Diagnostic evaluation of children presenting with febrile seizures

Abstract

OBJECTIVE: Febrile seizures are recognised as the most common seizure type affecting 3–4% of all children. Many affected children have recurrent febrile seizures but the risk of subsequent epilepsy is considered to be small. We examined diagnostic evaluation and management of children presenting with febrile seizures. METHODS: Retrospective case note review of 267 children (160 male), median age 48 months who presented to Accident and Emergency with febrile seizures, 2009–2013. RESULTS: Of 229/267 children presented with first febrile seizure, 37/ 267 with history of previous febrile seizures, (one undocumented). Of 233/267 children were diagnosed with simple (generalised tonic clonic seizures lasting <15min); 33/267 complex febrile seizures (22/33 focal seizures lasting longer than 15min, 11/33 recurrent seizure within 24h); one undocumented. Of 191/267 children had 1 or more recognized risk factors for febrile seizures namely: 134/191 early onset (aged <18mo); 78/191 seizures at lower temperature (<39.4); 42/191 with first or second degree relative with febrile seizures; 31/191 slow development; 23/191 delayed neonatal discharge; 18/191 day care attendance. Of 234/267 children were diagnosed with an inter-current illness; the most common being upper respiratory tract infection, tonsillitis and acute otitis media. 1Of 24/267 children were discharged from Accident and Emergency; 143/267 were admitted for investigations, and/or treatment. Of 37/267 previously diagnosed with an underlying condition. Of 3/37 children with an underlying condition had a pre existing diagnosis of epilepsy; 2/33 children who presented with complex febrile seizures were later confirmed SCN1A positive for Dravet Syndrome. Data analysis on management is in progress. CONCLUSION: Febrile seizures are common. More than half of children in this cohort were admitted to hospital for treatment and investigations. Implementation of evidence based guidelines for evaluation and management of children presenting with febrile seizures may decrease the number of hospital admissions and unnecessary investigations.