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Brief (<15 min), generalized, tonic-clonic seizure associated with a febrile illness, but without any CNS infection, severe metabolic disturbance, or other known neurological cause
The most common seizure disorder during childhood
Age: 6 m/o ~ 5 y/o Incidence: 2% ~ 4% in children
<5 y/o Peak age of onset: 18 ~ 22 m/o Sex: male = female Strong family history in siblings and pa
rents: increase risk 2~3 times
Viral URI Reseola Acute otitis media
80~90% of cases Occur early when core
temperature reaches 39 C or greater
Generalized, tonic-clonic for seconds to 15-min, followed by a postictal period of drowsiness
Age < 6 m/o or > 5 y/o Onset >24 hr after fever onset Duration >15 min Occur more than once in 24 hr Focal motor manifestations Abnormal neurological
examination
Typical: not required Atypical: required
• EEG• Toxicology screening• Assessment of electrolytes• CT or MRI
Routine treatment:• Search for the cause of fever• Control fever (avoid excessive clothing, encourage fluids, tepid sponge bath, and antipyretics)
Prophylactic anticonvulsants are not indicated for typical febrile convulsion
Excellent prognosis in most children
Risk of recurrence:• Onset < 1 y/o or with family history: 50%
• Onset > 1 y/o: 30 % up to the age of 5 yr
• After second episode: 50 %• Age > 5 y/o: near zero
Risk of epilepsy development:• 1~2% in the general population
• increase up to 9% when two or more risk factors are present
Risk factors for epilepsy development:• Positive family history of epilepsy• Atypical febrile convulsion• Previous abnormal development or neurological disorder
Antipyretic agents: ineffective Diazepam: effective and safe
• Oral or rectal form• For patients with frequent febrile convulsion or significant parental anxiety
• Dose: 0.3 mg/kg q8h PO (1 mg/kg/d) for the duration of the illness (2~3 days)
• Side effects: lethargy, irritable, ataxia
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