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Likely Hood of Complex Febrile Seizure to Happen Again

Ditulis Jumat, 22 April 2022 Tulis Komentar Edit

Seizure associated with high torso temperature

Medical condition

Delirious seizure
Other names Fever fit, febrile convulsion
Clinical thermometer 38.7.JPG
An analog medical thermometer showing a temperature of 38.8 °C or 101.eight °F
Specialty Emergency medicine, neurology
Symptoms Tonic-clonic seizure[i]
Usual onset Ages of six months to five years[ane]
Duration Typically less than 5 minutes[ane]
Types Uncomplicated, complex[1]
Causes Loftier torso temperature[ane]
Risk factors Family history[i]
Differential diagnosis Meningitis, metabolic disorders[ane]
Treatment Supportive care[i]
Medication Benzodiazepines (rarely needed)[1]
Prognosis Skilful[ane]
Frequency ~5% of children[two]

A febrile seizure, also known as a fever fit or febrile earthquake, is a seizure associated with a high torso temperature but without any serious underlying health upshot.[ane] Febrile seizures affect 2–10% of children[2] and are more than common in boys than girls.[3] They near usually occur in children between the ages of six months and five years although some authorities propose that the age range should include those down to ane calendar month.[4] [five] Most seizures last less than five minutes, and the kid typically recovers quickly.[4] [3] There are ii types: simple febrile seizures and complex febrile seizures.[1] [3] Unproblematic febrile seizures involve an otherwise healthy child with a unmarried, tonic-clonic seizure lasting less than 15 minutes.[4] [3] Circuitous febrile seizures take one of more of the following: focal symptoms such every bit jerking of only one side of the body, elapsing of > 15 minutes, or ii or more seizures inside 24 hours.[iv] [3] About 60-seventy% are classified as unproblematic febrile seizures and 30-twoscore% complex.[4]

Febrile seizures are triggered past fever, typically due to a viral infection.[iv] [6] The underlying machinery is not fully known, simply it is thought to involve genetics, environmental factors, brain immaturity, and inflammatory mediators.[6] [seven] The diagnosis involves verifying that there is not an infection of the brain, there are no metabolic problems, and at that place have non been prior seizures that have occurred without a fever.[3] [iv] Blood testing, imaging of the brain, or an electroencephalogram (EEG) is typically not needed.[four] Test to determine the source of the fever is important.[3] [7] In otherwise healthy-looking children a lumbar puncture is not necessarily required.[4] [7]

After a single febrile seizure there is an approximately 35% risk of having another one during babyhood.[viii] [ix] Neither anti-seizure medication nor anti-fever medication are recommended in an effort to prevent further febrile seizures.[x] [11] [12] Efforts to quickly cool the child's trunk during a seizure have not been extensively studied but are not recommended.[thirteen] Abode use of a benzodiazepine (diazepam, lorazepam or midazolam) at the time of subsequent fevers may be considered for children with an initial prolonged febrile seizure.[14] The long term outcome of children with febrile seizures is generally excellent with similar academic achievements to other children.[7] There is stiff evidence that children with delirious seizures have a slightly increased take a chance of epilepsy at two-3% compared to the full general population hazard of most 1%.[iv] [3] [15]

Signs and symptoms [edit]

In full general, the child's temperature is greater than 38 °C (100.four °F),[6] although most have a fever of 39 °C (102.ii °F) or college.[6] Most febrile seizures occur during the first 24 hours of developing a fever.[vi] Signs of typical seizure activeness include loss of consciousness, opened upturned optics, irregular animate, increased secretions or foaming at the mouth, and the child may look pale or bluish (cyanotic), The torso stiffens with rhythmic jerk of arms and legs. The child may be incontinent (wet or soil themselves) and may besides vomit.[16]

Types [edit]

