COMPLEX FEBRILE SEIZURE
16 month old male presenting to the emergency department with reports of stiffening and unresponsiveness at home. Parents report that he was stiff with head/eyes deviated to the right for about 10 minutes.
No history of fever or trauma. No history of seizures. No recent illnesses.
Vaccines up to date - just received two vaccines (Varivax and one other 1 day prior)
In the ED, still with eye and head deviation to the right, lasting about 5-10 minutes. Resolved spontaneously and then patient at baseline.
Vital signs: T 39.0 HR 189 RR 24 O2 98%
What is the appropriate workup?
Currently there is no consensus statement on the initial evaluation/workup of a first-time complex febrile seizure.
Each case should be looked at carefully on an individual basis.
Some relevant evidence is presented on the right.
Definiition: Seizure in association with fever, in a child age 6 months - 5 years. The child is otherwise neurologically normal, without neurological abnormality by exam or developmental history (or other history). The seizure is either focal, prolonged (> 15 minutes) or multiple seizures occur in close progression.
EVIDENCE
Summary:
526 patients with complex febrile seizure.
340 (64%) had lumbar puncture performed.
3 patients diagnosed with bacterial meningitis.
Out of the 3, 1 with "presumed" meningitis due to positive blood culture (strep. pneumoniae). 1 obtunded with full fontanelle and apnea requiring intubation.
Can seizures be the sole manifestation of meningitis in febrile children? Pediatrics 1993.
Summary:
111 children with febrile seizure found to have bacterial meningitis.
103 were classified as "comatose" or "obtunded." Remainder had other clinical findings of concern (nuchal rigidity, etc).
Summary:
Prospective study examining risk of emergent intracranial conditions in complex febrile seizures.
71 patients included.
38 had CT, MRI or both.
No patients found to have emergent intracranial pathologic condition.
Summary:
Retrospective study with 45 children presenting with first complex febrile seizure.
7 (16%) had abnormal CT or MRI findings, but none requriing emergent intervention.
Value of brain CT scan in children with febrile convulsions. J Neurol Sci 1995.
Summary:
13 patients who underwent CT after first complex febrile seizure.
None with abnormal findings.
Summary:
17 children with complex febrile seizures who underwent CT scan.
3 found to have non-emergent abnormalities on CT scan.
