Febrile Seizures

Supervised by:
dr. Pulung M. Silalahi, Sp.A

Created by:
Melani Oktavia
1102015131

Faculty of Medicine, YARSI

University Bhayangkara
Tk. I R. Said Sukanto
Hospital Periode 2nd Sept
– 9th Nov 2019
 Definition Febrile Seizures

 Having a seizure when the child’s body temperature is high (38°C or above)

 Occur between 6 months and 5 years

 That are not the result of central nervous system infection or any metabolic
imbalance.

 Occur in the absence of a history of prior afebrile seizures

Type of fibrile seizures

Simple febrile seizure

The most common type of febrile seizure ( 90% of cases)

Characterictics:
– Tonic clonic seizure
– Does not last >15 minutes
– Does not reoccur within 24 hours or during the period in
which the child has an illness.
Complex febrile seizure
Less common than simple febrile seizures (~10% of cases)

Has one or more of the following characteristics:

– Seizure lasts >15 minutes
– Partial or focal seizure
– Seizure reoccurs within 24 hours of the first seizure or
during the period in which they have an illness
Patophysiology
Risk Factors for Febrile Seizures
 Causes

- Upper respiratory tract infection

- Roseola infantum (HHV-6) .
- Gastroenteritis ( Shigella or campylobacter) .
- Influenza Virus .
- Urinary tract infection .
 Symptoms

– Febrile seizures often occur during the first day of a fever.

– Temperature: 38°C or above.
– Seizures may also develop:
After a mild temperature. It may not develop at all with an extremely high
temperature.
Rapid rise in temperature
 More Symptoms...

- Body stiffness
- Limbs twitching
- Unconsciousness
- Urine incontinence
- Vomiting
- Foaming at the mouth
- Sleepiness/drowsiness after seizure 1 hour
Diagnosis
01 Anamnesis

02 Physical Examination

03 Laboratory exam
 Physical Examination

- Awareness
- Body temperature
- Meningeal excitatory sign
- Signs of Increased intracranial pressure
- Signs of infection outside the central nervous system
- Neurological examination
 Laboratory examination

– Evaluation of the source of infection or other diseases that can cause

seizures
• Routine blood tests and peripheral blood
• Electrolyte levels
• Blood glucose levels
Lumbal Puncture

– An indication of lumbar puncture is to establish or rule out meningitis.

– Lumbar puncture is not done routinely in every FS child. If there is a

suspicion of meningitis, it must be done
Electroencephalogram

– If the child presents with the first simple febrile seizure and
is neurologically healthy, an EEG is not normally be
performed as part of the evaluation.
– An EEG would not predict the future recurrency of febrile
seizures
– EEG is performed in complex seizure to seek other risk
factors for later epilepsy
Neuroimaging

– A CT SCAN or MRI is not recommended in evaluating the

child after a first simple febrile seizure.
– EEG and neuroimaging (CT SCAN or MRI) is performed if
the child is neurologically abnormal.
Diffential Diagnosis...
which we need to be aware of

- Central nervous system infection ( i.e. meningitis or encephalitis ).

- Genetic epilepsies with febrile seizures .

- Metabolic imbalance.
Treatment
 Therapy
Antipyretics
- Paracetamol 10-15 mg / kg, 4x / day
- Ibuprofen 5-10 mg / kg, 3-4x / day
Anticonvulsants
- Diazepam 0.3 mg / kg po or 0.5 mg / kg pr
when fever> 38.50C
Maintenance medicine
- Valproate acid 15-40 mg / kg / day, 2 -3 Dose
- Phenobarbital 3-4mg/kg/day
- In most cases, most KDK in infants <12 months, are given up to 1 year free
from seizures
Further Management

Seizures are always scary to parents

To reduce anxiety in parents:
- Ensuring that FS has a good prognosis
- Tells how to treatment seizures
- Inform that there is a possibility of recurrence.
- Medication is effective to resolve seizure but parents must be caution for the
adverse effect.
Complications

– Risk of developing epilepsy ~1.5%

– Risk rises to 2.5% if the child was under 12 months old when they
had their first seizures (in those who had multiple simple seizure)
– Risk also increases with:
 Neurological abnormalities, or a developmental delay before the
onset of febrile seizures.
 A family history of epilepsy.
A brief fever (<1 h) before the seizure.
 Complex seizures.
 REFERENCE
– Abraham MR, Julien IE, Colin DR. 2007. Sistem saraf. Buku ajar pediatric Rudolph. Vol 3. Ed
20th. Jakarta: EGC
– Deliana M, 2002. Tatalaksana Kejang Demam Pada Anak,
https://saripediatri.org/index.php/sari-pediatri/article/viewFile/962/893 (diakses pada tanggal
12 september 2019 pukul 18:24 WIB)
– IDAI, 2012. Konsensus Penatalaksanaan Kejang Demam. http://www.idai.or.id/professional-
resources/guideline-consensus/konsensus-penatalaksanaan-kejang-demam (diakses pada
tanggal 12 september 2019 pukul 18:40 WIB)
– Irdawati, 2009. Kejang Demam dan Penatalaksanaannya.
https://publikasiilmiah.ums.ac.id/bitstream/handle/11617/2377/KEJANG%20DEMAM%20DAN
%20PENATALAKSANAANNYA.pdf?sequence=1&isAllowed=y (diakses pada tanggal 12
september 2019 pukul 18:50 WIB)
– Richard EB, Robert MK, Ann MA. 2004. Kejang-kejang pada masa anak-anak. Ilmu kesehatan
anak nelson. Vol 3. Ed 15th. Jakarta: EGC
– Roy M, Simon JN.2005. Kejang demam. Pediatrika. Ed 7 th. Jakarta: Erlangga
– Staf Pengajar ilmu kesehatan anak FKUI. 2003. Kejang demam sederhana. Buku kuliah ilmu
kesehatan anak. Vol 3. Jakarta: Balai Penerbit FKUI
– Taslim SS, Sofyan I. 2001.
Frightening but harmless!!

Thank you.