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febrile seizure /convulsion

Seizure accompanied by fever without central nervous system infection, metabolic or electrolyte disturbances, or a history of afebrile seizure or any acute neurological insult/head trauma in children aged 6 months to 6 years. Few guidelines include younger children up to 3 months [National Institutes of Health (NIH)] and even 1 month [International League against Epilepsy (ILAE)] after ruling out causes of provoked seizures. Fever can occur anytime during or after a seizure and the majority of febrile seizures (FSs) occur within 24 hours of fever onset Fever with isolated, generalized tonic clonic seizures, which last <15 minutes, and do not recur within 24 hours. Fever with seizures with any one of the following features: focal and/or prolonged for >15 minutes and/or recur within 24 hours and/or have incomplete recovery within 1 hour. febrile status convulsion Febrile seizure lasting for 30 minutes or more and/or series of seizures without full recovery in between that.  Nature and duration of the convulsions and postictal phase  Recent fever/ear discharge/dysuria  Recent antibiotic therapy/ antipyretics/rescue anticonvulsants Immunization history  Past history of previous episodes of FS, a diagnosis of epilepsy, and other neurologic conditions and diseases  Family history of FS, epilepsy,or neurologic diseases  History of neonatal intensive care unit stay or developmental delay, if any danger/ Red flag signs  Focal neurological signs  Persistent altered sensorium after 1 hour of seizure  Features of raised intracranial pressure such as headache, vomiting, papilledema, brisk deep tendon reflexes, Cushing’s triad of bradycardia, irregular respiration, and hypertension  Features of meningoencephalitis/ non-blanching rash in an unwell child  Features of sepsis/shock/ respiratory distress  The drug of choice for rescue management at home is intranasal midazolam (0.2 mg/kg; maximum: 5 mg). Other effective drugs are intramuscular/buccal midazolam, buccal lorazepam, and per rectal diazepam. Maximum two doses, 5 minutes apart.  Management of febrile status epilepticus at hospital is similar to management of convulsive status epilepticus.  Stabilize with ABCDE approach (airway, breathing, circulation, disability, and exposure/ examination).  If diagnosed with Dravet syndrome, FS+, GEFS+, sodium channel blockers (phenytoin) may be avoided.  In young children, in case of clinical suspicion of meningitis and febrile status start third- generation cephalosporin till lumbar puncture results.

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