Association of Child Neurology (AOCN) Consensus Statement on the Diagnosis and Management of Febrile Seizures

Justification: Febrile seizures are quite common in children but there are controversies in many aspects of their diagnosis and management. Methods: An expert group consisting of pediatric neurologists and pediatricians was constituted. The modified Delphi method was used to develop consensus on the issues of definitions and investigations. The writing group members reviewed the literature and identified the contentious issues under these subheadings. The questions were framed, pruned, and discussed among the writing group members. The final questions were circulated to all experts during the first round of Delphi consensus. The results of the first round were considered to have arrived at a consensus if more than 75% experts agreed. Contentious issues that reached a 50- 75% agreement was discussed further in online meetings and subsequently voting was done over an online platform to arrive at a consensus. Three rounds of Delphi were conducted to arrive at final statements. Results: The expert group arrived at a consensus on 52 statements. These statements pertain to definitions of febrile seizures, role of blood investigations, urine investigations, neuroimaging, electroencephalography (EEG), cerebrospinal fluid analysis and screening for micronutrient deficiency. In addition, role of rescue medications, intermittent anti-seizure medication and continuous prophylaxis, antipyretic medication and micronutrient supplementation have been covered. Conclusion: This consensus statement addresses various contentious issues pertaining to the diagnosis and management of febrile seizures. Adoption of these statements in office practice will improve and standardize the care of children with this disorder.

Clinical, epidemiological and laboratory characteristics of children with febrile seizures

Background: Febrile seizure is the most common type of seizure disorder that occurs in children aged 6-60 months. Recurrences are common. This study was conducted to evaluate the epidemiology, clinical profile and laboratory parameters of children presenting with febrile seizure in a teaching hospital.Methods: This was a descriptive retrospective study among children presenting with febrile seizure admitted to KIMS, Bengaluru from March (2018-2019). Children between six months to five years were included in the study while patients with prior episodes of afebrile seizures, abnormal neurodevelopment and not meeting the age criteria were excluded. Patient’s demographic and clinical data were collected from the in-patient records and analysed.Results: Among 60 children with febrile seizures were enrolled in our study with highest prevalence in males (58%) and amongst 13-24 months age group (37%). Majority (20%) presented in the monsoon season (June) and in the morning hours (43%). Simple febrile seizures and complex febrile seizures were observed in 60% and 40% respectively. Majority (73%) who developed first episode of seizure were below 24 months ago with mean age of 18.71±11.50 months. 42% had recurrence and was significantly associated with first episode of febrile seizures at age ≤1 year and family history of seizures. Upper respiratory tract infections were the commonest cause of fever. Anaemia and leucocytosis were seen in 72% and 70% cases respectively.Conclusions: Febrile seizure was observed predominantly in children below two years, simple febrile seizure being the commonest. Recurrence was common and significantly associated with the first episode of febrile seizure at the age one year or below and family history. Majority had anaemia which showed that iron deficiency anaemia could be a risk factor. Leucocytosis was present in most which could be either due to underlying infection or due to the stress of seizure itself.

Clinical profile of children with febrile seizure in a peripheral teaching hospital

Background: Febrile seizure is a common problem in children below 5years of age. This study was conducted to evaluate the clinical profile of children presenting with febrile seizures and to identify the risk factors for recurrence of febrile seizures in these children in a teaching hospital.Methods: A matched case-control study was conducted over a year period from November 2017 to November 2018 in the Department of Pediatrics. One hundred patients with febrile seizures admitted, aged 6-60 months were matched with another one hundred children having fever but without seizure with the same age range, attending the same hospital during the same period. Patients with prior episodes of afebrile seizures, abnormal neurodevelopment, on anticonvulsants and not meeting the age criteria were excluded.Results: The mean age and standard deviation for cases were 25.8'15.19 months and for control was 29.9'18.5 months. Out of which 64% had a febrile seizure for the first time and 36% had recurrent febrile seizures and 64% were males. Simple febrile seizure and complex febrile seizure were observed in 76.7% and 23.3% of patients respectively. The majority of children (71.8%) had a generalized tonic-clonic seizure followed by tonic seizures. Upper respiratory tract infections were the commonest cause of fever in these children. Low temperature at the onset of Febrile Seizure (p=0.001), short duration of fever before the onset of Febrile Seizure (0.026) and atypical Febrile Seizure (p=0.022) were the risk factors for a recurrent febrile seizure.Conclusions: Febrile Seizure is a common pediatric problem seen in males, observed predominantly in children below the age of two years and simple febrile seizure was the commonest variety. Almost one-third of children with Febrile Seizure are at risk for recurrence at a later date. The risk factors for these recurrences are modest rise in body temperature at the onset of febrile seizure, the onset of seizure within 12 hours of fever and atypical presentation.

Clinical characteristics of febrile seizures and risk factors of its recurrence in Chiang Mai University Hospital

Background & Objectives: Febrile seizures are the most common convulsive disorder in children under 5 years old. Among these children, some develop recurrent febrile seizures. The objective of this study was to describe clinical characteristics of children with febrile seizures and to identify risk factors for developing recurrent seizures. Methods: A retrospective study was conducted from January 2004 to December 2013 in Chiang Mai University Hospital. Infants and children between 6 months and 5 years of age who were diagnosed with febrile seizures were included in this study. Clinical characteristics of children and all factors associated with seizure recurrence were extensively reviewed using electronic medical records. Results: There were 335 cases included for analysis. The mean age at onset of febrile seizures was 1.85 ± 0.95 years; 64.78 % were males. Among 261 cases who presented with first episode of febrile seizures, 52 cases (19.92%) developed recurrent febrile seizures. Respiratory tract infections were the most frequent etiology of febrile illnesses. Younger age at onset and family history of febrile seizures were statistically significant predictors of developing recurrent febrile seizures (p = <0.001 and 0.02, respectively). After adjusting the confounding variables, similar findings were found from the multiple logistic regression analysis (p = 0.003 and 0.01 respectively). Conclusion: In this study, younger age at onset of first febrile seizure and family history of febrile seizures were found to increase the risk of the recurrence of febrile seizures.

