Case Report

Febrile Seizures

BETSHEBA E. S.
123307018

Mentor:
dr. Ifan Sp.A
 Definition of Febrile Seizure
Febrile Seizures are seizures occurring in children 6
months to 5 years of age with elevated body
temperature (temperatures above 380 C, with any
temperature measurement method) not caused by
intracranial processed.

Risk Factors Occurrence of Febrile Seizures

Body Temperature
Age
Family History
Perinatal and Postnatal Factor
 Epidomology of Febrile Seizure
Based on the place
Based on age
Based on gender
Pathophysiology of Febrile Seizure
 Classification of Febrile Seizures
Simple febrile seizures
Short febrile seizures (less than 15 minutes), generalized seizures
(tonic or clonic), and do not recur within 24 hours

Description :
Simple febrile seizures account for 80% of all febrile seizures
Most of the simple febrile seizures last less than 5 minutes and stop
alone

Complex febrile seizures

Febrile seizures with one of the following features (IDAI, 2016):
Old seizures (> 15 minutes)
Focal or partial seizures of one side, or generalized seizures
preceded by partial seizures
Repeating or more than once within 24 hours
 Differences Simple Febrile Seizures and
Complex Febrile Seizures
Num. Clinical Simple FS Complex FS
1. Long seizures <15 minutes >15 minutes
2. Type of seizures General General/focal
Number of seizures in one 1 times >1 times
3.
febrile period
4. Neurological deficit Never Might
History of febrile seizures in Might Might
5.
the family
History of seizures without Might Might
6.
fever in the family
The presence of previous Might Might
7.
neurological abnormalities
Enforcement Diagnosis of Febrile Seizures
Anamnesis
Physical check
Supporting check
Laboratory Check
Lumbar puncture
Electroencephalography (EEG)
Differential Diagnosis of Febrile Seizures
- Meningitis
- Encephalitis
- Epilepsy
Management of Febrile Seizure
 Management When Fever

1. Drug giving when fever

a. Antipyretics
b. Anticonvulsants
Giving intermittent anticonvulsant drugs
Provision of anticonvulsant drug formula
2. Education in the parents
 Prevention of Febrile Seizures
Primordial Prevention
Primary Prevention
Secondary Prevention

Complications Febrile Seizures

Complications of febrile seizures are the most
common is recurrent febrile seizures
Epilepsy
Impaired behavior and decreased intelligence and
academic achievement. Some results of research
on decreasing levels of intelligence after the rise
of febrile seizures are not the same.
Prognosis of Febrile Seizures

Disability or Neurological Disorders

Possibility of Recurrence in Febrile Seizures
Risk Factors for Epilepsy
 PATIENT STATUS
PATIENT IDENTITY
Name : Nadira
Age : 1 year 6 months years old
Gender : Female
Address : Komplek Brimob
Education :
Status :
Religion : Moslem
Login Date : June 12, 2017
Exit Date : June 15, 2017
Room : Flamboyan 1
ANAMNESIS
Main complaint : Seizures
Review :
Patient came brought by his parents to ER Bhayangkara Tk II Hospital
Medan at 10.00 am with complaints seizures. Seizures occur as much as 1
time. The duration of seizures is about 10 minutes. When the right and left
hand patient clenched, both arms and both lower legs trembled like people
shivering. Eyes do not glance up, not out foam from mouth patient and
tongue is not bitten. When seizures patient unconscious and after conscious
seizure patient but his body becomes weak. Patients mother confess before
seizure, patient had high fever. And while at the ER patients temperature is
39.5 C.
Fever occurs since 1 day before admission. Fever appears suddenly and is
felt continuously at home. Mother patient admitted her body temperature is
38,5 C. Parents also said patient already take the usual febrifuge given by his
mother and her body temperature is down. But 4 hours later after give the
medicine, patient felt seizures.The patient family denies the presence of
diarrhea, no vomiting, no nausea, no cough, no runny nose, no bowel
movements and no water complaints.
 Additional complaints : Swollen gums
Past history : Patients never felt seizures
Prescription drug history : Proris syrup
Family disease history : There is no similar history in the family
Allergy history :-
Immunization history : The patient's mother admitted to
routinely bringing her child to
immunization on schedule
Hepatitis B : 0 days , 1 months , 6 months
Polio : 0 months , 2 months , 4 months ,
6 months
BCG : 2 months
DPT : 2 months , 4 months , 6 months
Measles : 9 months
 History of growth :
First teeth growth : 6 months
Impaired mental development : no
Psychomotor :
- Sitting : 8 months
- Standing : 9 months
- Walking : 13 months
Food history :
Breast milk from birth until the age of 11 months.
Frequency 4-6 times per day
Eat bananas since the age of 1 month
Frequency 1 day
Eat a 6 month old rice
Frekuensi 1-2 times a day
 GENERAL CONDITIONS

