childhood febrile seizures_ overview and implications

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International ournalof Biological Sciences

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Int J Med Sci 2007! 4"2#$110-114% &oi$10%71'0/i()s%4%110

*e+ie,

Childhood %ebrile Seiures' (vervie) and Implications

Tonia Jones, Steven J. Jacobsen

*esearc an& .+auation aiser Per)anente Soutern aiornia Pasa&ena 3 91101 S3

Ho) to cite this article'

Jones 5 Jaco6sen SJ% i&oo& Fe6rie Seiures$ 8+er+ie, an& I)pications% Int

J Med Sci2007! 4"2#$110-114% &oi$10%71'0/i()s%4%110% 3+aia6e ro)ttp$//,,,%)e&sci%org/+04p0110%t)

Abstract

5is artice pro+i&es an o+er+ie, o te atest no,e&ge an& un&erstan&ing o

ci&oo& e6rie seiures% 5is re+ie, aso &iscusses ci&oo& e6rie seiureoccurrence eat ser+ices utiiation an& treat)ent costs% Parenta reactions

associate& ,it its occurrence an& o, eatcare pro+i&ers can assist parents

,it &eaing eecti+e: ,it tis potentia: rigtening an& an;iet:-pro&ucing

e+ent are aso &iscusse&%

*e+)ords$ ci&oo& e6rie seiure parenta reaction an;iet: eat ser+ices

utiiation parenta e&ucation

1. Introduction

3toug te occurrence o e6rie seiures in ci&oo& is 6ut ortunate: te +ast )a(orit: o e6rie seiures are 6enign%

*are: a+e e6rie seiures cause& 6rain &a)age =?> an& ,it te e;ception o

&e+eoping countries tere are no &ocu)ente& cases o e6rie seiure-reate&

&eats on recor& =4>% 5ere a+e 6een nu)erous re+ie,s an& up&ates ,ic a+e

e;pore& te natura istor: treat)ent an& su6se


2/11

5op1% Intro&uction

2% Fe6rie Seiures Deine&

?% Natura Cistor:

4% Fe6rie Seiure .+auation%%%

'% Ceat Ser+ices tiiation%%%

@% Parenta *eaction an&%%%

7% I)pications

% Su))ar:*eerences

5op

1% Intro&uction

e6rie iness not cause& 6: an inection o te centra ner+ous s:ste) ,itoutpre+ious neonata seiures or a pre+ious unpro+oe& seiure an& not )eeting

criteria or oter acute s:)pto)atic seiures =12>% Fe6rie seiures are cassiie&as eiter si)pe or co)pe;% Si)pe e6rie seiures consist o a 6rie "asting ess

tan 10 )inutes# tonic-conic con+usion ,ic occurs on: once ,itin a 24-our

perio&% 5ere are no oca eatures an& it reso+es spontaneous: =1?>% on+erse:co)pe; e6rie seiures are proonge& "greater tan 10-1' )inutes# oca or

)utipe "recurrent ,itin te sa)e e6rie iness o+er a 24-our perio% Aie

te )a(orit: o e6rie seiures are si)pe "70-7'E# =14> 9-?'E o e6rie

seiures are co)pe; =1'>%

3. Natural History

3ppro;i)ate: one- a )iion e6rie seiure

e+ents occur per :ear in te S =1@>% Most e6rie

seiures occur 6et,een @ )onts an& ?@ )onts

o age peaing at 1 )onts =1'>% 5e inci&ence

o e6rie seiures is 6et,een 2-'E =17> ,it at

east ?E to 4E o a ci&ren in Nort 3)ericae;periencing at east one e6rie seiure 6eore

te age o ' :ears =1>% 5e occurrence o aci&s irst "initia# e6rie seiures as 6een

associate& ,it$ irst or secon&-&egree reati+e,it istor: o e6rie an& ae6rie seiures =19>

