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Query: UMLS:C0009952 (febrile convulsions)
 1,215 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Febrile seizures are the most common seizures seen in children younger than 5 years old. Out-of-hospital and emergency department providers need to be familiar with the principles of the evaluation and management of this common disorder. Most febrile seizures are brief, do not require any specific treatment or extensive workup, and have a benign prognosis. Recognizing the pattern of a simple febrile seizure in young children is important to limit interventions and to reassure parents. Patients with febrile seizures are not at higher risk for serious bacterial illnesses than similarly aged febrile patients. Excluding meningitis and encephalitis are the primary clinical interventions through a thorough history and physical examination and, occasionally, a lumbar puncture. Reassuring parents of patients with febrile seizures and arranging primary care follow-up are important roles for the emergency physician.
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PMID:Evaluation and management of febrile seizures in the out-of-hospital and emergency department settings. 1254 71

Febrile seizures result from age-dependent hyperexcitability of the brain that is induced by fever. Although there are important genetic influences that render a febrile child more likely to develop seizures, it is the fever per se that causes the seizure. Of primary importance in the diagnostic assessment of such children are efforts directed at finding the cause of the fever. Once found, the cause should be treated specifically, e.g. antibacterials for otitis media, and/or symptomatically, e.g. antipyretics for viral pharyngitis. It is essential to exclude underlying meningitis in all children with febrile seizures, either clinically or, if any doubt remains, by lumbar puncture. In as many as one child in six with meningitis, seizures are the presenting sign, and in one-third of these patients, meningeal signs and symptoms may be lacking. The great majority of such cases of meningitis are bacterial in origin, and delay in diagnosis can result in serious neurologic morbidity, and even death.In the child who convulses with fever, it is always important to consider that something in addition to the fever has caused the child to have a seizure. Infection that has gone unnoticed, such as meningitis or encephalitis, as well as a systemic illness, head trauma, intoxication, electrolyte imbalance, low blood sugar, or a phakomatoses, can cause seizures. One must also consider the possibility that the child with a febrile seizure has epilepsy, and that fever has simply triggered a seizure recurrence in a child who also experiences unprovoked seizures.Thus, based on the specifics of each case, the diagnostic evaluation of the child with a febrile seizure can be very limited or moderately comprehensive. Imaging studies are necessary only in selected cases. The electroencephalogram is of limited value. The primary concern is always the need to exclude meningitis. Therefore, a lumbar puncture should be carried out, except in those cases where the possibility of CNS infection seems truly remote.
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PMID:Evaluation of the child who convulses with fever. 1283 18

The aim of this retrospective, multicenter clinical study was to evaluate the aetiology of epilepsy in surgically treated patients in China. The detailed clinical records of all intractable partial epilepsy (IPE) were reviewed in five tertiary referral centres from June 1991 to June 2000. 1650 patients (927 males, 723 females) were recruited. 41.4% had aetiological factors, including the histories of major brain trauma (20.9%), febrile seizure (6.5%), meningitis (5.4%), encephalitis (5.0%), prenatal distress (2.1%), birth trauma (0.8%) and family history of seizure (0.7%). The pathological lesions were divided into eight groups according to the nature of the lesion: scar (19.2%), vascular malformations (VM) (17.7%), hippocampal sclerosis (HS) (16.2%), tumours (15.0%), gliosis (12.1%), neuronal migration disorders (NMDs) (7.4%), intracranial infection (4.5%), and other lesions (7.9%). In conclusion, effective management of these aetiological factors and pathological lesions may be essential to deal with IPE. Scar, HS, VM, NMDs are the most likely consequences of antecedent morbid events.
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PMID:Aetiology of epilepsy in surgically treated patients in China. 1515 3

