Pediatric Febrile Seizures Workup

Updated: Nov 28, 2017
  • Author: Robert J Baumann, MD; Chief Editor: Amy Kao, MD  more...
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Workup

Laboratory Studies

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  • 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. A prospective study on the outcomes of febrile status epilepticus (duration ≥30 minutes), named the Consequences of Prolonged Febrile Seizures in Childhood or FEBSTAT, has shown that febrile status epilepticus is more frequently associated with hippocampal abnormality as compared to patients with simple febrile seizure. [7]

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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

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  • 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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