Febrile seizures - symptoms, signs, diagnosis and treatment
Symptoms, signs, diagnosis and treatment of febrile seizures
Febrile seizures develop in children under 6 years of age with an increase in body temperature above 38 ° C, a history of afebrile seizures and other possible causes. The diagnosis is clinical, it is made after the exclusion of other possible causes. Treatment of convulsions lasting less than 15 minutes is supportive. If the seizures continue for 15 minutes or more, treatment includes lorazepam intravenously and, in the absence of the effect, phosphonitoin intravenously. As a rule, prolonged maintenance drug therapy is not indicated.
Febrile seizures occur in approximately 2–5% of children under 6 years of age; in most cases the age of children is from 6 to 18 months. Simple febrile convulsions last less than 15 minutes and occur without focal symptoms, and if they occur in series, the total duration is less than 30 minutes.Complicated febrile seizures last more than 15 minutes, with focal symptoms or post-attack paresis, or convulsive seizures occur in series with a total duration of more than 30 minutes. Most febrile seizures are simple.
Febrile seizures occur against the background of bacterial or viral infections. They also sometimes develop after some vaccinations, such as DTP or trivaccine. Genetic and familial factors may increase susceptibility to febrile seizures. Monozygous twins have a significantly higher concordance than dizygotic ones.
Febrile seizures - symptoms, signs, diagnosis
Often, febrile convulsions occur during the initial rise in temperature, and most of them develop in the first 24 hours of fever. Characterized by generalized convulsions; in most cases, clonic convulsions, however, some appear as periods of atonic or tonic body position.
Convulsions are diagnosed as febrile after exclusion of other causes. Fever can also provoke seizures in children with episodes of afebrile convulsions in the anamnesis; in such cases it is not febrile convulsions, since the child already had a predisposition to convulsions.If a child is younger than 6 months old, he has meningeal signs or signs of CNS depression or convulsions developed after several days of febrile fever, you should take a spinal fluid for examination to rule out meningitis and encephalitis. Sometimes it is necessary to conduct laboratory tests for metabolic disorders or metabolic diseases. The level of glucose, sodium, calcium, magnesium, phosphorus, and liver and kidney function should be determined if a child has recently had diarrhea, vomiting, or a low fluid intake; if there are signs of dehydration or swelling, or in the case of complex febrile seizures. CT or MRI of the brain should be assigned if there are focal neurological symptoms or signs of increased intracranial pressure. EEG usually does not allow to identify a specific cause or predict the recurrence of seizures; its holding is not recommended after the first attack of febrile convulsions in children with normal results of neurological examination. You should think about the appointment of EEG after complex or recurrent febrile seizures.
Febrile seizures - prognosis and treatment
The overall frequency of repeated episodes is about 35%. The probability of recurrence is higher if the child is younger than 1 year in the first episode of seizures or the child has first-degree relatives who have febrile seizures. The likelihood of afebrile seizure syndrome after febrile seizures is about 2-5%.
Supporting treatment with an attack duration of less than 15 minutes. Seizures lasting more than 15 minutes require the use of drugs to stop them, with careful monitoring of the state of hemodynamics and respiration. It may be necessary to intubate the trachea if the response to the drugs is not fast and the seizures continue.
Preparations are usually administered intravenously, using short-acting benzo-diazepines. Phosphenithoin 15–20 mg PE / kg can be administered after 15 minutes if seizures continue. Rectal gel of diazepam 0.5 mg / kg can be administered once, and then repeated after 20 minutes if lorazepam can not be administered intravenously.
Supportive drug therapy to prevent recurrent episodes of febrile seizures or the development of febrile seizures is usually not indicated unless the child has had multiple or prolonged episodes of seizures.
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