Febrile Seizure

Last Updated on August 28, 2022

History Taking

Fitting

Pre-ictal
• What did the patient do?

Ictal
• What are the features suggestive of seizure?
• Duration of seizure?
• What did the care taker do to stop the seizure? Seizure aborted spontaneously?
• How many episodes?

Post-ictal
• How was patient’s condition post-ictally?

Other history

• Any documented temperature?
• Oral intake? Was was the last meal?
• Reduced urine output?
• Active?
• Any vomiting / loose stool?
• Features may be suggestive of meningitis: Crying when exposed to light? Inconsolable cry? Irritability? Rashes?

Notes

• It’s important to differentiate true fitting from shivering
• It’s important to differentiate simple febrile seizure from complex febrile seizure. Some literature mentioned that complex febrile seizure is at higher risk of developing epilepsy later on, compared to simple febrile seizure.

Simple VS complex febrile seizure

Physical Examination

• Neck stiffness?
• Signs of dehydration (especially patient has history of reduced oral intake / reduced urine output / vomiting / loose stool) ?

Neurological Examination

• Tone, presence of clonus
• Power
• Reflex
• Babinski

Investigations

Bedside

• Capillary blood glucose

Blood Investigations

• FBC, RP, electrolytes

Diagnosis

Differential diagnosis

• Meningitis / encephalitis
• Hypoglycaemia
• Electrolyte imbalance e.g. hypo/hypernatraemia, hypomagnesaemia
• Head trauma (may suspect NAI)
• Poisoning

Notes

• Remember that febrile seizure is NOT a standalone diagnosis. The underlying cause must be found out and treated.
• Points that must be included in a complete diagnosis: (i) simple or complex (ii) underlying cause

Example

• Simple febrile seizure secondary to acute tonsillopharyngitis, with mild dehydration

Take Home Message

1. Never forget to check the capillary blood glucose on arriva
2. Not all febrile seizure requires ward admission