Nothing Is Simple About a Complex Febrile Seizure: Looking Beyond Fever as a Cause for Seizures in Children

[摘要] Case: A 16-month-old, previously healthy girl presented with fever for 2 days. Other symptoms included rhinorrhea, cough, decreased activity, and oral ulcerations associated with decreased oral intake. The child had no vomiting, diarrhea, rashes, head trauma or other injuries. There were no sick contacts. The child’s father denied home medications and ingestions. Immunizations were up to date and included her first influenza vaccine.In triage the child had a temperature of 39.8°C, pulse of 164 beats per minute, respiratory rate of 20 breaths per minute, and oxygen saturation of 98%. She appeared tired and irritable but was consolable. She was given ibuprofen (10 mg/kg/dose). As the child was placed in the examination room, she became unresponsive with rightward eye deviation, drooling, and symmetric tonic-clonic seizure activity. The seizure continued for >10 minutes despite rectal diazepam (0.1 mg/kg/dose) and concluded after intravenous midazolam (0.1 mg/kg/dose). She was also given acetaminophen (15 mg/kg/dose per rectum). A 20-minute postictal period was followed by a second 10-minute seizure, which required intravenous (IV) midazolam (0.1mg/kg/dose) and a load of IV fosphenytoin (20 mg/kg/dose).Question: What are current recommendations for the evaluation and management of a child with a complex febrile seizure (CFS)? Discussion: Recent guidelines on management of simple febrile seizures (SFS) offer support for clinicians caring for children with this condition.1 However, similar consensus and guidance is harder to find for management of CFS in pediatrics. Febrile seizures affect 2% to 5% of children, usually aged between 6 months and 5 years.2 From 25% to 30% of febrile seizures are classified as CFS,2,3 defined as a those seizures associated with fever and with any of the following characteristics: duration >15 minutes, recurrence within 24 hours, focality, and/or associated neurologic abnormalities.4 A meta-analysis by Offringa et al5 showed …

[学科分类] 儿科学

[关键词] Campylobacter;proljev;dob