
Febrile Seizures
Presentation
Age: 6 months–6 years
Trigger: Fever >38°C, typically due to viral infections
Types:
Simple: Generalised tonic-clonic, <15 min, no recurrence within 24 hours
Complex: Focal features, >15 min, or ≥2 seizures in same illness
Recurrence Risk: ~50% within 1 year if onset before 12 months
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When to Refer
Urgent (ED) Referral
Seizure >10 minutes
Focal features or prolonged postictal weakness
Slow recovery (>1 hour) post-seizure
Multiple seizures in the same illness
Elective Referral
Abnormal neurological exam between episodes
Recurrent complex febrile seizures
Family history of epilepsy
Epilepsy Risk Factors
Family history of epilepsy
History of complex febrile seizures
Neurological abnormalities or developmental delay
Onset <12 months of age
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Management
During Seizure
Do not restrain or put anything in the mouth
Recovery position to prevent aspiration
Ensure safety, clear objects from surroundings
Post-Seizure
Call an ambulance if:
Seizure lasts >5 minutes
A second seizure occurs
No full recovery of consciousness
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Parent Education
Prognosis: Benign, low risk of epilepsy with simple febrile seizures
Fever Management: Antipyretics (paracetamol, ibuprofen) for comfort but do not prevent seizures
Seizure First Aid: Teach parents recovery steps and when to seek emergency care
Seizure Diary: Record details of episodes
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Additional Notes
Investigations: Not required for simple febrile seizures unless focal, prolonged, or meningitis is suspected
Prophylaxis: No role for routine antiepileptic drugs
Vaccination: Continue as normal, discuss MMRV timing due to slightly increased seizure risk
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