Seizures in Children Quiz

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Questions and Answers

What are the two main types of seizures in children based on their origin in the brain?

Generalized seizures and focal seizures.

What is the term for a seizure lasting more than 30 minutes?

Status epilepticus.

How prevalent are febrile seizures among the population?

They can affect 4-10% of the population.

What is Todd's paralysis?

<p>Transient paralysis that can occur after a seizure.</p> Signup and view all the answers

What are infantile spasms, and at what age do they typically begin?

<p>General myoclonic jerking of neck, trunk, and limbs that begin around 3-7 months.</p> Signup and view all the answers

List one metabolic cause of seizures.

<p>Hypoglycemia.</p> Signup and view all the answers

What is the relationship between seizures and brain infections?

<p>Infections like meningitis and encephalitis can cause seizures.</p> Signup and view all the answers

What seizure type is characterized by 'staring spells' without jerking?

<p>Absence seizures.</p> Signup and view all the answers

Identify one cause of focal seizures.

<p>Brain tumors.</p> Signup and view all the answers

What are the typical EEG findings in infantile spasms?

<p>Hypsarrhythmia.</p> Signup and view all the answers

What distinguishes pseudoseizures from epileptic seizures?

<p>Pseudoseizures are not caused by electrical disruptions in the brain like epileptic seizures and are often associated with psychological conditions.</p> Signup and view all the answers

What is the initial assessment for a patient suspected of having seizures?

<p>A basic workup includes an EEG and electrolyte tests to rule out metabolic anomalies.</p> Signup and view all the answers

What are some protective measures to take during a febrile seizure?

<p>Loosen tight clothing, place something soft under the person's head, and stay with them until they recover.</p> Signup and view all the answers

What should you avoid doing during a seizure?

<p>Do not try to restrain the person, put anything between their teeth, or give them food or drink.</p> Signup and view all the answers

What is the typical duration for a febrile seizure, and when should medical care be sought?

<p>Febrile seizures last less than 15 minutes, and medical care should be sought if they last more than 5 minutes.</p> Signup and view all the answers

What are some potential side effects of Valproic Acid?

<p>Potential side effects include fetal anomalies in pregnant women and the need to check blood levels for adequacy.</p> Signup and view all the answers

What non-pharmacologic treatment options exist for seizures?

<p>Options include a ketogenic diet, vagal nerve stimulation, and surgery.</p> Signup and view all the answers

What percentage of children experience at least one reoccurrence of febrile seizures?

<p>30-40% of children will experience at least one reoccurrence of febrile seizures.</p> Signup and view all the answers

What is the general population risk for developing epilepsy compared to children with febrile seizures?

<p>The general population risk of epilepsy is 0.5-1%, while the risk in patients with febrile seizures is 1-2%.</p> Signup and view all the answers

What long-term effect can Lamotrigine have on cognitive ability?

<p>Lamotrigine may cause decreased cognitive ability among its long-term effects.</p> Signup and view all the answers

What is the first-line treatment for infantile spasms?

<p>Adrenocorticotropic hormone (ACTH) or oral steroids (prednisolone).</p> Signup and view all the answers

What characterizes absence seizures in children?

<p>Sudden episodes of staring with unresponsiveness lasting 5-15 seconds, often accompanied by subtle automatisms.</p> Signup and view all the answers

What are common triggers for myoclonic seizures?

<p>Sleep deprivation, stress, or flashing lights.</p> Signup and view all the answers

Describe a tonic-clonic seizure's presentation.

<p>It consists of a tonic phase with sudden limb stiffening followed by a clonic phase with rhythmic jerking.</p> Signup and view all the answers

What type of seizure is characterized by sudden loss of muscle tone and often leads to falls?

<p>Atonic seizures, also known as drop attacks.</p> Signup and view all the answers

Which medication is considered the first-line treatment for absence seizures?

<p>Ethosuximide.</p> Signup and view all the answers

How are developmental delays managed in children with epilepsy?

<p>Through long-term care focusing on developmental milestones and addressing underlying causes.</p> Signup and view all the answers

What is a characteristic feature of myoclonic seizure episodes?

<p>They involve brief muscle jerks without loss of consciousness.</p> Signup and view all the answers

What is a notable sign that may accompany tonic-clonic seizures?