Date : June 12, 2017

General awareness : Patient seems weak, GCS 15
Awareness : Compos mentis
Heart Rate : 96 x/i
Respiration Rate : 24 x/i
Temperature : 39,5 C
Weight : 10 kg
Height : 68 cm
Nutrition status : BBN = 11,2 , nutrition status =
89,2% good nutrition
 PATIENT STATUS
Pale : (+)
Cyanosis : (-)
Thetype : (-)
Bleeding Signs : (-)
Turgor : Fine, hurry back
 PHYSICAL CHECK
Head
Shape : Nomorcepali
Hair : Straight, black, not easily revoked
Eye : Conjunctiva is not pale, sclera not iksenk,
kokor (+/+), R Light (+ / +)
Ear : Serumen (- / -), secretions (- / -)
Nose : Septum deviation (-), secretions (- / -),
nasal lobe breathing (- / -)
Mouth : Dry lips mucosa, cyanosis (-), thypoid
tongue (-), Bleeding gums (-), toxil (T, left
& right), swollen gums (+)
Neck
Shape : Normal
Trachea : There is no deviation
Lymph gland : No palpable lymph gland
enlargement
Thorax
Inspection : Right and left symmetry
Palpation : Stem right fremitus = left
Percussion : Sonor on both stomach
pitches

Auscultation : Sp = vesicular
Sr = wheezing (-/-) , rouki (-/-)
Heart
Inspection: Ictus cordis is not palpable
Palpation : Ictus cordis palpable in the apex of the
heart
Percussion: Boundary of upper heart of ICS II sinistra
Right heart line linea parasternalis dextra
ICR IV-V
The left heart linea midclavicular line of the
sinus dextra ICR IV
Auscultation: Rhythm of the heart of I / II regular,
noisy (-)
Abdomen
Inspection : Looks basic, symmetrical
Follow the motion of breath
Palpation : Soepel, epigastric tenderness (-),
undulation (-), tugor back quickly,
spleen and liver not enlarged
Percussion : Tumpani, knuckle pain (-),
deafness (-)
Auscultation : Normal bowel sound (+) normal:
4x / min
Skin
: Ikterik (-)
: Petechie (-)

Genitalia
No genital examination was performed

Ekstremities
: Cold acral
: Cyanosis does not exist
: Capillany refill <2 second
: Deformity (-)
 SUPPORTING CHECK
1. Complete blood
2. Widal test
Complete blood check result on June 12, 2017
Check Result Unit Normal Value
Complete blood (FBC)
Hemoglobin 11,2 g/dl 12,0 16,0
Leukocytes 20,8 109 /L 4,0 11,0
Blood Deposition Rate 15 mm/1 hour P=0-10 W=0-20
Platelet Count 267 109 /L 150 - 450
Hematocrit 33,8 % 37,0 47,0
Erythrocytes 4,28 1012/L 3,80 6,00
MCV 79,0 FI 77,0 95,0
MCH 26,1 Pg 27,0 32,0
MCHC 33,1 g/dL 32,0 36,0
Calculate Leucocyte Type
Eosinophils 2 % 1,0 3,0
Basophils 0 % 0 10
Neotrophils 67 % 50,0 70,0
Lymphocytes 28 % 20,0 40,0
Monocyte 3 % 2,0 8,0
Complete widal test result on June 12, 2017.