Chickenpox is self limiting disease, with potentially dangerous course. Chickenpox complications can evoke the necessity of hospitalization. Assess the types and courses of chickenpox complications in child patients hospitalized in Provincial Hospital of Infectious Diseases in Bydogoszcz between 1999 and 2003. Cases of chickenpox complications being the reason of children hospitalization were retrospectively analyzed. The total number of children hospitalized because of chickenpox complication is 153. Patients age ranged from 18 days to 18 years, with average of 5,4 years. 62% of children were younger than 5 and, 1/3 children were younger than 1. The average period of hospitalization was 7 days. 17% of patients stayed in hospital longer than 10 days. 53% of patients were male. In 5 cases chronic diseases were diagnosed. The most common reason of hospitalization connected with chickenpox were symptoms of alimentary canal disorder (30%), respiratory tract inflammations, with pneumonia and bronchitis in the lead (30/47). Neurological complications during chickenpox occurred in 23 of 153 hospitalized (15%): febrile convulsions - 6/153, cerebellar ataxia - 9/153, meningitis and brain fever - 6/153, peripheral nerve - 2/153. Bacterial skin infection as the reason of hospitalization of 16 children, hepatitis of 3 and joints inflammation of 1 child.
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PMID:[Complications of chickenpox as reason for children's hospitalization]. 1580 72

Neurologic morbidities seen in the children's emergency facility of the University of Benin Teaching Hospital, Nigeria, over a five-year period (July 1996-June 2001) was evaluated to determine the pattern and outcome. Notes and ward records of patients with neurologic morbidities were retrieved. Data obtained from these sources include age, sex principal diagnosis, duration of stay and outcome. Six-hundred-four out of 3,868 patients (15.6%) had neurologic morbidity. Children five years of age and under were 466 (77.2%), and modal age group was 1-2 years. Febrile convulsion was the most common neurologic morbidity seen (35.1%) followed by cerebral malaria (28.0%) and then meningitis (27.0%). An increased incidence of cases occurred during the rainy season. Sixty-four out of 406 with complete records (15.8%) died. Forty-seven (67.2%) died within 24 hours of admission. Cerebral malaria and meningitis accounted for all the deaths. Preventable infectious diseases are the major causes of emergency neurologic morbidities and mortality. The majority die within 24 hours largely due to a delay in presentation to the hospital. Effective malaria control and prevention of meningitis would reduce the incidence of neurologic morbidities and, if this is coupled with health education of the populace on the importance of attending health facility early, mortality from these causes would be greatly reduced.
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PMID:Pattern of emergency neurologic morbidities in children. 1587 Nov 44

Febrile seizures are the most common cause of convulsions in children. Most are simple in nature, although those with focal onset, prolonged duration ((3)15 min) or those that recur within 24 h or within the same febrile illness are considered complex. Diagnosis of this condition is essentially clinical and based on its description provided by parents. Its pathophysiology remains unclear, but genetics plays a major role in conferring susceptibility. Although most febrile seizures are benign and associated with minor viral illnesses, it is critical that the child be evaluated immediately to reduce parental anxiety and to identify the cause of the fever. It is essential to exclude underlying pyogenic meningitis, either clinically or, if any doubt remains, by lumbar puncture. The risk of pyogenic meningitis is as low (< 1.3%) as the risk in a febrile child without seizures. After an initial febrile seizure (simple or complex), 3-12% of children develop epilepsy by adolescence. However, the risk of developing epilepsy after an initial simple febrile seizure is low (1.5-2.4%). Since the vast majority of children have a normal long-term outcome, antiepileptic medication is not recommended to prevent recurrence of febrile seizures. Oral diazepam or clobazam, given only when fever is present, is an effective means of reducing the risk of recurrence. The family physician can play an important role in counseling the parents that most febrile seizures are brief, do not require any specific treatment or extensive work-up, the probability of frequent or possibly threatening recurrences is low and the long-term prognosis is excellent.
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PMID:Febrile seizures: a review for family physicians. 1733 19

A 12-month-old girl with occult bacterial meningitis presented with a simple febrile seizure. On examination, the patient was alert, interactive, and smiling responsively without meningeal signs, focal neurologic findings, or signs of extreme illness. Her parents were reluctant to allow a lumbar puncture, and the patient was admitted for observation without lumbar puncture. Her fever resolved, and she was playful, had good oral intake, and was discharged 24 hours after admission. Her initial blood-culture result remained negative. Within 24 hours of discharge, the patient had a focal febrile seizure, came back to the hospital, and was found to have meningitis with a penicillin-susceptible, nonvaccine Streptococcus pneumoniae strain 12F.
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PMID:Pneumococcal meningitis presenting with a simple febrile seizure and negative blood-culture result. 1797 57

