• Seizures are a manifestation of abnormal neural discharge in the cerebral cortex. Convulsions are the most common neurological disease.
Between 4% and 10% of children experience at least one seizure (febrile or afebrile) in the first 16 years of life. The cumulative incidence of lifetime epilepsy in the population is 3%, and more than half of these begin in childhood. Its annual prevalence is 0.5-1%.
- Seizures in newborns occur mostly due to perinatal asphyxia and congenital anomalies.
Infection is the most common cause of convulsions in infants and young children.
In older children, idiopathic epilepsy is the most common cause of seizures.
Seizure Causes
a) Developmental disorders
b) Cerebral palsy
c) Infectious diseases
d) Metabolic diseases
e) Cerebrovascular events
f) Due to toxic agents
g) Lesions occupying space in the brain
h) Collagen tissue diseases
Febrile convulsions
• Febrile convulsions are the most common type of acute non-recurrent seizures.
• Seizures accompanying fever in children aged 3-6 months-5 years (peak age is 12-18 months).
The etiology of fever is an extracranial infection. There should be no central nervous system infection, no metabolic imbalance, and no previous history of afebrile seizures.
• It is seen secondary to conditions such as otitis media, roseola infantum (HHV6-7), shigella infection. HHV6B (most common) and HHV7 are detected in one third of patients with febrile convulsions.
• In studies conducted in many families, the SCNA 1A, 18, 9A and CPA6 genes have been associated with febrile convulsions. In addition, dysregulation of IL-1-beta, IL-6 and 8, ILR-1A cytokines is thought to be associated with febrile status epilepticus.
• Some types of epilepsy may begin with febrile seizures. The two best-known examples are GEFS+ (Generalized Epilepsy with Febrile Seizures Plus) and severe myoclonic epilepsy of the infant (Dravet syndrome).
1. Simple Febrile Convulsion
• It is seen between the ages of 6 months and 5 years.
• Convulsion is generalized, not focal.
• Convulsion duration does not exceed 15 minutes and usually ends in a few seconds.
• There is no neurological finding after the seizure. There may be a very short time postictal period.
• It is seen due to high fever due to a disease other than the central nervous system (upper respiratory tract infection or urinary infection). CSF findings are normal.
• It usually shows a genetic transition, there is a family history of febrile convulsions (OD).
• Mortality does not increase and long-term sequela etc. no such effect was demonstrated.
2. Complicated Febrile Convulsion
• If focal convulsion has been experienced,
• If the convulsion lasts longer than 15 minutes (if it exceeds 30 minutes, it is called febrile status)
• If it recurs within 24 hours,
• If there is a focal neurologic finding after convulsion.
• Increased risk of mortality.
LP indications in febrile convulsions
• If it is <6 months, it should be strongly considered.
• Children aged 6-12 months should not be vaccinated against Haemophilus influenzae type b and streptococcus pneumonae or if their vaccination status is unknown.
• LP should be performed in all age groups if the child seems depressed, if there are clinical signs and symptoms of meningitis.
Risk factors facilitating the occurrence of epilepsy after febrile convulsion
Risk factor .................................. Risk of developing epilepsy
Simple febrile convulsion----------------------------1%
Neurodevelopmental anomalies--------------------33%
Focal complex febrile seizure----------------------29%
Family history of epilepsy---------------------------18%
Seizure within 1 hour of fever-----------------------11%
complex febrile seizures
(lasts >15 min/repeats in 24 hours)----------------- 6%
Recurrent febrile seizures-----------------------------4%
Lab and Imaging
• The most important indication of LP is suspicion of meningitis. While CSF findings are normal in patients with non-meningitis febrile convulsions, pleocytois is seen in CSF samples taken from patients with febrile status epilepticus.
• Routine EEG is not required in febrile convulsions. EEG can be performed for patients who are at high risk for risk factors that facilitate the occurrence of epilepsy.
• Routine laboratory blood tests are not recommended. In patients with prolonged postictal period, blood sugar should be checked. If there are findings suggesting electrolyte disturbance such as dehydration on physical examination, electrolyte levels can be checked.
• CT or MR imaging is not recommended in the first simple febrile convulsion. However, MRI is required in febrile status epilepticus and the risk of developing hippocampal atrophy and temporal epilepsy is high.
Treatment and Prophylaxis in Febrile Convulsions
• The family is trained on what to do during the seizure. Washing with cold water is not recommended as it will cause shaking and hence heat generation. Paracetamol can be given as an antipyretic. Antipyretics may provide comfort to the child but do not reduce the risk of recurrent febrile convulsions. Because convulsions can also occur when the fever rises or falls.
• If the convulsion does not stop, 0.3-0.5 mg/kg Diazepam is given IV. Complicated febrile convulsions should be treated like epilepsy.
• Continuous or intermittent antiepileptic therapy is not routinely recommended in children with simple febrile convulsions.
• Prophylaxis is given in some febrile convulsions because the risk of recurrence is high. The best method for prophylaxis today is intermittent prophylaxis during fever, and it is most commonly administered as rectal diazem (5 mg, 10 mg) during fever. In cases where the family is very worried, valproate can be started considering its side effects (hepatotoxicity).
