Introduction

Febrile convulsion can be defined as fever associated with convulsion in children aged 6months to 5years after excluding intracranial and metabolic causes.

Etiology

Conditions that can cause convulsions include:

• Uncomplicated malaria
• Otitis media
• Urinary tract infections
• Acute gastroenteritis
• Typhoid fever
• Pneumonia
• Pharyngotonsillitis
• Pharyngitis
• Other upper and lower respiratory tract infections.

Types

Febrile convulsions can be categorized into two types: simple and complex.

Simple febrile convulsions

• It is characterized by generalized tonic-clonic convulsions
• The duration of convulsion is 15secs or less
• The frequency of one episode of convulsion in a 24hours period
• There is usually no family history
• Neurological sequel is also absent.

Complex febrile convulsions

• It is characterized by focal seizures
• The duration of each convulsion is greater than 15secs
• The frequency of more than one episode in 24 hours
• There is a positive family history of febrile convulsion
• Neurological sequel is present and the EEG finds are abnormal.

Management

This includes a thorough history, detailed investigations, and effective treatment.

History: It is important to take a thorough history to

• Know the onset of the fever, character of the fever and grade
• Rule out the cause of the fever
• Inquire about any family history of febrile seizures
• know the interventions given; cow urine, pouring of salt into the mouth, mother urinating in the child’s mouth, forceful spoon insertion into the mouth.

Investigations

• Lumbar puncture: for cerebrospinal fluid M/C/S infections in the CNS
• Electrolytes, urea and creatinine: to rule out metabolic causes
• Random blood glucose: to rule out metabolic causes
• Full blood count (FBC)
• Urinalysis
• Urine M/C/S : to rule out urinary tract infection.
• Chest xray : to rule out pneumonia.
• Blood film for malaria parasite.

Treatment

The principles of treatment are;

1. Control fever
   • Non-pharmacological methods are: tepid sponging with lukewarm water, expose the child, cold saline lavage
   • Pharmacological : administer paracetamol, ibuprofen
2. Abort seizures: using I.M paraldehyde (1ml/year of life, max. 5ml) , or rectal or IV diazepam( 0.3- 0.5mg/kg)
3. Treat underlying cause: give antibiotics for infections, Anti-malarial for malaria
4. Counselling:
   • Advise the mother on avoiding harmful actions during convulsions
   • Advise her to position the child on their left side during convulsions and ensure the surrounding area is free of any harmful objects.
   • Inform her that if the child develops a fever, she should give rectal diazepam or paracetamol and take the child to the hospital without delay.

Risk factors for recurrent febrile convulsion

1. Fever of 38-39⁰C
2. Age >1year
3. Fever < 24hours
4. Family history of febrile convulsion
5. 30% chance of recurrence after first episode
6. 50% chance of recurrence after 2 or more episodes.

Risk factors for developing epilepsy later on.

1. Presence of an underlying neurodevelopmental disorder.
2. Complex febrile convulsions
3. Family history of epilepsy.