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==Background==
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*Occur in 2-5% of American children before age 5<ref>https://www.ninds.nih.gov/disorders/patient-caregiver-education/fact-sheets/febrile-seizures-fact-sheet</ref>
*50% of patients never have temperature >39
*Febrile seizures do not increase the risk of serious bacterial illness
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===Prognosis===
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*2-3% chance of developing epilepsy (1% for general population)
*50% of patients <12 mo will have another simple febrile seizure
*30% of patients >12 mo will have another simple febrile seizure
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==Clinical Features==
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*[[Special:MyLanguage/Seizure|Seizure]] + [[Special:MyLanguage/fever|fever]]
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===Simple Febrile Seizure===
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*Age 6mo-5yr, with majority occurring between 12mo-18mo
*Single seizure in 24hr
*Duration <15min
*Generalized with no focal features
*Returns to neurologic baseline and has normal neuro exam after brief post-ictal period
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===Complex Febrile Seizure===
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*Any exception to above
*May indicate more serious disease process
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==Differential Diagnosis==
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{{Pediatric seizure DDX}}

{{Pediatric fever DDX}}

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==Evaluation==
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*The key is to distinguish between simple febrile seizure secondary to minor illness vs. seizure from serious central nervous system infection, which may also present with fever and seizure.
*Glucose in all patients
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====Simple febrile seizure====
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*Neither labs nor neuroimaging are absolutely necessary
*Normal [[Special:MyLanguage/Fever (Peds)|pediatric fever workup]]
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====Complex febrile seizure====
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*Consider CBC, [[Special:MyLanguage/blood culture|blood culture]], UA, urine culture, [[Special:MyLanguage/CSF studies|CSF studies]]
**Studies have suggested a link between iron deficiency anemia and rate of febrile seizure <ref>Sulviani R, Kamarullah W, Dermawan S, et al. Anemia and poor iron indices are associated with susceptibility to febrile seizures in children: a systematic review and meta-analysis. J Child Neurol. 2023;38(3-4):186-197</ref>
*Consider CT if:
**Persistently abnormal neuro exam (especially with focality)
**Signs/symptoms of [[Special:MyLanguage/increased ICP|increased ICP]]
**Patient has [[Special:MyLanguage/VP shunt|VP shunt]]
*Consider [[Special:MyLanguage/ECG|ECG]] if:
**Family history of [[Special:MyLanguage/long QT|long QT]], [[Special:MyLanguage/Brugada|Brugada]], sudden death
*Routine EEG not indicated
**Consider only if developmental delay or for focal symptoms
*Causes amenable to specific treatment
**[[Special:MyLanguage/Hypoglycemia|Hypoglycemia]]
**[[Special:MyLanguage/Hyponatremia|Hyponatremia]] (water intoxication, dilution of formula)
**[[Special:MyLanguage/Hypocalcemia|Hypocalcemia]]
**[[Special:MyLanguage/Hypomagnesemia|Hypomagnesemia]]
**[[Special:MyLanguage/INH ingestion|INH ingestion]]
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[[File:Febrile Seizure.png|thumb|Algorithm for the differentiation between simple and complex febrile seizures. Guidelines for evaluation of each.]]
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==Management==
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{{Initial management of pediatric status epilepticus}}

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===Seizure Stopped===
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*Treat underlying infection if indicated
**See [[Special:MyLanguage/pediatric fever of uncertain source|pediatric fever of uncertain source]]
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==Disposition==
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===Discharge===
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*Simple febrile seizure if patient at baseline
**Follow-up in 1-2d
**Around-the-clock [[Special:MyLanguage/acetaminophen|acetaminophen]] may prevent seizure recurrence in the same febrile episode<ref>Murata et al. Acetaminophen and Febrile Seizure Recurrences During the Same Fever Episode. Pediatrics. November 2018, VOLUME 142 / ISSUE 5</ref>
*Complex febrile seizure if patient well-appearing, work-up normal
**Follow-up in 24hr
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===Admit===
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*Ill-appearing
*Lethargy beyond postictal period
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==See Also==
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*[[Special:MyLanguage/Seizure (peds)|Seizure (peds)]]
*[[Special:MyLanguage/Fever (Peds)|Fever (Peds)]]
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==References==
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<references/>
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[[Category:Pediatrics]]
[[Category:Neurology]]
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Febrile seizure/en - Revision history

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