<p>Tongue biting or urinary incontinence.</p> Signup and view all the answers

Which medication alternatives exist for treating tonic-clonic seizures?

<p>Valproic acid, carbamazepine, or levetiracetam.</p> Signup and view all the answers

What type of seizure is characterized by rhythmic jerking without sustained muscle stiffness?

<p>Clonic seizures</p> Signup and view all the answers

At what age are febrile seizures most commonly observed?

<p>6 months to 5 years</p> Signup and view all the answers

What is the medical emergency that requires immediate intervention if seizures last more than 5 minutes?

<p>Status Epilepticus</p> Signup and view all the answers

Which epileptic syndrome is associated with multiple seizure types and a high risk of intellectual disability?

<p>Lennox-Gastaut Syndrome</p> Signup and view all the answers

What distinct EEG pattern is associated with West syndrome, commonly seen in infantile spasms?

<p>Hypsarrhythmia</p> Signup and view all the answers

What type of seizures are triggered by specific stimuli, such as flashing lights or reading?

<p>Reflex seizures</p> Signup and view all the answers

What type of seizure involves sudden loss of muscle tone, often causing the individual to collapse?

<p>Atonic seizures</p> Signup and view all the answers

What are the common features of neonatal seizures observed in infants?

<p>Eye deviation, lip-smacking, apnea, or rhythmic limb movements</p> Signup and view all the answers

What age range characterizes Benign Rolandic Epilepsy, and how does it usually manifest?

<p>Ages 3-13 years; it presents with focal seizures during sleep involving the face and mouth.</p> Signup and view all the answers

What are the main features of juvenile myoclonic epilepsy (JME)?

<p>Myoclonic jerks, generalized tonic-clonic seizures, and absence seizures</p> Signup and view all the answers

What is the primary management for febrile seizures in children?

<p>Antipyretics; no anticonvulsants.</p> Signup and view all the answers

Which medication is commonly used to manage myoclonic seizures in adolescents?

<p>Valproic acid.</p> Signup and view all the answers

Which type of seizure is characterized by flexor/extensor spasms and typically occurs between 3 to 12 months of age?

<p>Infantile spasms.</p> Signup and view all the answers

What is the usual management for absence seizures in children?

<p>Ethosuximide.</p> Signup and view all the answers

In which seizure type does a child remain conscious but may experience twitching or sensory changes?

<p>Focal aware seizures.</p> Signup and view all the answers

What is the primary treatment for neonatal seizures that typically occur in the first 28 days of life?

<p>Treat underlying cause; phenobarbital.</p> Signup and view all the answers

What protective measure should be taken during atonic seizures in children?

<p>Wear a protective helmet.</p> Signup and view all the answers

What clinical feature is associated with tonic-clonic seizures?

<p>Stiffening followed by rhythmic jerking and loss of consciousness.</p> Signup and view all the answers

What is the name of the seizure type characterized by brief episodes of staring, often unresponsive to stimuli?

<p>Absence seizures.</p> Signup and view all the answers

Which seizure type can progress from focal to bilateral tonic-clonic seizures?

<p>Focal impaired awareness seizures.</p> Signup and view all the answers

What triggers febrile seizures in children, and what is the peak age range for their occurrence?

<p>Febrile seizures are often triggered by a rapid rise in temperature, occurring in children aged 6 months to 5 years.</p> Signup and view all the answers

Name one common cause of neonatal seizures.

<p>Hypoxic-ischemic encephalopathy (HIE) is a common cause of neonatal seizures.</p> Signup and view all the answers

What is the characteristic clinical presentation of infantile spasms?

<p>Infantile spasms are characterized by sudden, symmetric flexor or extensor jerks of the head, trunk, and limbs.</p> Signup and view all the answers

List two management strategies for acute neonatal seizures.

<p>Correcting metabolic abnormalities and administering phenobarbital as an anticonvulsant are management strategies.</p> Signup and view all the answers

What are two clinical signs that may indicate neonatal seizures?

<p>Subtle signs include eye deviation or blinking and rhythmic limb jerking.</p> Signup and view all the answers

What is the recommended management for a simple febrile seizure in children?

<p>Management includes ensuring airway patency and providing antipyretics for comfort, without using routine anticonvulsants.</p> Signup and view all the answers

Which demographic factor increases the risk of febrile seizures in children?

