Febrile Seizures _7 Practice Points

7 Practice points on Febrile Seizures 

1. Complex febrile seizure can be either focal, duration more than 15 min, or multiple episodes in 24 hours.
2. Simple febrile seizure plus (SFS+) are febrile seizures that are generalized, last for less than 15 min, but have more than one episode in 24 hours. SFS+ behaves like SFS rather than CFS and the overall prognosis is same as SFS.
3. There are only three indications for lumbar puncture: (a) Presence of Meningeal signs, (b) Infant 6-12 months when not vaccinated for Hib/Pneumococcal or when the immunization status is not known, and (c) optional indication if the child has been pretreated with antibiotic.
4. There is no role of EEG or MRI Brain in simple febrile seizure. Role is restricted to focal febrile seizure and febrile status epilepticus or when there is pre-existing developmental delay.
5. The use of antipyretic agents does not alter the recurrence rate (class 1 evidence), and there is no evidence to support initiation of regular antiepileptic drugs for simple febrile seizures (class 1 evidence)
6. Intermittent prophylaxis with clobazam is prescribed only when there are more than three seizures in 6 months, or more than four seizures in 12 months, seizures last for more than 15 minutes, or in the seizures that require medication.  
7. Continuous prophylaxis with sodium valproate is indicated among children with febrile status epilepticus (prolonged febrile seizure beyond 30 minutes), complex and recurrent FS >6 yr despite intermittent prophylaxis.

Happy Reading. Feel free to spread the message to Parents and your pediatrician friends.

Best regards

Piyush Gupta MD, FNNF, FIAP, FAMS, Professor of Pediatrics and In-charge, Medical Education Unit, University College of Medical Sciences, Delhi.

Editor-in-Chief, Indian Pediatrics (2008-2013)

Email: drpiyushguptaucms@gmail.com; Mob: 9625900641

References

1. Mastrangelo M, Midulla F, Moretti C. Actual insights into the clinical management of febrile seizures. Eur J Pediatr. 2014;173:977–82.

2. Lewis DV, Shinnar S, Hesdorffer DC, Bagiella E, Bello JA, Chan S, et al. Hippocampal sclerosis after febrile status epilepticus: the FEBSTAT study. Ann Neurol. 2014;75:178–85.

3. Subcommittee on Febrile Seizures, American Academy of Pediatrics. Neurodiagnostic evaluation of the child with a simple febrile seizure. Pediatrics. 2011;127:389–94.

4. Grill MF, Ng Y-T. “Simple febrile seizures plus (SFS+)”: more than one febrile seizure within 24 hours is usually okay. Epilepsy Behav EB. 2013;27:472–6.

5. Wilmshurst JM, Gaillard WD, Vinayan KP, Tsuchida TN, Plouin P, Van Bogaert P, et al. Summary of recommendations for the management of infantile seizures: Task Force Report for the ILAE Commission of Pediatrics. Epilepsia. 2015;56:1185–97. Visit to read https://onlinelibrary.wiley.com/doi/epdf/10.1111/epi.13057

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