There are two main types of febrile seizures: unproblematic and complex.[3] [4] The distinction betwixt unproblematic and circuitous is based on the risk of subsequent epilepsy.[3] Simple febrile seizures accept a very low risk (~2%) of later epilepsy (seizures without fever).[3] [iv] The risk of epilepsy following circuitous febrile seizures depends on the number of circuitous features with each factor adding about a v% risk.[3] Thus children with all iii factors accept a adventure of subsequent epilepsy of about 15%. Delirious condition epilepticus (FSE) implies that the seizure lasts for longer than 30 minutes.[7] It occurs in upwards to five% of delirious seizure cases and has some special long term concerns (see below)[17] [xviii]

Types[3] [four] [18]
Simple Complex
Characteristics Generalized tonic clonic movements (stiffening and shaking of arms and legs) Focal movements (ordinarily affecting a single limb or side of the body)
Duration <15 minutes (with about lasting <5 minutes) >15 minutes
Postictal state None or curt period of drowsiness Longer catamenia of drowsiness; may experience Todd's paralysis
Recurrence No recurrence in the first 24 hours May recur in the first 24 hours

Causes of Fever [edit]

Genetic associations[19]
Type OMIM Gene
FEB3A 604403 SCN1A
FEB3B 604403 SCN9A
FEB4 604352 GPR98
FEB8 611277 GABRG2

Febrile seizures are brought out by fever,[iii] usually higher than 38 °C (100.4 °F).[12] The crusade of the fever is oftentimes a viral illness.[iv] The likelihood of a delirious seizure is related to how loftier the temperature reaches.[4] [6] It is very hard to prove in humans if rate of rise of the temperature (i.e. how fast the temperature goes upward) is important.[4] [18]

In children, illnesses that ofttimes cause a fever include eye ear infections and viral upper respiratory infections.[twenty] [21] Other infections associated with febrile seizures include Shigellosis, Salmonellosis, and Roseola.[22] How these infections provoke febrile seizures remains unclear. Is information technology just the fever or could there be direct invasion of the encephalon or the effect of a neurotoxin?[22]

There is a pocket-sized chance of a febrile seizure after certain vaccines.[23] The risk is simply slightly increased for a few days later on receiving 1 of the implicated vaccines during the time when the child is likely to develop a fever every bit a natural immune response.[6] Implicated vaccines include:[vi] [23]

  • measles/mumps/rubella/varicella
  • combined diphtheria/tetanus/acellular pertussis/polio/Haemophilus influenzae type b
  • diphtheria-tetanus-whole-cell pertussis, which is not used in North America anymore
  • some versions of the pneumococcal vaccine
  • some types of inactivated influenza vaccine

Overall, vaccination is rarely followed by febrile seizures.[24] The MMRV (measles, mumps, rubella, varicella) vaccine may accept a slightly higher hazard for febrile seizures than MMR alone.[25] For children with a genetic predisposition for febrile seizures, vaccines may induce a febrile seizure simply by causing fever.[26] [27] [28] The risk of febrile seizures does not announced to outweigh the benefits of routine immunization.[29] Importantly, experiencing a delirious seizure post-obit immunization does non constitute equally an adverse reaction.[29]

Genetics [edit]

At that place is evidence that many children with febrile seizures have a genetic predisposition to have febrile seizures.[30] If a kid with a delirious seizure has an identical twin (monozygotic), the twin is much more likely to also have a febrile seizure than if the twin is non-identical (dyzygotic)[iii] Beginning caste relatives (female parent, father, sibling) of a child with delirious seizures have a hazard of 10-15% of having a febrile seizure compared with the general risk in the population of just 3-4%.[iii] At least 20 chromosomal areas accept been linked to febrile seizures and several of the specific mutated genes coming from these areas accept been identified (for example, SCNA1, SCN1B, SNCA9A, GPR98,GABRG2).[xxx]