Incidencia de meningitis en lactantes con crisis febriles simples. Experiencia en un hospital de 3er nivel / Incidence of meningitis in infants with simple febrile seizures. Experience in a 3th level hospital

IINTRODUCCIÓN. Se denominan convulsiones febriles (CF) simples aquellas crisis generalizadas, autolimitadas, de menos de 15 minutos de duración, sin recurrencia en las primeras 24 horas y sin alteración neurológica postictal. Las CF constituyen el cuadro convulsivo más frecuente en niños menores de 5 años y se caracterizan por ser eventos benignos y autolimitados. Aproximadamente 2-4% de los niños tienen al menos una CF en algún momento de la vida. OBJETIVO. Determinar la incidencia de meningitis en niños menores de 18 meses de edad con un primer episodio de convulsión febril simple. MATERIAL Y MÉTODOS. Revisión retrospectiva de historias clínicas de pacientes entre 3 y 18 meses que consultaron a urgencias del Hospital Universitario San Vicente Fundación (HUSVF), en Medellín, por un primer episodio de convulsión febril simple, entre 2006 y 2011. RESULTADOS. Se revisaron 286 registros de pacientes con diagnóstico de convulsión febril, 79 (27%) correspondían a CF simple. 50 niños (63%) tenían menos de 12 meses, Se realizó punción lumbar en 45 (57%), y se identificaron 6 casos con pleocitosis, uno de los cuáles fue considerado meningitis bacteriana y tres como meningitis aséptica. Dos casos adicionales se consideraron meningitis parcialmente tratada. Los niños con meningitis o meningitis parcialmente tratada tenían sígnos clínicos sospechosos, habían recibido antibióticos o tenía vacunación incompleta. CONCLUSIÓN. La meningitis en niños con CF simple es poco frecuente y los casos sospechosos pueden detectarse con los criterios de la Academia Americana de Pediatría; si se realiza punción lumbar a niños que han recibido antibióticos, con vacunas incompletas o con signos clínicos neurológicos. La punción lumbar no debe ser rutinaria en casos de CF. Debe estudiarse el perfil epidemiologico de las de las infecciones por neumococo en Colombia, luego de la inclusión de la vacuna de 10 serotipos, para determinar su efecto en el riesgo de meningitis.

INTRODUCCTION. Febrile seizures (FS) are defined as generalized, self limited crisis lasting less than 15 minutes with no recurrence in 24 hours and without neurological inpairment in the post ictal period. FS are the most common cause for convulsions in patients less than 5 years old. These type of crisis are benign and self-limited . FS Lifetime incidence has been calculated between 2-4% in pediatric population. OBJECTIVE. To determine the inicidence of meningitis in children under 18 months with first simple febrile seizure (FS). Materials and METHODS. A retrospective review of medical records of patients 3 to 18 months of age who visited the emergency room at the Hospital Universitario San Vicente Fundación (HUSVF) after first episode of simple febrile seizure (FS), between January 2005 and December 2010. RESULTS. We analized 286 clinical records of patients between 3 and 18 months of age with febrile seizures, 79 (27%) were considered a single FS. Fifty-patients were under 12 months of age (63%). Lumbar puncture was performed in 45 children (57%) and there were 6 children with pleocytosis, one of them was considered as bacterial meningitis, and three as aseptic meningitis. Two cases had diagnosis of partially treated meningitis. Children with suspected meningitis had abnormal neurological signs, had previously received antibiotics or had incomplete vaccination. CONCLUSION. Meningitis in children with simple FS is not frequent and all cases could be detected according to the criteria of the American Academy of Pediatrics to perform lumbar puncture in children who previously received antibiotics, had incomplete vaccination or have positive neurological signs. Routine lumbar puncture in children with simple CF must be discouraged. The current state of pneumococcal infections in Colombia after implementation of immunization 10 serotypes vaccine must be assessed, in order to know the effect of vaccination status on the risk of meningitis in children with FS.

Crisis epilépticas en la población infantil / Seizures in children

Las crisis epilépticas son un problema neurológico que afecta entre un 4-10 por ciento de los niños hasta los 16 años. Las crisis deben ser diferenciadas de otros desórdenes neurológicos de los niños y clasificadas según su tipo. El tratamiento de emergencia está focalizado en la estabilización del paciente, terminar con la actividad convulsiva y determinar la causa de ésta. Diferentes modalidades de tratamiento existen a largo plazo, pero el adecuado tratamiento va a depender de un diagnóstico correcto y el conocimiento de los beneficios y efectos adversos de la terapia indicada.

Seizures are a neurological problem that affects between 4 to 10 per cent of children up to age 16. The crisis must be differentiated from other neurological disorders of children and classified by type. Emergency treatment is focused on stabilizing the patient, ending the seizure activity and determine the cause of this. There are different treatment modalities in the long term, but proper treatment will depend on a correct diagnosis and awareness of the benefits and adverse effects of prescribed therapy.