Febrile Seizures Follow-up

Updated: Sep 19, 2017
  • Author: Nooruddin R Tejani, MD; Chief Editor: Kirsten A Bechtel, MD  more...
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Follow-up

Further Outpatient Care

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  • Arrange for medical reevaluation of discharged patients and parental education in a follow-up appointment within 24-48 hours.
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Further Inpatient Care

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  • The decision to admit should be individualized, but admission usually is not necessary for patients with febrile seizure.
  • Most patients should be observed in the ED until awake and alert.
  • Conditions requiring admission of the patient include the following:
    • More than 1 seizure within 24 hours
    • Unstable clinical status
    • Lethargy beyond the postictal period
    • Uncertain home situation
    • Unclear follow-up care
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Inpatient & Outpatient Medications

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  • Discharge medications include antipyretics and, if indicated, antibiotics (eg, otitis media, pneumonia).
  • Prophylactic use of antipyretics and sedatives/anticonvulsants for possible recurrence of febrile seizure has not shown to be effective.
    • Regular or sporadic administration of antipyretics during febrile illness is generally safe, but no study has shown them to be effective in reducing recurrence of febrile seizures. [45, 46] Acetaminophen and ibuprofen are no better than placebo for preventing recurrences of febrile seizures . [47]
    • Phenobarbital and valproic acid can be given daily and are effective, but they are associated with multiple adverse effects. Carbamazepine and phenytoin are not effective in preventing recurrent febrile seizures. Citing a preponderance of harm over benefit, the 2008 Clinical Practice Guideline for the Long-Term Management of the Child with Simple Febrile Seizures recommends neither continuous nor intermittent use of anticonvulsants for children with one or more simple febrile seizures. [46]
    • Some studies report that diazepam, given orally or rectally every 8 hours during febrile illnesses, is effective in preventing recurrence of febrile seizures. [48, 49] . However, these benzodiazepines can cause lethargy, drowsiness, and ataxia, and sedation could mask an evolving central nervous system infection. The AAP guideline released in 2008 does not recommend prophylactic use of diazepam as the risk outweighs the benefits. [46]
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Deterrence/Prevention

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  • Given a more established role of influenza A in the etiology of febrile seizure, both acute and recurrent, vaccination against influenza A in the flu season may have a role in preventing development of both acute and recurrent febrile seizures. [8]
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Prognosis

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  • Simple febrile seizures may slightly increase the risk of developing epilepsy, [50] but they have no adverse effects on behavior, scholastic performance, or neurocognition. The risk of developing epilepsy is increased further in children with a history of complex febrile seizures. [13, 51, 52, 53]
  • A strong association exists between febrile status epilepticus or febrile seizures characterized by focal symptoms and later development of temporal lobe epilepsy. [50, 54]
    • Children with febrile seizures have a slightly higher incidence of epilepsy compared with the general population (2% vs 1%).
    • Risk factors for epilepsy later in life include complex febrile seizure, family history of epilepsy or neurologic abnormality, and developmental delay. Patients with 2 risk factors have up to a 10% chance of developing afebrile seizures. [55]
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Patient Education

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  • Parents should be taught what to do if their child has another seizure.
  • The parent should be advised to call for assistance if the seizure lasts longer than 10 minutes or if the postictal period lasts longer than 30 minutes.
  • Parents should be counseled on the benign nature of febrile seizures.
  • Parents should be reassured that simple febrile seizures do not lead to neurologic problems or developmental delay.
  • For excellent patient education resources, visit eMedicineHealth's Brain and Nervous System Center. Also, see eMedicineHealth's patient education articles Seizures and Fever and Seizures in Children.
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