Febrile Seizures Workup

  • Author: Robert J Baumann, MD; Chief Editor: Amy Kao, MD   more...
 
Updated: Mar 27, 2012
 

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.
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Imaging Studies

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

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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.

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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.
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Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Robert J Baumann, MD  Professor of Neurology and Pediatrics, Department of Neurology, University of Kentucky College of Medicine

Robert J Baumann, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Pediatrics, and Child Neurology Society

Disclosure: Nothing to disclose.

Specialty Editor Board

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: Up To Date Royalty Section Editor

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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.

Selim R Benbadis, MD  Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, Tampa General Hospital, University of South Florida College of Medicine

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: UCB Pharma Honoraria Speaking, consulting; Lundbeck Honoraria Speaking, consulting; Cyberonics Honoraria Speaking, consulting; Glaxo Smith Kline Honoraria Speaking, consulting; Pfizer Honoraria Speaking, consulting; Sleepmed/DigiTrace Honoraria Speaking, consulting

Chief Editor

Amy Kao, MD  Attending Neurologist, Children's National Medical Center

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.

References

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

  2. 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].

  3. 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].

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

  5. [Best Evidence] Nørgaard M, Ehrenstein V, Mahon BE, Nielsen GL, Rothman KJ, Sørensen HT. Febrile seizures and cognitive function in young adult life: a prevalence study in Danish conscripts. J Pediatr. Sep 2009;155(3):404-9. [Medline].

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

  7. [Guideline] 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].

  8. [Guideline] 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].

  9. [Guideline] 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].

  10. 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].

 
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