Titer O Titer H

S. Thyphi 1/80 1/160

S. Parathypi A 1/80 1/160

S. Parathypi B 1/80 1/80

S. Parathypi C 1/80 1/80

Impression: - Leukocytes increased by 20.8 x 109 /L
- Widal test, titer H S.thypi and S.parathypi A - 1/160
 DIFFERENTIAL DIAGNOSIS
Simple Fever Seizures
Complex Fever Seizures
Meningitis
Epilepsy
Tetanus
TEMPORARY DIAGNOSIS
Simple Fever Seizures
 INITIAL MANAGEMENT
IVFD RL 40 gtt/i (micro)
Injektion ceftriaxon 250 mg/12 hours
Paracetamol syr 3x1cth
Stesolite Rectal 5 mg
Phenobarbital 200 mg in 20 cc Dextrose 5%
discharged in 30 minutes per 12 hours
Phenobarbital 50 mg in 20 cc Dextrose 5%
discharged in 30 hours
 RESUME
ANAMNESIS
Patient came brought by his parents to the ER
Bhayangkara Tk. II Hospital Medan at 10.00 am with a
seizure complaint that happened as much as 1 time. The
duration of seizures is about 10 minutes. When the right
and left hand os clenched clenched, both the upper arms
and both lower legs trembled like people were shivering.
Eyes do not glance up, not out the foam from the mouth,
and tongue is not bitten. When seizures patient
unconscious and after conscious seizure os but his body
weak. Patients mother confess before seizure os have
high fever, diarrhea (-), vomiting (-), nausea (-), cough (-),
colds (-), defecate & urinate normal.
 PHYSICAL CHECK
General awareness : Patient looks limp
Awareness : Compos mentis
Hearth Rate : 96 x/i
Respiratory Rate : 24 x/i
Temperature : 39,5 C
Weight : 10 kg
Height : 68 cm
Nutritional status : 89,2 % Good nutrition
Head
Mouth : Dry lips mucosa, swollen gums
Thorax : No extra sound
Ekstremities
Superior : Cold acral
Inferior : Cold acral
 SUPPORTING CHECK
General check up
Leukocytes 20,8 x 109

Widal test
On the titer H S.thypi and S.parathypi A -1/160
 WORK DIAGNOSIS
Simple Febrile Seizure

INITIAL MANAGEMENT
IVFD Ringer Laktat 40 gtt/i micro
Stesolide Rectal 5 mg
Inj. Ceftriaxone 250 mg/12 hours
Paracetamol syr 3x1 cth
Phenobarbital 200 mg in 20 cc Dextrose 5% in 30
minutes per 12 hours
Phenobarbital 50 mg in 20 cc Dextrose 5% in 30
minutes
 FOLLOW UP
Follow up on June 12, 2017, 03.30 P.M.
S= - Fever (+) - Seizures (-)
- Diarrhea (-) - Defecate (-) , Urinate (-)
- Nausea (-) - Weak (+)
- Vomite (-)
O = Sensorium : Compos Mentis
T : 38,1 C ST : Rhonchi(-) , Wheezing (-)
HR : 86 x/i EXT : Superior & Inferior Cold Acral
RR : 22 x/i
A = Simple Febrile Seizure
P= - IVFD RL 40 gtt/i
- Inj. Ceftriaxone 250 mg/12
- Phenobarbital 200 mg in 20 cc Dextrose 5% 30 minutes/12 hour
- Phenobarbital 50 mg in 20 cc Dextrose 5% 30 minutes/12 hour
 FOLLOW UP
Follow up on June 13, 2017, 12.00 noon
S= - Fever (+) - Seizure (-)
- Diarrhea (-) - Defecate (-) , Urinate (+)
- Nausea (-) - Weak (+)
- Vomite (-) - Shiver (-)
O = Sensorium : Compos Mentis
T : 37,6 C AS : Rhonchi (-) , Wheezing (-)
HR : 94 x/i EXT : Superior & Inferior Warm Acral
RR : 24 x/i Peristaltic (+) Normal
A = Simple Febrile Seizure
P= - IVFD RL 40 gtt/i
- Inj. Ceftriaxone 250 mg/12
- Phenobarbital 50 mg in 20 cc Dextrose 5% 30 minutes/12 hours
- PCT syr 3x1 cth
- Inj. Novalgin 120 mg/ k/p
 FOLLOW UP
Follow up on June 14, 2017, 06.00 P.M.
S= - Fever (-) - Shiver (-)
- Seizure (-) - Defecate (N) , Urinate (N)
- Nausea (-) - Weak (-)
- Vomite (-)
O = Sensorium : Compos Mentis
T : 36,8 C AS : Rhonchi (-) , Wheezing (-)
HR : 80 x/i EXT : Superior & Inferior Warm Acral
RR : 20 x/i
A = Simple Febrile Seizure
P= - IVFD RL 40 gtt/i
- Inj. Ceftriaxone 250 mg/12
- Inj. Novalgin 120 mg/ k/p
- Phenobarbital 50 mg in 20 cc Dextrose 5% 30 minutes/12 hours
- PCT syr 3x1 cth
 FOLLOW UP
Follow up on June 15, 2017, 09.00 P.M.
S= - Fever (-) - Shiver (-)
- Seizure (-) - Defecate (N) , Urinate (N)
- Nausea (-) - Weak (-)
- Vomite (-)
O = Sensorium : Compos Mentis
T : 36,5 C AS : Rhonchi (-) , Wheezing (-)
HR : 80 x/i EXT : Superior & Inferior Warm Acral
RR : 20 x/i

A = Simple Febrile Seizure

P= - Cefadroxil 2x1 cth
- Phenobarbital 3x5 mg
- Paracetamol 3x1 cth