Managing Febrile Convulsions in Children: Common Challenges, Common Pitfalls

Background: Febrile seizure is a common condition occurring in 2-5 % of children with peak at 18-24 months. There is variation in practice amongst experts. EEG is not routinely indicated. Neuroimaging has a place in selected group of patients. No clear guidelines for rescue medication in atypical febrile seizure.

Objective: To assess current management of children with febrile-seizures against national/local guidelines and identify areas for improvement.

Methods: A retrospective audit of children admitted with febrile seizure in 2017 (Total N =67). Data was collected and analysed by clinicians.

Results: EEG was done in 7% (N=5/67), 3patients with recurrent febrile seizures, 2patients had afebrile focal seizures with back ground of febrile-convulsions. CT-Scan was done in 6% (N=4/67) of patients; 2 for recurrent seizures, 1 with prolonged seizure, and 1 with focal seizure. 6%(N=4/67)of patients had MRI ; 2 for afebrile seizure on background of febrile seizures ;1 with prolonged seizure & 1 for recurrent simple seizures .Rescue medications were offered to 12%(N=8/67) of patients ;7 with complex seizures ; 3 with prolonged seizures and 4 for recurrent seizures within 24 hours. One patient was prescribed rescue medication without indications. Another patient with prolonged seizure wasn’t offered rescue medication. 89% of patients were provided with information on febrile seizures (written/ verbal).52% of patients were educated on first aid in seizures. All patients with prolonged or atypical seizures were offered follow up in epilepsy clinic.

Conclusion: Though febrile seizure is a common condition there is huge variation in practice. Clear guideline is required to identify those who need further management like EEG, neuroimaging and genetic testing as well as rescue medication. More effort should be implemented in patients’ education. All patients with complex febrile convulsions should be offered follow up.