The exact pattern of inheritance of febrile seizure susceptibility genes is usually unclear.[3] [30] In two situations the mode of inheritance is autosomal dominant – Dravet syndrome and GEFS+.[3] [thirty] Dravet syndrome is a serious epilepsy syndrome caused by mutations in the gene SCN1A.[31] These children accept prolonged, oftentimes focal, febrile seizures in the first year of life followed past severe epilepsy. Dravet syndrome is usually not inherited. The syndrome of GEFS+ (genetic epilepsy with febrile seizures plus) is an inherited condition (autosomal dominant) as well with mutations in the SCN1A gene.[32] Here, afflicted family members nigh often have delirious seizures that may be followed by later development if a multifariousness of types of epilepsy (defined as unprovoked seizures).[32] A variety of factors increase the chance that a kid volition have a showtime febrile seizure. These factors include a family history of delirious seizures, delay in going abode afterward birth, possible slow development and possibly attendance at day care (increasing the risk of illnesses).[33] The effect of socio-economical status has not been extensively studied although lower socio-economical status is associated with a higher rate of infectious illness, so might well contribute to a higher risk of febrile seizures.[34] [35] Studies in developing countries take shown an clan between febrile seizures and atomic number 26 deficiency anemia.[36] There is also evidence that serum zinc levels are, on average, lower in children with febrile seizures than those without.[37] Unfortunately supplemental zinc treatment does not seem to foreclose recurrent febrile seizures.[38]

Mechanism [edit]

The exact underlying machinery of febrile seizures is yet unknown, only it is thought to exist multi-factorial involving genetic and environmental factors.[six] [vii] Clearly, febrile seizures have something to do with brain maturity only it is unclear why the immature brain is more vulnerable to the effects of fever.[6] 1 proposal is that inflammatory mediators, particularly cytokines play a role in febrile seizures.[xxx] [39] There are many cytokines and their roles in the body are complicated; some are of import for fever, others touch encephalon excitability.[39] At that place is some show that children with febrile seizures accept different amounts of some cytokines compared with children without febrile seizures.[xl] Additionally, at that place is compelling testify that febrile seizures are an age-related miracle due to increased excitability of the brain during normal development.[41]

Immediate medical care and diagnosis [edit]

If the child is all the same having a seizure at the time of assessment, emergency treatment to stop the seizure should be initiated, usually with intravenous diazepam, lorazepam or midazolam.[42] If intravenous access is difficult and then rectal diazepam or intranasal midazolam or intramuscular midazolam may be constructive.[43] One time the seizure has stopped then the diagnosis of a febrile seizure can be confirmed by gathering a detailed history including the value of highest temperature recorded, timing of seizure and fever, seizure characteristics, time to return to baseline, vaccination history, illness exposures, and family history.[30] A careful physical exam is important to attempt to detect the source of the fever, exclude meningitis and assess neurological status.[6] [30] Mimics of delirious seizures include shivering, delirious delirium, febrile myoclonus, breath property spells, convulsive syncope and benign convulsions with balmy gastroenteritis.[6] [xxx] [44]

Meningitis and encephalitis must be excluded which may be challenging since small children may not show the typical signs of meningitis such as strong neck.[45] Children who are immunized against pneumococcus and Haemophilus influenzae take a low risk of bacterial meningitis although there are other bacteria that may cause meningitis.[46] Viral meningitis or encephalitis may present with a seizure.[seven] The most effective way to rule out meningitis/encephalitis is a lumbar puncture with analysis of the cerebrospinal fluid.[45] If a kid has recovered quickly from the seizure and is acting normally, so bacterial meningitis is very unlikely and a lumbar puncture is unnecessary.[30] [45] [46] If at that place is doubt, then a lumbar puncture is recommended considering the consequences of delayed handling of meningitis may exist catastrophic.[45] Lumbar puncture is recommended if at that place are obvious signs and symptoms of meningitis, in that location is loftier clinical suspicion, the child has non recovered chop-chop or if the child lacks immunization against Haemophilus influenzae and pneumococcus or vaccination status is unknown.[vi] [45] In particular a lumbar puncture should exist considered in children younger than 12 months of historic period since the signs and symptoms of meningitis may be subtle.[45] Blood tests, encephalon imaging and an electroencephalogram are generally not needed.[3] [4] [45] However, for circuitous febrile seizures, EEG and imaging with an MRI of the encephalon may exist considered; although in that location is no compelling data to support either investigation.[47] [48] [49] [50]

Recurrence of Delirious seizures [edit]

