Febrile Convulsions.



The Benign Form of Febrile Convulsions Does Not Increase The Risk of Death , Cerebral Palsy Or Epilepsy. It Accounts For 85 % Of Cases. Seizures occur Between 6 Mo And 5y Of Age With A Peak At 18 Mo. of Age And A Positive Family History of (F.C.). Seizures, Usually Occurring During The Rising Phase of Fever, Are Single, Brief (<15 min), Generalized Tonico- Clonic or Tonic With A Brief Postictal Phase. They occur In A Child Who Is Neurologically Normal, And Who Usually Displays An Upper Respiratory Tract Infection .

The Dilemma About (F. C.) Resides In The Fact That There Is A Strong Correlation Between Prolonged (F.C.) And The Temporal Lobe Sclerosis That May Need Surgery .

Febrile Convulsions Should Not Be Preceded By Afebrile Seizures And Can Be The First Manifestation Of Fever. Just 13 % of Cases of (F.C.) occur After 24h of Fever .

The Risk of A Second (F. C.) Is 30 % And only 9 % of Cases of (F.C.) Will Display 3 or More Attacks .



The Risk Factors For (F. C.) Recurrence Are :

1. Age At onset <18 mo.
2. Low Temperature At The Time of The First Seizure.
3. History Of Febrile Or Afebrile Seizures In A First Degree Family Member.
4. Short Delay Between Onset of Fever And Seizure (<1 hr).
5. Frequent Febrile Episodes .

In ¾ of Cases of (F.C.), Recurrence occurs Within 1 Year Following The First Seizure And In 90% Within 2 Years .


Daily Prophylactic Treatment Is Indicated When The Following Risk Factors For Epilepsy Are Present :

1. Initial Febrile Seizure Before <12 Mo. Of Age.
2. Family History Of Epilepsy.
3. Abnormal Neurologic State.
4. Presentation With Complex Febrile Convulsion (Unilateral, Repeated Within 24 hrs, Longer Than 15Min , Associated With Motor Deficit ).
5. Complex Partial Seizure With Fever.
6. Complex (F.C.) With Severe Interictal EEG Abnormalities.
7. Febrile And Afebrile Seizures In The Same Child.

Lumbar Puncture For The Research of Meningitis That Can Occur Just In 0 - 7% of Cases of (F.C.) Is Indicated In:

1. All Infants < 6mo
2. Occurrence of Seizures At The Emergency Room
3. Prolonged Postictal Phase
4. Seizure Occurring 3 - 4 Days After The onset of Fever
5. Age < 12 Mo And > 24 mo
6. Physician Visit Within 48 Hrs Before The Convulsion
7. Anorexia.

The Main Differential Diagnosis Of (F.C.) Is (C.N.S.) Infection And A Special Attention Should Be Given For Herpetic Encephalitis Where Lp, EEG, And CT Scan Can Be Normal In The Beginning .

EEG Is Not Helpful In The Management Of Benign (F.C.). Brain Imaging Is Indicated In Recurrent Hemiclonic (F.C.) on The Same Side And In Prolonged Postictal Phase With Inability To Localize Pain Within 1 hour.

For Continuous Prophylactic Treatment ,Valproic Acid Is The Drug of Choice; But According To My Experience Some (F.C.) May Escape To This Drug. When Daily Continuous Treatment Is Not Indicated, Diazepam 1 mg/kg/day In 3 Doses During Days Of Fever And only For 3 Days , Can Be Another Option .


And Finally Some Pitfalls In Case Of (F.C.) Should Be Kept In Mind :

1. Convulsive Febrile Syncope
2. Febrile Delirium
3. Intense Febrile Shivering
4. Epileptic Encephalopathies
5. Metabolic Diseases
6. Rassmussen Encephalitis
7. Posterior Fossa Tumor.

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