Seizure - Febrile
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Paediatric Clinical Guideline Febrile Seizure
Febrile Seizure Guideline
Title of Guideline (must include the word Guideline(not protocol, pol icy, procedure etc)
Contact Name and Job Title (author ) Kiran Damera (Specialist Registrar), Colin Dunkley(Consultant Paediatrician) on behalf of ChildrensEpilepsy Workstream in Trent (CEWT) Steering Group
Directorate & Speciality PaediatricsDate of submis sion July 2011Date on which guideline must be reviewed (this shouldbe one to thr ee years)
July 2014
Explicit definition of patient group to which i t applies(e.g. inclusion and exclusion c riteria, diagnosis)
Children and young people presenting with seizure withfever to acute paediatric services
Abst rac t as aboveKey Words Febrile convulsion, Febrile Fit, Febrile SeizureStatement of the evidence base of the guideline hasthe guideline been peer reviewed by colleagues?
Evidence base: (1-5)
1a meta analysis of randomis ed contr olledtrials
1b at least one randomised controlled trial
2a at least one well-designed controlled studywithout randomisation
2b at least one other type of well-designed quasi-experimental study
3 well designed non-experimental descriptivestudies (ie comparative / correlation and casestudies)
4 expert committee reports or opinions and / orclinical experiences of respected authorities
5 recommended best practise based on theclinical experience of the guideline developer
Multiple evidence based sources largely 3-4.
Consultation Process Nottingham Childrens Hospital Guideline GroupChildrens Epilepsy Workstream in Trent (CEWT)Steering GroupDerived from RCPCH GUIDELINE APPRAISAL.Paediatric Accident and Emergency Research Group.
Evidence-based Guidelines for Post SeizureManagement.(www.rcpch.ac.uk/publications/clinical_docs/post_seizure.pdf)
Target audience Paediatric health professionals
This guideline has been registered with the trust. However, clinical guidelines are guidelines only. The
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Paediatric Clinical Guideline Febrile Seizure
Scope
Children and young people presenting with seizure with fever to acute paediatric services
Definitions and background
Fever:
DefinitionRecorded temperature >37.8 or perceived to have fever by parents/carers around time of seizure
Febrile Seizures: (Sometimes termed Febrile Convulsion)
Definition:An event in infancy or childhood between 6 months and 5 years of age (peak age 20 months) associatedwith fever but without evidence of intracranial infection or defined cause of seizure. Population studiesreport a cumulative incidence of 25%.
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Risk Factors:
Previous febrile seizure
Family history (first degree relative): 10 - 45%
Types of febrile seizures:
Simple Febrile Seizures: A single generalised (no focal features) seizure lasting 15 min or focal features.
Acute symptomat ic seizures with fever
Other conditions can cause seizure associated with fever. These include
Intracranial infections (e.g. meningitis/encephalitis),
Metabolic or neurodegenerative disease.
Epilepsy with fever-related seizures
Seizures can be precipitated by fever in children with a known epilepsy
Other situations e.g. Fever with rigors
There are other types of episode occurring with fever that may need to be considered
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Seizure(s) with Fever
Meningism orMeningococcal shock?
Concerning Features?*
First Febri le Seizure?OR
No clear focus of in fection?OR
Parental concern?
Meningitis /Meningococcal SepsisGuidelines
Further Paediatric Assessment History and examination
Identify source of fever, investigate &treat according to NICE feverish illnessguidelines
Paracetomol and/or ibuprofen prn
Routine investigations are not indicated inall children with febrile seizures
Consider LP if concerning features*(note contraindications)
Senior review prior to discharge
Minimum 2 hours observations
Care for any child may need
supplementing with other guidelines e.g.Petechial rashUrinary Tract InfectionChest InfectionDiarrhoea and VomitingBone and Joint Infection
Once fit for discharge:
Discuss risk of future seizures
Consider home Buccal Midazolam if
prolonged convulsive seizure >10minutes. Ensure prescribed withindividualised care plan and appropriateparental training.
Febrile seizure and fever managementadvice and written information
*Concerning Features: Complex febrile seizures
o Multiple seizures in same illnesso Prolonged >15 mino Focal features
Infant < 18 months
Prior treatment with antibiotics
Drowsy before the seizure
More than 3 days illness
GP contact in last 24 hrs
Vomiting at home
Drowsy > 1 hr post seizure Neck stiffness
Petechial rash
Bulging fontanelle
Hypertension
Previous febrile seizuresAND
Focus of infection identifiedAND
No signif icant parental concern
Manage according to cause
Consider discharge
Discuss risk of future seizures Febrile seizure and fever management advice and
written information
Known or suspected epilepsy?
Review epilepsy and management
Inform epilepsy specialist nurse Review need for admission or earlier outpatient
appointment
The management of epilepsy is outside scope ofthis guideline
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NoYes
Yes
No
Continuing convulsiveseizure > 5 minutes?
Decreased conscious level? Before seizure onset
Or > 1 hour after seizure end
Or longer than typical post-ictalperiod for child in question
Prolonged Convulsive SeizureGuideline
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Reduced Conscious LevelGuideline4
Reproduced from RCPCH Reduced Conscious Level Guideline4
No
No
No
Yes
Yes
Yes
Yes
Yes
No
For further info please see www.cewt.org.uk