Afterwards a start delirious seizure, the overall run a risk of another febrile seizure during another febrile illness is 30-40%, and this typically occurs inside the next year.[ix] [51] The most consistent factor that increases the risk of recurrence is historic period less than one yr.[9] [52] Other factors that increment the risk of recurrence are a family unit history of delirious seizures, a low temperature (<39C) at the time of the first seizure, and a short duration of fever before the first febrile seizure.[51] Children with none of these factors accept a recurrence run a risk of nigh 20% and those with all of the factors have a risk of about 60-70%.[51] Children with focal febrile seizures may exist at increased risk of recurrence although other complex features (2 or more seizures during the same illness and prolonged febrile seizures) exercise non increase the risk of recurrence.[9]

Prevention of Recurrent Febrile seizures [edit]

Drugs to prevent recurrent febrile seizures take been administered in 2 ways – continuous daily medication and intermittent medication to be given just at the time of fever, daily phenytoin, valproate, pyridoxine and zinc sulfate do non prevent further febrile seizures.[10] Intermittent utilise of phenobarbital is ineffective.[10] Intermittent employ of rectal or oral diazepam at the time of fever does somewhat decrease the hazard of recurrence although side furnishings are common, peculiarly extreme tiredness which may increment the business for meningitis.[ten] With oral diazepam at the time of fever, 14 children need to be treated to prevent one febrile seizure.[fourteen] Intermittent use of clobazam may exist effective but has not been sufficiently studied.[xxx] [10]

In that location is no evidence to back up the employ of fever reducing medications (antipyretic medications) such as acetaminophen, ibuprofen or diclofenac the time of fever to prevent a recurrent febrile seizure.[12] Especially when the ambient temperature is high, tepid sponging plus antipyretic medications has a modest effect on reducing the temperature of febrile children although the value of this treatment to forbid febrile seizures is not.[53] [54] [55] [56] Rapid cooling methods such as an water ice bath or a common cold bath should be avoided.[56]

Treatment [edit]

Side positioning for person having a seizure

If a child is having a delirious seizure, the post-obit recommendations are fabricated for caregivers.[57]

  • Notation the commencement fourth dimension of the seizure. If the seizure lasts longer than 5 minutes, call an ambulance. Only if previously prescribed, rectal diazepam or intranasal midazolam may be used. The child should be taken immediately to the nearest medical facility for further diagnosis and treatment.[57]
  • Gradually place the kid on a protected surface such as the floor or basis to foreclose accidental injury. Practise non restrain or hold a child during a earthquake.[57]
  • Position the child on his or her side or stomach to prevent choking. When possible, gently remove any objects from the child's mouth. Cipher should ever be placed in the child'due south mouth during a convulsion. These objects can obstruct the child's airway and make breathing hard.[57]
  • Seek immediate medical attention if this is the child's first febrile seizure and accept the child to the medico in one case the seizure has ended to check for the cause of the fever. This is especially urgent if the child shows symptoms of potent cervix, farthermost lethargy, or abundant vomiting, which may be signs of meningitis, an infection over the brain surface.[57]

There is special concern for those with a single seizure lasting greater than 5 minutes, if the child becomes cyanotic, or two consecutive seizures lasting greater than 5 minutes without recovery between the seizures because the seizure is probable to continue for 30 minutes or more (febrile condition epilepticus or FSE)[58] Status epilepticus may damage the encephalon (run into below) and should exist stopped promptly with medications such as intravenous lorazepam, rectal or intranasal diazepam, or intranasal midazolam.[58] Fortunately, most children with FSE recover completely with normal intelligence.[17] [59]

Prognosis [edit]

