Clinical Review Evidence based paediatrics

Evidence based management of seizures associated with fever

BMJ 2001; 323 doi: https://doi.org/10.1136/bmj.323.7321.1111 (Published 10 November 2001) Cite this as: BMJ 2001;323:1111
  1. Martin Offringa, consultant paediatriciana,
  2. Virginia A Moyer, associate professor of paediatrics and epidemiology (Virginia.A.Moyer@uth.tmc.edu)b
  1. a Emma Children's Hospital, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, Netherlands
  2. b Department of Pediatrics, University of Texas, Houston Health Science Center, Houston, TX 77030, USA
  1. Correspondence to: V A Moyer

    This is the third in a series of five articles

    THE CASE

    A previously healthy 19 month old boy was rushed to the emergency department after being found unconscious at home by his mother. As she went to wake him from his afternoon nap she heard a short cry. She found him lying on his back, rigid and unresponsive, with blue lips and apparently not breathing. His breathing and circulation were adequate on arrival in the emergency room. His pulse rate was 110 per minute, blood pressure 100/60 mm Hg, and temperature 39.9°C. The boy was lethargic and confused but seemed to recognise his mother. Apart from a slightly red pharynx there was no obvious focus of infection and no rash. Neck rigidity was difficult to evaluate because he actively resisted examination and refused to sit.

    Summary points

    Seizures occurring in association with fever affect approximately 4% of all children

    In children with a seizure associated with fever the probability of bacterial meningitis is low but not zero (ranging between 0-4%)

    A normal physical examination and history make bacterial meningitis highly improbable

    After a first febrile seizure the probability of seizure recurrence in subsequent fever episodes is related to age, and is highest between 1 and 3 years

    After a first febrile seizure prophylactic treatment with antiepileptic drugs does not decrease the likelihood of future febrile seizures

    Background

    A febrile seizure is defined as a seizure occurring in a neurologically healthy child aged 6 months to 5 years. Simple febrile seizures are brief (under 15 minutes' duration), are generalised, and occur in association with fever and only once during any 24 hours.1 Seizures occurring with fever are the most common neurological disorder in paediatrics, affecting 2-4% of all children in Britain and the United States.2 Children whose seizures are attributable to a central …

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