<p>A family history of febrile seizures or epilepsy increases the risk.</p> Signup and view all the answers

At what age do infantile spasms typically start, and what metabolic disorder is associated with them?

<p>Infantile spasms typically start between 3 to 12 months of age; they can be associated with metabolic disorders.</p> Signup and view all the answers

What role do viral infections play in the occurrence of febrile seizures?

<p>Viral infections, such as influenza or HHV-6, are often the cause of the fever that triggers febrile seizures.</p> Signup and view all the answers

What is the primary goal when managing acute neonatal seizures?

<p>The primary goal is to correct metabolic abnormalities and treat any underlying infections.</p> Signup and view all the answers

Flashcards

What are seizures?

Uncontrolled firing of nerves in the brain, causing abnormal electrical activity.

What are generalized seizures?

Seizures that involve both hemispheres of the brain.

What are focal seizures?

Seizures that involve only one hemisphere of the brain.

What is a tonic-clonic seizure?

A type of seizure characterized by muscle stiffening and jerking.

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What is a focal seizure?

A type of seizure where one side of the body is affected, with symptoms like twitching or numbness.

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What is a myoclonic seizure?

A type of seizure characterized by brief, sudden jerks in the body.

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What is an atonic seizure?

A type of seizure that causes a sudden loss of muscle tone, leading to a fall.

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What is an absence seizure?

A type of seizure that results in staring spells without any physical movements.

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What is status epilepticus?

A prolonged seizure lasting for more than 30 minutes, which can be life-threatening.

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What are infantile spasms?

A type of seizure that begins in infancy, characterized by jerking movements in the neck, trunk, and limbs.

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Febrile Seizure

A seizure caused by a fever, typically occurring in children between 6 months and 5 years old.

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EEG (Electroencephalogram)

A brain wave recording used to diagnose seizures and other neurological disorders.

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Vagal Nerve Stimulator

A device implanted in the chest to send regular electrical stimulation to the vagus nerve, helping to reduce seizure frequency in some individuals.

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Ketogenic Diet

A high-fat, low-carbohydrate diet used to control seizures, especially in children with epilepsy.

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Phenytoin (Dilantin)

A medication commonly used to treat seizures, but can cause side effects like fetal anomalies in pregnant women, gum hyperplasia, and the need for regular blood level monitoring.

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Phenobarbital

A medication commonly used to treat seizures, but can cause long-term cognitive decline and decreased cognitive ability.

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Lamotrigine

A medication commonly used to treat seizures, but can cause Stevens-Johnson Syndrome, a serious adverse drug reaction.

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Valproic Acid

A medication commonly used to treat seizures, but can cause fetal abnormalities in pregnant women.

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Seizure Workup

A set of tests often performed to determine the cause of a seizure.

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Epilepsy

A neurological condition characterized by recurrent seizures, often with an unknown cause.

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Simple Febrile Seizure

A type of febrile seizure that lasts less than 15 minutes and doesn't happen more than once within 24 hours.

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Complex Febrile Seizure

A type of febrile seizure that lasts longer than 15 minutes, happens more than once in 24 hours, or involves complex symptoms like confusion or altered consciousness.

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Neonatal Seizures

Seizures that occur in newborns, often due to metabolic issues, infections, birth trauma, or hypoxia.

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Hypoxic-Ischemic Encephalopathy (HIE)

The most common cause of neonatal seizures, occurring due to lack of oxygen to the brain during birth.

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Infantile Spasms (West Syndrome)

A rare but serious seizure disorder that begins in infancy, characterized by spasms that occur in clusters, developmental delays, and a specific pattern on EEG.

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Infantile Spasms

Sudden, symmetrical jerking movements of the head, trunk, and limbs that occur in clusters, often in infants with West Syndrome.

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Tuberous Sclerosis Complex

A condition often associated with infantile spasms, characterized by tumors in the brain and other organs.

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ARX Gene Mutations

A genetic disorder that can cause infantile spasms, characterized by mutations in the ARX gene.

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Hypoglycemia

A common cause of seizures in newborns, characterized by a low blood sugar level.

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Focal seizures

Seizures that start in one specific part of the brain. These can involve only one side of the body, causing symptoms like twitching, numbness, or sensory changes, or they can spread to other parts of the brain.

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Focal aware seizures

A type of focal seizure where the child remains conscious but experiences symptoms like twitching, sensory changes, or autonomic signs.

