PE27.6 | Febrile Seizures — Summary & Reflection

KEY TAKEAWAYS

Febrile seizures are the most common convulsive disorder of childhood (2–5% of children), occurring between 6 months and 5 years of age in association with fever ≥38°C, without CNS infection. Simple febrile seizures are generalised, <15 minutes, and single within 24 hours; complex febrile seizures are focal, ≥15 minutes, or recurrent within 24 hours. Pathophysiology involves fever-induced lowering of seizure threshold in the immature brain via cytokine-mediated NMDA excitation and developmental GABAergic immaturity. HHV-6 is the most common viral trigger. Lumbar puncture is NOT routine — reserved for meningeal signs, age <12 months with uncertain clinical picture, or ill-looking child with complex seizure. EEG and MRI are not routine for simple febrile seizures. Acute management prioritises airway protection; benzodiazepine (rectal diazepam 0.5 mg/kg or buccal midazolam) is given if the seizure exceeds 5 minutes. Antipyretics do not prevent recurrence. Prophylactic AEDs are not recommended for simple febrile seizures. Parental education — reassuring about brain safety, teaching seizure first-aid, and correcting the fever-prevention myth — is the most important intervention.

REFLECT

Think back to the anxious mother in our opening scenario. She asked, 'I thought he was dying — is this going to keep happening?' Reflect on how you would structure your consultation to: (1) validate her fear and distress; (2) give her an honest and calibrated probabilistic statement about recurrence risk; (3) explain the fever-seizure mechanism in lay terms she can understand; (4) teach her the specific actions to take if it happens again. Consider also: if this child goes on to have three more febrile seizures over the next 18 months, all simple, at what point would you revisit the decision not to give prophylactic medication? What does Kolb's experiential learning cycle suggest about how parents learn seizure first-aid — what is the most effective format for delivering this information?