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.

Review on Febrile Seizures in Children

Background: Febrile seizures are a common, yet benign neurological disorder and characterized by convulsions associated with fever in childhood due to the effect of fever ontheimmature brain. All treating clinicians must understand the nature and evaluation of this benign condition.Objective:To provide up-to-date knowledge on febrile seizures and their evaluation.Methods:A search was conducted with key terms “febrile seizures” or “febrile convulsion” invarious databases and writings. The literature included clinical trials, descriptive and observational studies, meta-analyses, and randomized control trials. Results:Febrile seizures occur between the ages of6 months to 5years in all ethnic groups. The exact mechanism has been still unknown although several etiologies have been proposed including genetic and environmental factors. Febrile seizures can be either simple or complex. Febrile seizures generally occur within the first day of feverbut rarely happen after 24 hours. Most of the time, febrile convulsions are short-lasting and self-limiting. The diagnosis is mainly based on the clinical description,and investigations have a limited role. Children less than one yearof age with suspicion of bacterialinfection need lumbar puncture to exclude meningitis. Management mostly depends on control of fever and the treatment of underlying conditions which precipitate fever. Some children can have prolonged convulsions which need anticonvulsants to abort an acute attack. Otherwise,long term prophylactic anticonvulsants have an insignificant role in the prevention of recurrencesof febrile seizures. Physical methods also play an insignificant role. As the condition commonly carries a favorable prognosis, unnecessary interventions should be avoided. Since febrile seizures recur in a significant proportion of children, they may bring needless fears and anxieties in parents. However, proper health education for parents by health care personnel might alleviate the anxiety and improve the quality of life of children with febrile seizures.Conclusion:Febrile convulsions are benign and self-limiting. Continuous use of anticonvulsants to prevent the recurrence of febrile seizures is notendorsed. Intermittent prophylaxis at the time of fever is also not routinely recommended. Both physical methods and antipyretics have limited value in the prevention of febrile seizures

Clinical Features of Children with Febrile Status Epilepticus / 대한소아신경학회지

PURPOSE: Febrile seizures(FS) are the most common form of childhood seizures and their prognosis are favorable. Despite the fact, there are still some concerns that prolonged febrile seizures may cause brain damages or neurological sequelae, which may be associated with the development of mesial temporal sclerosis and intractable temporal lobe epilepsy in later life. The aim of this study was to evaluate the clinical characteristics and outcomes in children with febrile status epilepticus(FSE). METHODS: 39 children aged 6 months to 5 years were enrolled in this study, who presented with FSE at Kyungpook National University Hospital, from January, 2000 to December, 2004. They were compared with 250 children who presented with the first episodes of FS at the same period. We reviewed retrospectively the medical records for the clinical characteristics and outcomes of the two groups. RESULTS: There were no statistically significant differences between the two groups in terms of age, etiology, degree and duration of fever, type of seizure, family history of FS or epilepsy, EEG and MRI findings, and recurrence rates of FS. Children with FSE were more likely to have neurological sequelae(12.5% vs. 2.4%; P=0.008), to develop afebrile seizures(21% vs. 4%; P=0.00) and to take anticonvulsants chronically(33% vs. 2%; P=0.00) than children with FS. CONCLUSION: Our results indicate that prolonged febrile seizures are associated with unfavorable neurological outcomes compared with simple febrile seizures. However, long-term, and extensive follow-up studies are needed to find out the relationship between prolonged febrile seizures and subsequent mesial temporal sclerosis as well as intractable temporal lobe epilepsy.

An Analysis of Results of Surgical Treatment of Epilepsy at National Epilepsy Center in Japan / 대한간질학회지

PURPOSE: The neurosurgical group of the National Epilepsy Center in Japan has been operating on epileptic patients for 17years. In recent 10 years, The 387 patients that have been operated on have enjoyed positive results. in this study, the authors will attempts to make a scheme for surgical treatment of epilepsy based upon the analysis of the patients who were treated with surgery METHODS: THe authors investugated the influenced of advanced in diagnostic procedures. In order to study the relationship between the previous disease and the histologic results, we divided the 152 temporal lobe epilepsy patients who received a resection of both medial temporal structure and lateral neocortex two groups : those with hippocampal sclerosis and those with some other histologic finding. For analysis, patients were divided into 3 groups : first, a lesional group : second, a skip group that had no chronic intractanial recording : third, an intracranial recording group. The results at 2 years, 5 years, 8 years, and 10 years after surgery were studied based on Engel's classification RESULTS & CONCLUSION: With the development of better diagnostic equipment, the incidences of epilepsy surgery have increased, while the percentage of the cases requiring invasive diagnostic procedure has been decreased overall. Not only have the cases of surgery for temporal lobe epilepsy increased but also for extratemporal epilepsy as well. Mesial temporal sclerosis and cortical migration disorder were the most common lesions requiring operative treatment. Febrile status epilepticus in childhood was the most common etiology of epilepsy found. Eighteen children among the twenty-three who had been operated were lesional cases. Longterm follow up studies up studies up to 10 years after surgery shows no worsening in patients condition based on Ecgel's grade of temporal lobe epilepsy.