&a: care atten&ance =20!21> &e+eop)enta &ea: =19!21> Inuena 3 +ira

inection =1!22> Cu)an erpes+irus-@ inection =2?!24> Metapneu)o+irus =2'>

an& iron &eicienc: ane)ia =2@>% 8ter e;ogenous circu)stances tat a+e 6een

i&entiie& as pre&icting an increase& ris o initia e6rie seiures incu&e &iicut

6irt neonata asp:;ia an& coiing o te u)6iica cor& =27>% i&ren ,it

e6rie seiures an& te e;ogenous con&itions pre+ious: iste& are ie: to a+e

aecte& a)i: )e)6ers an& a+e a ris o recurrence o seiures on G '

occasions =27>%

5e ris o initia e6rie seiures as aso 6een stu&ie& ater receipt o pe&iatric

+accinations suc as &ipteria-tetanus-,oe ce pertussis "D5P# =2!29> an&

Meases Mu)ps an& *u6ea "MM*# =?0!?1>% Stu&ies 6: Haro, an& associates"2001# an& Aaer an& coeagues "19# oun& a 4-o& increase in te ris oe6rie seiures ,itin 1-? &a:s o receipt o D5P +accination% Ait regar& to MM*

+accination te ris o e6rie seiures increases 6: 1%' an& ?%0 o& ,it te

pea occurring 1-2 ,ees ater +accination =?0!?2>! an a&&itiona 2'-?4 e6rie

seiures a+e 6een esti)ate& to occur per 100000 &oses o MM* a&)inistere&

=?0>%

Fe6rie seiures re an& increases to

'0E i te initia e6rie seiure occurs in a ci& un&er one :ear o age =?4>% 8

tose ,o e;perience a secon& e6rie seiure te ris o recurrence increases

2-o& =?'!?@>% Pre&ictors o recurrent e6rie seiures incu&e$ a istor: o oca

proonge& an& )utipe seiures =?7!?> Inuena 3 +ira inection =?9> a)i:istor: o e6rie seiures =?@> onset o e6rie seiure 12 )onts o age =40>te)perature 40 "104 F# at ti)e o seiure =41> an& a istor: o co)pe;

initia e6rie seiures =42>% 3 o, proportion "2-4E# o ci&ren ,o e;perience at

east one e6rie seiure e+ent =4!4?> go on to &e+eop recurrent ae6rie seiures"epieps:# =1@!44>%

4. Febrile Seizure Evaluation and ana!e"ent

Aie e6rie inesses in inants an& ci&renaccount or 10-20E o a pe&iatric e)ergenc:

roo) +isits =4'> up to one percent o tese +isits

hood Febrile Seizures: Overview and Implications http://www.medsci.org/v04p

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2% Fe6rie Seiures Deine&?% Natura Cistor:

4% Fe6rie Seiure .+auation%%%'% Ceat Ser+ices tiiation%%%


7% I)pications% Su))ar:

*eerences

5op

1% Intro&uction

2% Fe6rie Seiures Deine&

?% Natura Cistor:

4% Fe6rie Seiure .+auation%%%



7% I)pications

% Su))ar:

in+o+e pe&iatric seiure patients =4@!47>% .igt:percent o tose pe&iatric seiure patients are

&iagnose& ,it e6rie seiures an& 20E are&iagnose& ,it ae6rie seiures =4-'0>%

Seiures o an: t:pe are usua: a )aniestation

o a nu)6er o un&er:ing patoogic con&itionsto &ierentiate 6et,een te) careu istor:

taing p:sica e;a)ination an& a6orator:

,or-up are usua: re In te case o irst si)pe e6rie seiure prop:actic antip:reticor anticon+usant terapies are not reco))en&e& to re&uce te recurrence rate

='4!''>% 3s to te sort-ter) treat)ent o ongoing e6rie seiures

anticon+usants suc as Peno6ar6ita an& Diaepa) a+e 6een oun& to re&uce

te reoccurrence o e6rie seiures 6ut not su6se% 5e costs to initia: e+auate an& treat e6rieseiures &epen& on te cinica ,or-up in&icate& 6: cinica suspicion%