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Focal impaired awareness seizures

A type of focal seizure where the person's awareness is altered. They may have automatic movements like lip-smacking, chewing, or fumbling.

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Generalized seizures

Seizures that involve both hemispheres of the brain from the beginning. These are often more severe and affect the whole body.

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Tonic-clonic seizures

A type of generalized seizure characterized by a stiffening (tonic) phase followed by rhythmic jerking (clonic) movements. It usually involves loss of consciousness.

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Absence seizures

Brief episodes (5-15 seconds) of staring and unresponsive to stimuli, often seen in children.

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Myoclonic seizures

Sudden, brief muscle jerks without loss of consciousness. Often seen in conditions like juvenile myoclonic epilepsy.

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Atonic seizures

Sudden loss of muscle tone, causing a drop attack. Often occurs in children aged 1-8 years.

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What are febrile seizures?

Seizures that occur specifically in children and are related to a fever (usually above 38°C), but without a brain infection. There are two main types.

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What is a simple febrile seizure?

A type of febrile seizure lasting less than 15 minutes and occurring only once in a 24-hour period.

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What are neonatal seizures?

Seizures occurring in newborns (birth to 28 days old). They often have subtle signs like eye twitching, lip smacking, or breathing pauses, and can be caused by various factors.

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What is West syndrome?

A rare but serious epilepsy syndrome primarily affecting young children (3-12 months). It's characterized by sudden jerky movements of the body and abnormal brainwaves, plus a high risk of developmental delays.

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What is Lennox-Gastaut syndrome?

A severe type of epilepsy, typically emerging between 1-8 years old. It involves multiple seizure types (tonic, atonic, absence) and is often associated with intellectual disability.

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What is Benign Rolandic Epilepsy?

A generally mild type of epilepsy that usually begins in childhood (3-13 years). It often causes seizures involving the face and mouth, particularly during sleep. It often goes away on its own without long-term problems.

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What is Juvenile Myoclonic Epilepsy?

This epilepsy type mostly affects adolescents and adults. It's characterized by sudden muscle jerks, generalized tonic-clonic seizures, and brief periods of unresponsiveness. It can be triggered by sleep deprivation.

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What are reflex seizures?

Special types of seizures triggered by specific stimuli like flashing lights, reading, or hot water.

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What is hypsarrhythmia?

A type of generalized seizure in which the brain waves show disorganized, high-amplitude activity. Often seen in infants and young children.

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What are absence seizures?

A type of seizure characterized by sudden staring spells with unresponsiveness lasting 5-15 seconds. Often occurs in children and may be accompanied by subtle automatisms like lip-smacking or eye blinking.

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What are tonic-clonic seizures?

A type of seizure characterized by sudden stiffening of the limbs (tonic phase) followed by rhythmic jerking (clonic phase). Often associated with loss of consciousness and postictal confusion.

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What are atonic seizures?

A type of seizure causing a sudden loss of muscle tone, leading to a fall. Often associated with Lennox-Gastaut syndrome and developmental delays.

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What are myoclonic seizures?

Sudden, brief muscle jerks that usually do not cause loss of consciousness. Often triggered by sleep deprivation, stress, or flashing lights.

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What is ethosuximide?

A drug commonly used to treat absence seizures.

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What is valproic acid?

A common drug used to treat tonic-clonic seizures, but can also cause fetal abnormalities in pregnant women.

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What is lamotrigine?

A drug used to treat myoclonic seizures and Lennox-Gastaut syndrome, often in combination with other medications.

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Study Notes

Seizures in Children

  • Seizures are uncontrolled nerve firings in the brain
  • Generalized seizures involve both cerebral hemispheres
  • Focal seizures involve one hemisphere
  • Young infants' seizures can be subtle and look different from other seizures

Learning Objectives

  • Identify different types of seizures in children
  • Differentiate the causes of seizures
  • Recognize components of a seizure workup
  • Discuss treatment for seizures in children

Seizure Prevalence

  • Seizures affect 1% of the population
  • Febrile seizures occur in 4-10% of the population
  • 15% of children with an initial seizure will have another within a year.