Although a few concerns have been raised (see below), the long term outcomes are mostly expert with little risk of neurological problems or epilepsy.[4] [30] Those who take one febrile seizure have an approximately thirty- 40% run a risk of having another ane in the side by side two years, with the risk being greater in those who are younger.[four] [eight] [30] Uncomplicated febrile seizures do non tend to recur oft (children tend to outgrow them) and are associated with a slight increase in later epilepsy (about 2-3%) compared with the full general public without febrile seizures (1%)[15] [30] As noted higher up, children with a first febrile convulsion are more likely to have a recurrent febrile seizure if they were immature at their first seizure (less than 18 months old), have a family history of a febrile convulsions in first-degree relatives (a parent or sibling), have a brusque fourth dimension between the onset of fever and the seizure, had a low degree of fever before their seizure, or have a history of abnormal neurological signs or developmental delay.[51] Children with a outset prolonged delirious seizure are not at increased run a risk of a recurrent febrile seizure; however, if there is a recurrence, it is also likely to be prolonged.[15] Similarly, the overall prognosis after a complex febrile seizure is commonly excellent.[30] About ten-15% will eventually develop epilepsy but 85-xc% will not.[30] A single, very large report from Denmark suggested that, compared with the normal population, children with complex febrile seizures had a slightly increased risk of death in the ii years afterwards their starting time febrile seizure.[60] This increase appeared mostly to exist related to the evolution of epilepsy or low birth weight, neonatal asphyxia and congenital malformations. In one case 2 years had passed since their offset delirious seizure, children with complex febrile seizures no longer had an increased take chances of death.[60]

Another, very large study from Denmark has explored the relationship between febrile seizures and subsequent psychiatric disorders. "Compared to the group of children without seizures, the risk of developing a psychiatric disorder was marginally elevated for children with a history of febrile seizures" during the ~20 years after the febrile seizures.[61] A continuing controversial upshot is the human relationship between prolonged febrile seizures and temporal lobe epilepsy.[17] This issue began with the observation that patients with drug resistant epilepsy start in i of their temporal lobes often showed the pathologic features of hippocampal sclerosis when the temporal lobe was surgically removed.[62] The hippocampus is a part of the temporal lobe that is important for retention formation). Patients with hippocampal sclerosis often had preceding, very long febrile seizures in infancy (Febrile Condition Epilepticus FSE).[62] Studies with very long, intense seizures in baboons found that the temporal lobe could exist damaged by these seizures.[63] However, not all hippocampal sclerosis is associated with FSE.[64] Major questions that remain incompletely answered are: how ofttimes do prolonged delirious seizures cause hippocampal sclerosis and how many children with hippocampal sclerosis develop drug resistant epilepsy? The offset question has been addressed past two major studies. I MRI report of children with FSE (FEBSTAT) (>i hour in most) constitute about 10% of children have i-sided hippocampal swelling within a few days of the delirious prolonged seizure.[65] A year subsequently nearly half of those with early on hippocampal swelling had hippocampal sclerosis suggesting that about 5% of children with very long febrile seizure later develop hippocampal sclerosis.[65] ] How many of these children will develop drug resistant epilepsy is still unknown. Another MRI written report found that shortly later on FSE, swelling of both hippocampi was common but this resolved iv–viii months later without mesial temporal sclerosis.[17] [66] Ane long follow up study suggested that the risk of febrile status followed by hippocampal sclerosis and intractable temporal lobe epilepsy is low - approximately i of every 150 children.[67]

Epidemiology [edit]

Febrile seizures happen between the ages of 6 months and five years.[ane] [68] [69] The peak age for a delirious seizure is xviii months, with the most common age range being 12–thirty months of historic period.[70] They impact between 2-five% of children.[1] [68] [69] They are more common in boys than girls.[71] Febrile seizures can occur in any indigenous group, although at that place have been higher rates in Guamanians (xiv%), Japanese (six-9%) and Indians (5-10%).[72]

Conclusions [edit]

About all children with febrile seizures have a good long term prognosis.[4] [30] Febrile seizures are not easily anticipated and oft recur.[9] [33] [51] Later on epilepsy is uncommon.[4] [30] Fifty-fifty prolonged febrile seizures typically practise not have sequelae;[17] [59] however, febrile seizures are frightening for parents – most fear that their kid is dying during the seizure.[73] Reassurance is well-nigh always the virtually of import part of handling, joined with appropriate counseling about chance of recurrent delirious seizures and appropriate management during subsequent seizures.[73]

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External links [edit]

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Source: https://en.wikipedia.org/wiki/Febrile_seizure

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