In 200? Free)an &etaie& te cost o e+auating an initia ae6rie seiure in te

e)ergenc: roo) "S ?0'7# an& concu&e& tat ess testing is nee&e& in te .*

oo,ing tis occurrence =@?>% 5,o stu&ies a+e in&icate& tat ci&ren ,it

e6rie seiures &o not consu)e e;cess eat care resources% In a )atce&case-contro stu&: 7' ci&ren e;periencing teir irst e6rie seiure ,ere

age-)atce& ,it 1'0 e6rie an& 1'0 ae6rie contros% It ,as concu&e& tat

ci&ren ,it e6rie seiures a& near: i&entica rates o su6se% 3 secon&ar:

ana:sis o tis sa)e &ata set ,as un&ertaen an& it ,as oun& tat ci&ren ,it

a no,n a)i: istor: o e6rie seiures at te ti)e o stu&: entr: a& 24E

e,er p:sician +isits =@4>% In contrast ci&ren e;periencing teir irst e6rieseiure a& 4'E )ore p:sician +isits ,en te: ne, o a reati+e ,it ae6rie

seiures tan tose ,it negati+e a)i: istories% 5us it appears tat no,e&geo a a)i: istor: o e6rie seiures is correate& ,it re&uce& oice +isits%

). *arental +eaction and +es,onse to Febrile Seizures in

'$ildren

Parenta reaction an& response to e6rie seiure

occurrence in ci&ren can co)prise p:sica

ps:coogica an& 6ea+iora )aniestations%

o))on p:sica s:)pto)s e;perience& 6:

parents oo,ing teir ci&s e6rie seiure

incu&e &:spepsia =@'> anore;ia =1> an& seep

&isruption =1!!9!@'>% Ps:coogica reactions

e;perience& 6: parents incu&e ear oreoccurrence => ear o su6se appreension an&


1 29/06/2014


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*eerences

5op

1% Intro&uction2% Fe6rie Seiures Deine&

?% Natura Cistor:4% Fe6rie Seiure .+auation%%%



7% I)pications

% Su))ar:

*eerences

e;cessi+e an;iet: an& ,orr: a6out o,-gra&ee+ers =@@>%

5e occurrence o e6rie seiures can potentia: &isrupt te a)iia %

5e u ter) to &escri6e tis perception is reerre& to as te +unera6e ci&

s:n&ro)e ,ic incu&es a co)piation o 6ea+iors tat are tougt to &e+eop

as a resut o tis e;cessi+e parenta an;iet: =@7!@>% 5ese parents e;perienceincrease& an;iet: an& ear =@> ,ene+er a ci& &e+eops a e+er =!9>% 3s aresut tis eigtene& parenta ear o e+er an& e6rie seiures can a+e series

negati+e conse parenta 6ea+ior =4!@9> an&

parent-ci& interactions =@!70!71>% 3s a conse ci&ren e;periencing e6rie seiures &i& not utiie a iger rate oresources co)pare& ,it age-)atce& contros%

-. I",lications

5e occurrence o ci&oo& e6rie seiures areco))on! tus parents an& caregi+ers sou& 6e

pro+i&e& inor)ation a6out te)% Instructions

an& parenta e&ucation sou& 6e speciic ,ritten

in a: ter)s taiore& to teir anguage an&

cuture an& a&&ress te oo,ing "See 5a6e 1#$

!able ,

Fe6rie Seiure Inor)ation an& .&ucation

Clinical

Information

Clinical Education

Aat is a e6rie

seiureO

Fe6rie seiures are

con+usions 6rougt on 6:

