Febrile Seizures

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Common causes of febrile seizures
A viral upper respiratory tract infection, roseola infantum, Malaria and acute suppurative otitis media are the common underlying causes of fever in febrile seizures.
Pattern recognition:
a. History : should elicit details of quality, duration, number of seizures, history of trauma, current illness and family history of seizures previous similar episodes.
b. A thorough physical examination is undertaken
(i) For ruling out an intracranial infection or residual neurological signs or both (look for meningeal signs)
(ii) To uncover the cause of fever (eg. Examination of the ear, nose, throat, look for rash, chest and abdominal examination to detect cause of fever.)

Laboratory investigations:
a. A complete Blood count
b. Metabolic screen (blood sugar, electrolytes, liver and renal function)
c. Any relevant investigation to detect cause of fever
d. Lumbar puncture : One of the controversies
in Pediatric Emergency Medicine is the indication for Lumbar Puncture in a child who presents with first febrile seizure. The present recommendation is that Lumbar puncture following first attack of febrile seizure is indicated in the following situations:
Any doubt exists with regards to the possibility of meningitis on clinical examination
(ii) First febrile seizures in the age group 12 months to 18 months and over 3 years of age.
(iii) Prior antibiotic therapy in any child with febrile seizures as the signs of meningitis may have been masked
(iv) Immuno suppressed children

In a child between 12 to 18 months of age with febrile seizures, the symptoms of meningitis may not be evident. Hence high degree of suspicion is required and lumbar puncture is indicated to rule out Acute Intracranial infection.
Lumbar puncture is not indicated during recurrence of febrile seizures, but at the same time, intracranial infection should not be overlooked during such recurrences.
e. EEG in febrile seizures : EEG is not warranted for simple febrile seizures. But EEG is indicated in all cases of atypical febrile seizures or the child at risk for developing epilepsy.

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