During a Seizure

  • Alteration of vital signs and respiratory suppression are possible
  • A period of sleepiness (post-ictal period) follows a seizure
  • Transient paralysis (Todd's paralysis) can develop after a seizure
  • Seizures vary depending on where they start in the brain

Types of Seizures

  • Tonic-clonic (generalized): May be tonic or clonic
  • Focal (one side of the body)
  • Myoclonic: Few to many short jerks in the body
  • Atonic/Akinetic: "Drop spells"
  • Absence: No jerking; "staring spells"

Status Epilepticus

  • A seizure lasting more than 30 minutes
  • Can result in death

Differential Diagnosis of Seizures

  • Infections (e.g., brain abscess, encephalitis, meningitis, tuberculosis, viral illnesses, HIV, toxoplasmosis)
  • Toxins (e.g., cocaine, methamphetamine, lead poisoning, organophosphates, salicylates, sympathomimetics, tricyclic antidepressants, alcohol withdrawal)
  • Traumatic/Vascular (e.g., cerebral contusion, stroke, child abuse)
  • Idiopathic (Epilepsy)
  • Congenital Anomalies
  • Genetic causes
  • Metabolic causes (e.g., hypercarbia, hypocalcemia, hypoglycemia, hyponatremia, hypomagnesemia, inborn errors of metabolism, pyridoxine deficiency)
  • Neoplastic (e.g., brain tumors, metastatic cancers)

Infantile Spasms

  • General myoclonic jerking of neck, trunks, and limbs
  • Typically begins between 3-7 months old
  • Associated with some genetic syndromes
  • Atypical EEG finding: "hypsarrhythmia"
  • Poor prognosis: Death within 3 years in 1/3 of children
  • Often has profound cognitive effects
  • Difficult to control seizures
  • Survivors may develop other seizure types

Benign Rolandic Epilepsy

  • Simple partial seizures often involving face and hands
  • EEG shows centrotemporal spikes
  • Seizures occur or are aggravated during or around sleep
  • Almost always outgrown by adolescence

Conditions That Mimic Seizures

  • Breath holding spells
  • Syncope
  • Panic attacks
  • Tic disorders
  • Benign myoclonus (infants)
  • Dystonic reaction
  • Pseudoseizures
  • Night terrors

Seizure Workup - Basic

  • EEG
  • Electrolytes (to rule out metabolic anomaly)
  • CBC (to rule out infection)

Additional Workup

  • Depends on assessment and physical exam findings
  • Sometimes requires head CT or MRI

Treatment: Febrile Seizures

  • Loosen tight clothing to prevent injury
  • Protect the person from injury
  • Place something soft under their head if they fell
  • Stay with them until fully recovered
  • Call for medical help if seizure lasts over 5 minutes
  • Do not try to restrain the person
  • Do not put anything between their teeth
  • Do not move them unless they are in danger
  • Do not give them food

Acute Seizure Control

  • Treatment varies depending on the duration and type of seizure, presence of complications and the underlying cause. Multiple medications are used in the acute setting.

Anticonvulsants (Medication)

  • Many different drugs with varying mechanisms of action.
  • Side effects are listed in the accompanying table.

Medication Side Effects

  • Valproic Acid/Phenytoin: May cause fetal anomalies, gum hyperplasia. Blood levels need monitoring.
  • Phenobarbital: Long-term cognitive effects
  • Lamotrigine: Can lead to Stevens-Johnson syndrome

Non-Pharmacological Seizure Treatment

  • Vagal Nerve Stimulator
  • Surgery
  • Ketogenic Diet

Febrile Seizures

  • Occurs in approximately 4% of children (6-60 months) associated with a febrile illness
  • Most common form of seizures and neurological disorders in children
  • 30-40% of children with febrile seizures will have a recurrence.
  • General risk of epilepsy 0.5 - 1%. Risk in febrile seizure patients is 1-2%.

Simple Febrile Seizures

  • Symmetrical
  • Lasts less than 15 minutes (Most <5 minutes)
  • Only one seizure associated with a febrile illness/24 hour timeframe.

Complex Febrile Seizures

  • Focal features during or after event
  • Lasts more than 15 minutes.
  • More than one seizure in a 24-hour period.

Febrile Seizures & Epilepsy

  • Dravet Syndrome: Severe myoclonic epilepsy of infancy (prolonged, asymmetric, progressive, starts without fevers)
  • Generalized Epilepsy with Febrile Seizures Plus (GEFS+): Autosomal dominant, febrile seizures can disappear by age 6, or evolve.

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