Febrile seizures are the most common form of childhood seizures, affecting 2-5% of all children and usually appearing between 3 months and 5 years of age. Despite its predominantly benign nature, a febrile seizure (FS) is a terrifying experience for most parents. The condition is perhaps one of the most prevalent causes of admittance to pediatric emergency wards worldwide. FS, defined as either simple or complex, may be provoked by any febrile bacterial or (more usually) viral illness. No specific level of fever is required to diagnose FS. It is essential to exclude underlying meningitis in all children with FS, either clinically or, if any doubt remains, by lumbar puncture. There is no evidence, however, to support routine lumbar puncture in all children admitted with simple FS, especially when typical clinical signs of meningitis are lacking. The risk of epilepsy following FS is 1-6%. The association, however small, between FS and epilepsy may demonstrate a genetic link between FS and epilepsy rather than a cause and effect relationship. The effectiveness of prophylactic treatment with medication remains controversial. There is no evidence of the effectiveness of antipyretics in preventing future FS. Prophylactic use of paracetamol, ibuprofen or a combination of both in FS, is thus a questionable practice. There is reason to believe that children who have experienced a simple FS are over-investigated and over-treated. This review aims to provide physicians with adequate knowledge to make rational assessments of children with febrile seizures.
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PMID:Assessment of febrile seizures in children. 1957 74

Fever with seizure, a common presentation with which a child may present to the emergency is mainly due to febrile seizure, but it may also be due to meningitis. This study was done to find out the incidence of meningitis and to find out whether lumbar puncture is necessary in different age groups of children presenting with first episode of fever with seizure. A prospective study was conducted in the emergency department of Kanti Children's Hospital. Children who presented with first episode of fever and seizure in the age group of 6 months to 5 years were included. Meningitis was diagnosed on the basis of either cytological and biochemical criteria or if a bacterial pathogen was isolated. Of the 175 children included, 17% were diagnosed to have meningitis. Cerebrospinal fluid was positive for a bacterial pathogen in 4.5% of the cases. In the age group of 6 months to 12 months, 30% of the children had meningitis as compared to 20 % and 5% in other age groups of 12- 18 months and above 18 months respectively. All children with culture proven bacterial meningitis were in the age group of 6-12 months and had no evidence of meningeal irritation. Signs of meningeal irritation had high specificity in diagnosing meningitis. Organisms grown were Haemophilus influenza in three cases, Streptococcus pneumoniae in two cases and Staphylococcus aureus in three cases. In conclusion, incidence of meningitis was found to be high in children presenting with first episode of fever and seizure. Lumbar puncture to rule out meningitis should especially be considered in children in the younger age group even without evidence of meningeal irritation.
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PMID:Children with first episode of fever with seizure: is lumbar puncture necessary? 1907 73

In the second revision of the practice guideline 'Children with fever' from the Dutch College of General Practitioners, due to its greater reliability rectal measurement of the body temperature above measurement with an ear thermometer is recommended in the case of children younger than 3 months, where the classical signs of infectious diseases are often less apparent. The practice guideline distinguishes between alarm signs which can be recognised by the parents and alarm symptoms which can be diagnosed by the physician during a physical examination. In children younger than 2 years who are feverish with no apparent cause, the urine should be examined at the first consultation. An X-ray of the thorax of a child with fever is only necessary if pneumonia is suspected. As it is not possible at an early stage to identify serious cases among children who are feverish without an apparent cause, these children should be re-examined within 24-48 hours. Children with fever who are younger than 3 months should be referred to a paediatrician. A typical febrile seizure is harmless, nevertheless an underlying meningitis should be excluded.
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PMID:[Summary of the practice guideline 'Children with fever' (Second Revision) from the Dutch College of General Practitioners]. 1917 14


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