Update on the management of simple febrile seizures: emphasis on minimal

intervention
Oluwabusi, Titilayoa,b; Sood, Sunil K.a,b,c

Abstract
Purpose of review: We summarize recent clinical reviews and updated American Academy of Pediatrics (AAP) clinical
guidelines for the management of children with simple febrile seizures.
Recent findings: There has been a dramatic reduction in the incidence of bacterial meningitis and of occult bacteremia
since the advent of Haemophilus influenzae type b andStreptococcus pneumoniae immunization. This has made routine
laboratory evaluation for these bacterial infections unnecessary in a fully immunized, well appearing child who presents
with a simple febrile seizure. At the same time there is increasing evidence that the neurotropic human herpes viruses 6
and 7 (HHV-6, HHV-7) comprise a significant proportion of viral infections associated with febrile seizures, and may be
the primary cause of the seizure in many instances. Recent evidence-based guidelines emphasize the lack of a need for
routine laboratory and neurodiagnostic evaluation, and for prophylactic antipyretics and anticonvulsants, in the majority
of children with simple febrile seizures.
Summary: If a child who is fully immunized according to the recommended schedule presents with a simple febrile
seizure, minimal intervention should be the norm. Routine blood tests and routine lumbar punctures are usually
unnecessary, and the risks of neurodiagnostic procedures (imaging or EEG), prophylactic antipyretics and
anticonvulsants far outweigh their potential benefits.

Emergency Department Evaluation and

Management of Children With Simple
Febrile Seizures
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1.

Stephanie Carapetian, MD, MS1

Joseph Hageman, MD2,3
Evelyn Lyons, RN, MPH4
Daniel Leonard, MS5
Kathryn Janies, BA6
Kent Kelley, MD3
Susan Fuchs, MD7,8
1. 1Seattle Childrens Hospital, University of Washington, Seattle, WA, USA
2. 2Comer Childrens Hospital, University of Chicago, Chicago, IL, USA
3. 3NorthShore University HealthSystem, Evanston Hospital, Evanston, IL, USA
4. 4Illinois Department of Public Health, Springfield, IL, USA
5. 5Loyola University, Chicago, IL, USA
6. 6The American Academy of Pediatrics, Elk Grove Villiage, IL, USA
7. 7Northwestern University Division of Pediatric Emergency Medicine, Chicago, IL, USA
8. 8Ann & Robert H. Lurie Childrens Hospital of Chicago, Chicago, IL, USA
Stephanie Carapetian, Division of Pediatric Neurology, Seattle Childrens Hospital, University of Washington,
4800 Sand Point Way NW, Neurology B-5552, Seattle, WA 98105, USA. Email: scarapet@uw.edu

Abstract
Workup of simple febrile seizures (SFS) has changed as the American Academy of Pediatrics made revisions to
practice guidelines. In 2011, revisions were made regarding need for lumbar puncture (LP) as part of the SFS workup.
This study surveyed more than 100 emergency departments regarding workup of children with SFS and performed a
medical record review of workup that was performed. The survey shows that laboratory workup is done routinely and LP
is done infrequently. The majority documents a complete exam. The medical record review demonstrates
documentation of the examination, frequent laboratory and infrequent LP evaluation. Consistent with the American
Academy of Pediatrics revisions, survey and record reviews demonstrate that LP testing is infrequent. Contrary to the
guideline, laboratory studies are routinely performed. This study suggests there is an opportunity to improve
management of SFS by directing efforts toward finding the source of the fever and away from laboratory workup.