NR 602 Soap Note -Febrile Seizures

Febrile seizures are the most common type of seizures in children. They are brief, generalized, clonic or tonic-clonic in nature, and can be either simple or complex. A concurrent illness is present with rapid fever rise to at least more than 102.2° F (39° C), but the fever is not necessarily that high at the time of the seizure. It is conjectured that these seizures may be related to peak temperature reached during the febrile episode. Minimal postictal confusion is associated with febrile seizures. Simple febrile seizures last less than 15 minutes and may recur during the same febrile illness period. Complex febrile seizures last longer than 15 minutes, can recur on the same day, and can have focal attributes (even during the postictal phase). Febrile SE is uncommon, rarely stops spontaneously, is fairly resistant to medications, and can persist for a long period of time. Most children in febrile SE require one or more medications to end the seizure. A report found that reducing the time from seizure onset to anticonvulsant medication administration was key to reducing the seizure duration during an episode (Seinfeld et?al, 2014).

The etiology of febrile seizures is unclear and by definition excludes seizures that are caused by intracranial illness or are related to an underlying CNS problem. The risk is higher in children with a family medical history for febrile seizures or in those with predisposing factors (e.g., neonatal intensive care unit [NICU] stay more than 30 days, developmental delay, day care attendance).

The age range associated with febrile seizures is 6 months to 60 months. Male gender is a minor risk factor as is a lower sodium level. Approximately 2% to 5% of neurologically healthy infants and young children experience at least one simple febrile seizure with about 30% of this group experiencing a second episode (Mikati, 2011).

NR 602 Soap Note -Febrile Seizures

Clinical Findings

History.

Include the following:

Description of seizure duration,…

Physical Examination.

The physical examination is the same as that described earlier for seizures.

Diagnostic Studies.

Diagnostic studies include the following:

NR 602 Soap Note -Febrile Seizures

Differential Diagnosis

Consider sepsis, meningitis, metabolic or toxic encephalopathies, hypoglycemia, anoxia, trauma, tumor, and hemorrhage. Febrile delirium and febrile shivering can be confused with seizures. Breath-holding spells can mimic febrile seizures; however, the former are always related to crying or tantrums. Febrile seizures come at unpredictable times during sleep, eating, play, or other generally calm times and are related to the onset of an illness. Epileptic seizures occur without concurrent illness and at unpredictable times.

Management

Protect the airway, breathing, and circulation …
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NR 602 Soap Note -Febrile Seizures

Prophylaxis for Recurrent Febrile Seizures

Prolonged anticonvulsant prophylaxis is not recommended. In the rare instance that prophylaxis is indicated, …

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Education

The family should receive information about febrile seizures, their risks, and their management. Education should include information explaining the febrile seizure, reassurance that no long-term consequences are associated with febrile seizures, information that febrile seizures recur in some children and that nothing can be done to prevent the seizures, and first-aid information in case another seizure occurs at some time. The decision to use prophylaxis is up to the parents and the PCP on a case-by-case basis. A follow-up phone call after the event is useful.

Complications

Death or persisting motor deficits do not occur in patients with febrile seizures. No indication has been found that intellect or learning is impaired. An affected child has an increased risk for the development of epilepsy (less than 5%) if the seizure is prolonged and focal; if the child has repeated seizures with the same febrile episode; or if the child has had a prior neurologic deficit, a family history of epilepsy, or both. Two thirds of children who have had one simple febrile seizure will have no more. The younger the age at onset (younger than 18 months old) of the first febrile seizure, the lower the temperature threshold that is needed to cause the child to seize and the more likely the child is to have a recurrence.

NR 602 Soap Note -Febrile Seizures