a e+er in inants or s)a

ci&ren% Most e6rie

seiures occur ,itin te

irst 24 ours o an

iness/e+er% Fe6rie

seiures )a: ast ro) a

e, secon&s to )ore tan1' )inutes%

5e in 6et,een

e+er an& e6rieseiures "FS# in

ci&ren%

Fe6rie Seiures occur in

?E -' E o oter,iseeat: ci&ren @-@0)onts o age% It is

&e6ate& 6: e;perts

,eter it is te


5/11

Clinical

Information

Clinical Education

Aat )a: appento te ci& &uring

te e6rie seiureO

During a e6rie seiure aci& )a: ose

consciousness orresponsi+eness sae an&

)o+e i)6s on 6ot si&es

o te 6o&:% 5e ci&

6eco)es rigi& or ast,itces in on: a portion

o te 6o&: suc as an

ar) or a eg or on te

rigt or te et si&e on:%5e ci& )a: +o)it or

pass urine%

Aat )easure"s#

sou& 6e taen or

a+oi&e& &uring tee6rie seiure

e+ent%

-o sta+ calm. Focus :our

attention on 6ringing te

e+er &o,n% Insert rectaaceta)inopen "5:eno#

"i a+aia6e#% 3pp: coo,ascots to te oreea&

an& nec% Sponge te rest

o te 6o&: ,it ue,ar)

"not co ,ater% Loosen

an: restricti+e coting%-on/ttr: to o& or

restrain te ci& or stop

te seiure )o+e)ents%Dont tr: to orce an:ting

into is )out to pre+ent

i) ro) 6iting is tongue

as tis increases te ris

o in(ur:% Mo+e te ci&

on: i in a &angeroussituation% *e)o+e an:

o6(ects tat )a: in(ure

i)%

Aat does not

appen to te

ci&s 6rain &uring

a e6rie seiureO

5ere is no e+i&ence tat

si)pe e6rie seiures

"10 )inutes# cause

&eat 6rain &a)age

epieps: )enta

retar&ation a &ecrease inI or earning &iicuties%

5e ieioo& o

reoccurrence%

3 tir& o ci&ren ,i

a+e anoter e6rieseiure ,it a su6se


6/11

Clinical

Information

Clinical Education

Aen to consut aeatcare

pro+i&er ,en toca 911 an& ,en

tae te ci&

&irect: to an

e)ergenc: roo)".*#%

1% i&ren sou& consuta eatcare pro+i&er as

soon as possi6e ater teirst e6rie seiure% 2% a

911 i te seiure asts

)ore tan a e, )inutes%

?% ontact a eatcarepro+i&er or go to te .* i

an: oter s:)pto)s occurbefore or afterte

seiure$ nausea +o)itingras tre)ors a6nor)a

)o+e)ents pro6e)s ,it

coor&ination &ro,sinessagitation conusion

se&ation etc%

Aat )a: occur

&uring teeatcare

pro+i&ers

e+auation an&/or

testing o te ci&

Hoo& an& urine tests )a:

6e e;a)ine& to &etectinections% 5:pica: a u

seiure ,orup incu&ing

an ..K ea& 5 an&

u)6ar puncture "spina

tap # is not ,arrante&%

Aat are te

possi6e se


7/11

5op

1% Intro&uction

2% Fe6rie Seiures Deine&?% Natura Cistor:

4% Fe6rie Seiure .+auation%%%'% Ceat Ser+ices tiiation%%%


7% I)pications% Su))ar:

*eerences

care pro+i&ers un&erstan& potentia parenta )isconceptions an;ieties an& earsa6out e+er an& e6rie seiures so tat te: )a: aa: tose ears eecti+e:% 5e

eatcare pro+i&er aso nee&s to assess parenta reactions to te occurrence oe6rie seiure an& to &eter)ine te coping patterns utiie& as ,e as to &etect

an: &isruptions in parent-ci& interactions% 3&&itiona stu&ies are nee&e& to

e+auate te costs o treat)ent or initia e6rie seiures as ,e as eat ser+icesutiiation%

'onflict of interest

5e autors a+e &ecare& tat no conict o interest e;ists%

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