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Cardiovascular

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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