Chapter 2 Index

A. Evaluation by system:

1. General

2. HEENT

3. Cardiopulmonary

4. GI

5. GU

6. Orthopedics

7. Neurological
--Breath-Holding Spells

Benign Febrile Seizures

Definition: A benign condition characterized by a tonic-clonic or tonic seizure occurring in a 6-month-old to 5-year-old that lasts less than 20 minutes and is not accompanied by a postictal state. (PREP article Jan 97: may have a postictal state)  Children are neurologically normal with no evidence of focal seizure.

Prognosis: Febrile seizures can recur, but usually disappear by 3-4 years of age. No significant increase in epilepsy unless child has risk factors present.

Risk of Recurrent Febrile Seizures (Arch Ped Ad Med:97;151:371).  31.8% recur with 17% one recurrence, 9% two recurrences; 6% 3 or more.  Risk factors recurrence: Increased if:

1. young age at onset;
2. first degree relative with febrile seizures;
3. low degree of fever when in ER; brief duration between onset of fever and initial seizure. Early Rx with Ibuprofen doesn’t help prevent febrile seizures.

Risk Factors for Later Development of Epilepsy:

1. Positive Family History for Epilepsy
2. Seizure is focal - not generalized
3. Child is less than 6 months old at time of first seizure
4. Seizure lasts more than 20 minutes
5. Child’s neurological examination is abnormal
6. Repeat seizure occurs with same illness

Differential Diagnosis: Seizure with fever: associated with underlying neurological abnormalities

How to Approach the Treatment of the Child With Recurrent Febrile Seizures With No Risk Factors:

1. Reassure parents that there are no problems from recurrent seizures: no brain damage, no increased epilepsy risk, etc.

2. Take careful history of family, past medical history, and history of actual event – i.e. generalized, how long lasted, and postictal state.  If history and physical are normal fits the category of benign febrile seizure.

3. Urge parents to give Ibuprofen in future - more effective than acetaminophen in preventing febrile seizure (Arch Pediatr Adol Med 149:632-637;1995)

4. Urge parents:

• DO NOT put things down child s mouth to open the mouth.
• DO NOT give mouth to mouth resuscitation; the color of the child is due to the seizure, not to cardiac or respiratory arrest.

5. Do not need to order EEG: Don't know what to do with the information once you get it.

6. No need for referral to neurologist.

How to Approach the Treatment of the Child With Recurrent Seizures, Fever, and Risk Factors:

1. Must inform parents that this is not the same thing as seizures with no risk factors:

• If one risk factor present: 6-8% later epilepsy
• If two risk factors present: 17-22% later epilepsy
• If 3 risk factors present: 49% later epilepsy               

2. Workup will need to be complete: EEG, CT or MRI, possible neurology consult.

3. Depending on nature of seizure and workup, anticonvulsant medications may be indicated.

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Department of Pediatrics  |  Medical College of Georgia
Please email comments, suggestions or questions to:
John T.  Benjamin M.D.,  jbenj@mcg.edu

February 27, 2004