FEBRILE CONVULSIONS
B Kumar*, H Paramesh**, Salim Khatib***
Lakeside Institute of Child Health, Bangalore.*, Lakeside Institute of Child Health, Bangalore.**, Lakeside Institute of Child Health, Bangalore.***
Abstract
Aim:
Analysis of Febrile convulsions in our center and to highlight the current management.

Material and Methods:
Retrospective study of children diagnosed to have febrile convulsions during one year period from August 2005-06, children who were admitted to hospital with history of fever and convulsions were included in the study. Detailed family history was taken. Children with history of congenital anomalies, neonatal seizures and metabolic condition were excluded from the study.

Results:
Of 822 admissions during this period, 20 children (2.5%) were diagnosed to have febrile convulsions. Of this, 13(65%) were males and 7(35%) females. Age ranged from 5.5 months to 5.5 yrs. Convulsions were associated with viral URI in 10 (50%), Acute gastroenteritis in 5 (25%), no specific cause for fever was found in 5 (25%). Family history was strongly present in 75% of children. Fever ranged from 102*f - lO4*f. Convulsions were of generalized tonic clonic type lasting for few seconds to 5mins. Children were managed with intra rectal diazepam when presented with convulsions, and paracetamol to control the temperature.

Conclusion:
Febrile convulsions is most common problem in pediatric practice. Opinion regarding febrile convulsion has changed over the time, Recent consensus regarding management of febrile convulsion is to use only antipyretics.
Introduction
Febrile convulsions are the most common disorder during childhood. Prognosis is generally excellent. Incidence is 2- 5% of all children. It is defined as seizure occurring in children with fever, not associated with any intracranial infection or definable cause for seizure. It commonly occurs between age group of 6 month- 6yrs. It is more common in males. A strong family history of febrile convulsions in the sibling or parents suggests a genetic predisposition. Seizure is usually of generalized tonic clonic type and last for few seconds to 10 mins with no postictal neurological abnormalities.
Materials and Methods
The aim of this study is analysis of febrile convulsions during 1 year period from August 2005 to August 2006in our centre. Children who were admitted to the hospital with history of fever and convulsions were included in the study.

Children with history of congenital anomalies of CNS, neonatal seizure, neuroinfection and other metabolic conditions causing seizure were excluded from study.

Retrospective case study of children diagnosed as febrile convulsions and their case files were analyzed for a detailed history of type of convulsions, its duration, postictal state and associated symptoms. Detailed family history was recorded. Investigations done and the management was analyzed. EEG was included in the investigations for the study purpose. Intrarectal diazepam was given to children who presented to the causality with convulsions. All children were admitted for observation and investigations done to rule out the cause for fever. Parents were counseled regarding the disease and its management in detail.
Results
Of 822 admissions during the study period, 20 (2.5%) were diagnosed to have febrile convulsions. 2 were complex febrile seizures and the rest simple febrile seizures. Age ranged from 5.5 months to 5.5 years. Of 20 children, 13 (65%) were males and 7 (35%) were females. Convulsions were associated with viral URI in 10 (50%), acute gastro enteritis in 5 (25%), and no specific cause for fever found in 5 (25%). Family history was strongly positive in 75%. Convulsions were of generalized tonic clonic type lasting for few second to 5mins. Temperature ranged from 102* F to 104*F. children were managed with intra rectal diazepam when presented with convulsions and antipyretic to control temperature. Supportive treatment of associated symptoms was given.

 Number of Pediatric admissions

  822

  Number of children with convulsions

  20 (2.5%)

  Type of convulsions
  Simple febrile convulsions
  Complex febrile convulsions


  18(90%)
  2 (10%)

  Sex
  Male
  Females

    
13(65%)
  7 (35%)

  Family history

  Positive (75%)

  Associated symptom
  Viral URI
  Acute gastro enteritis
  No specific cause for fever

  
50%
  25%
  25%



Discussion
Febrile convulsions are the common condition seen in pediatric practice. Opinion regarding febrile convulsion have changed over the time. In 1949 Lennox stated that febrile convulsions may cause brain pathology as evidenced by transient or permanent neurological deficit. In contrast recent studies have correlated febrile convulsions to immunological problem through, interleukin, cytokine, immunoglobulin and interferon's. Also correlation between febrile convulsions and iron deficiency anemia, hypozincemia or to specific infection has been published. It has been recognized that there is significant genetic component for susceptibility of febrile convulsions. Risk factors for febrile convulsions are 1st or 2nd degree relative with the history of febrile convulsions. History of neonatal stay for more than 30 days, development delay, and attending day care center are other risk factors. Routine laboratory investigations, electroencephalogram, and neuroimaging are not indicated for patients diagnosed to have febrile convulsions and should be performed only as part of evaluation for a source of fever or an atypical case. There is no convincing evidence that antipyretic measure reduce the frequency of febrile recurrence or that the administration of intermittent or continuous prophylactic anticonvulsant medication reduces the risk of occurrence of later epilepsy.

The parents should be counseled about the benign nature of the febrile convulsions, that it generally doesn't lead to neurological problems, developmental delay or intellectual deficit. It has no relation to occurrence of future epilepsy and that febrile convulsions generally have excellent prognosis.
Conclusion
Febrile convulsion is recognized as a benign syndrome with increasing reports on the molecular genetic factors. Longterm management should be focused on parent education, to decrease their anxiety and to teach them about home management of febrile convulsions. Treatment to prevent recurrence has not been shown to prevent the later development of epilepsy. Potential risk of anticonvulsant therapy should be weighed against benefits. The majority of children with febrile convulsion requires no treatment. Febrile convulsion has excellent prognosis.
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