eMedicine Specialties > Neurology > Pediatric Neurology

Febrile Seizures: Differential Diagnoses & Workup

Author: Robert Baumann, MD, Program Director, Professor, Departments of Neurology and Pediatrics, University of Kentucky
Contributor Information and Disclosures

Updated: Dec 11, 2008

Differential Diagnoses

Acute Disseminated Encephalomyelitis
Neonatal Seizures
Acute Stroke Management
Partial Epilepsies
Anterior Circulation Stroke
Posterior Cerebral Artery Stroke
Aseptic Meningitis
Seizures and Epilepsy: Overview and Classification
Basilar Artery Thrombosis
Simple Partial Seizures
Benign Childhood Epilepsy
Tonic-Clonic Seizures
Complex Partial Seizures
Viral Encephalitis
First Seizure: Pediatric Perspective
Viral Meningitis
Meningococcal Meningitis
Neonatal Meningitis

Other Problems to Be Considered

Benign epilepsy syndromes
Brain abscess
Bacterial meningitis
Encephalitis
Epilepsy

Workup

Laboratory Studies

  • No specific studies are indicated for a simple febrile seizure.
  • Physicians should focus on diagnosing the cause of fever.
  • Other laboratory tests may be indicated by the nature of the underlying febrile illness. For example, a child with severe diarrhea may benefit from blood studies for electrolytes.

Imaging Studies

Neither computed tomography (CT) nor magnetic resonance imaging (MRI) is indicated in patients with simple febrile seizures.

Other Tests

EEG is not indicated in children with simple febrile seizures. Published studies demonstrate that the vast majority of these children have a normal EEG. In addition, some of those with an abnormal EEG have remained free of seizures for the duration of their follow-up. On the other hand, some of the children with a normal initial EEG have experienced 1 or more afebrile seizures subsequent to the EEG. Finally, no evidence indicates that beginning anticonvulsant therapy for a child with simple febrile seizures and an abnormal EEG will alter the child's eventual outcome.

Procedures

  • Strongly consider lumbar puncture in children younger than 12 months, because the signs and symptoms of bacterial meningitis may be minimal or absent in this age group.
  • Lumbar puncture should be considered in children aged 12-18 months, because clinical signs and symptoms of bacterial meningitis may be subtle in this age group.
  • In children older than 18 months, the decision to perform lumbar puncture rests on the clinical suspicion of meningitis.

More on Febrile Seizures

Overview: Febrile Seizures
Differential Diagnoses & Workup: Febrile Seizures
Treatment & Medication: Febrile Seizures
Follow-up: Febrile Seizures
References
[ CLOSE WINDOW ]

References

  1. Baumann RJ. Technical report: treatment of the child with simple febrile seizures. Pediatrics. Jun 1999;103(6):e86. [Medline].

  2. Practice parameter: the neurodiagnostic evaluation of the child with a first simple febrile seizure. American Academy of Pediatrics. Provisional Committee on Quality Improvement, Subcommittee on Febrile Seizures. Pediatrics. May 1996;97(5):769-72; discussion 773-5. [Medline].

  3. Febrile seizures: clinical practice guideline for the long-term management of the child with simple febrile seizures. Pediatrics. Jun 2008;121(6):1281-6. [Medline].

  4. Riemenschneider TA, Baumann RJ, Duffner PK, et al. Practice parameter: the neurodiagnostic evaluation of the child with a first simple febrile seizure. American Academy of Pediatrics. Provisional Committee on Quality Improvement, Subcommittee on Febrile Seizures. Pediatrics. May 1996;97(5):769-72; discussion 773-5. [Medline].

  5. Rosman NP, Colton T, Labazzo J, et al. A controlled trial of diazepam administered during febrile illnesses to prevent recurrence of febrile seizures. N Engl J Med. Jul 8 1993;329(2):79-84. [Medline].

  6. Thoman JE, Duffner PK, Shucard JL. Do serum sodium levels predict febrile seizure recurrence within 24 hours?. Pediatr Neurol. Nov 2004;31(5):342-4. [Medline].

  7. Verity CM, Golding J. Risk of epilepsy after febrile convulsions: a national cohort study. BMJ. Nov 30 1991;303(6814):1373-6. [Medline].

  8. Vestergaard M, Pedersen MG, Ostergaard JR, Pedersen CB, Olsen J, Christensen J. Death in children with febrile seizures: a population-based cohort study. Lancet. Aug 9 2008;372(9637):457-63. [Medline].

  9. Winawer M, Hesdorffer D. Turning on the heat: the search for febrile seizure genes. Neurology. Nov 23 2004;63(10):1770-1. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

febrile convulsions, fever fits, epilepsy, seizure, simple febrile seizures, complex febrile seizures, symptomatic febrile seizures

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Robert Baumann, MD, Program Director, Professor, Departments of Neurology and Pediatrics, University of Kentucky
Robert Baumann, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Pediatrics, American College of Epidemiology, American Epilepsy Society, and Child Neurology Society
Disclosure: Nothing to disclose.

Medical Editor

James J Riviello Jr, MD, George Peterkin Endowed Chair in Pediatrics, Professor of Pediatrics, Section of Neurology and Developmental Neuroscience, Professor of Neurology, Peter Kellaway Section of Neurophysiology, Baylor College of Medicine; Chief of Neurophysiology, Director of the Epilepsy and Neurophysiology Program, Texas Children's Hospital
James J Riviello Jr, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Kenneth J Mack, MD, PhD, Senior Associate Consultant, Department of Child and Adolescent Neurology, Mayo Clinic
Kenneth J Mack, MD, PhD is a member of the following medical societies: American Academy of Neurology, Child Neurology Society, Phi Beta Kappa, and Society for Neuroscience
Disclosure: Nothing to disclose.

CME Editor

Selim R Benbadis, MD, Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida School of Medicine, Tampa General Hospital
Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Amy Kao, MD, Assistant Professor, Department of Neurology, Division of Pediatrics, Department of Pediatrics, Oregon Health and Science University; Consulting Staff, Shriners Hospital for Children
Amy Kao, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Pediatrics, American Epilepsy Society, and Child Neurology Society
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.