assessment if febrile convulsion

Last reviewed 01/2022

evaluation of a patient with febrile seizures

Majority of patients present for medical care after the seizure has resolved.

  • post-ictal symptoms is rare (except for drowsiness )
  • patients will reach normal level of alertness which occurs gradually within an hour (1,2)

Eyewitnesses should be questioned about the conscious status prior to seizure, duration of the seizure, a prolonged postictal phase and presence of any focal symptoms (3)

Patient history should focus on obtaining the following information:

  • history of prior seizures, and other potential causes of seizures
  • family history of febrile seizures or epilepsy
  • immunizations
  • recent antibiotic use
  • neurodevelopment delay (2,3,4)

The main concern for a GP in this situation is failing to identify a more serious diagnosis such as meningitis. 

  • incidence of meningitis in children who present with febrile seizure is 2-5%
  • a seizure might be the only presenting symptom in a febrile child with meningitis
  • the following signs suggests a diagnosis of central nervous system infection
    • history of irritability, decreased feeding, or lethargy
    • complex febrile seizures
    • physical signs of meningitis or encephalitis e.g. – bulging fontanelle, neck stiffness, photophobia, focal neurological signs
    • prolonged postictal period - altered consciousness or neurological deficit for more than 1 hour
    • drowsiness with limited response to social cues (lasting >1 hour)
    • previous or current treatment with antibiotics
    • incomplete immunisation in children aged 6-18 months against Haemophilus influenzae b and Streptococcus pneumoniae
  • in children less than 2 years old          
    • features of meningeal irritation may not be present, therefore further assessment by a senior paediatrician is recommended
    • a lumbar puncture (LP) should be done if there is genuine uncertainty (LP postponed if there is reduced consciousness) (1)  

The National Institute for Health and Care Excellence (NICE) traffic light system can be used to identify the risk of serious illness in children with fever (5)

Reference:

Related pages:

febrile convulsion

traffic light system table for identifying risk of serious illness in child under 5 years with fever (feverish)

criteria for admission if febrile convulsion/seizure