizures last <15 minutes and have no focal symptoms. Complex febrile seizures last for> 15 min, either continuously or with breaks, have focal symptoms or relapse within 24 hours. Routine testing is not required, but if the children complex seizures, neurologic deficits or signs of serious underlying disease (eg. As meningitis, metabolic disorders) have, tests should be performed. Attacks which last for ?15 min, require drug treatment (eg. B. Lorazepam 0.05 to 0.1 mg / kg i.v. over 2 to 5 minutes repeated every 5 to 10 minutes for up to 3 doses). to develop a afebriles epilepsy after a simple febrile seizure is a risk, is about 2 to 5%. The gift of a Antipyreticums beginning of a febrile illness has not been shown to be successful, to prevent a febrile seizure.

Health Life Media Team

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