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Running Head: FEBRILE SEIZURES
Febrile Seizures in the Pediatric Population
Presented to
Dr. Warren- Dorsey and Dr. Dionne Raley
In partial fulfillment of the requirements of
NURS 640 Primary Health Care of Children in the Family
Coppin State University
Helene Fuld School of Nursing
December 02, 2013
FEBRILE SEIZURES
Definition of the Problem
The National Institute of Neurological Disorders and Strokes (NINDS) define febrile
seizures as “convulsions brought on by a fever in infants or small children” ("Febrile seizures
fact," 2013). Febrile seizures is a common pediatric form of seizure which affects “2–5% of all
children and usually appearing between 3 months and 5 years of age” (Fetveit, 2008). Although
in most cases it is nonthreatening, febrile seizures contribute to pediatric emergency room visits
worldwide. Children with febrile seizures generally present with a “body temperature above
37.8-38.5°C (100.3-101.3°F)” (Scanlon & Cook, 2010).
Epidemiology
In a study conducted by Sfaihi et al (2012), based on 482 pediatric patients with febrile
seizures, epidemiology reports conveyed that 55.2% of the study participants exhibited simple
febrile seizures, while 44.8% of the participants exhibited complex febrile seizures. The
researchers of this study also “observed a slight predominance of febrile seizures in the male
participants” (Sfaihi, Maaloul, Kmiha, Aloulou, Chabchoub, Kamoun, & Hachicha,
2012). Also noted in the study was a genetic link of 14.7% familial febrile seizures. The study
concludes that there is a minor risk of death and or long term complications from febrile
seizures. It is important to note that although high temperatures are usually associated with
febrile seizures, patients with known risk factors may develop seizures regardless of the presence
of a fever.
Analysis of the Topic
Febrile seizures in pediatric populations are generally classified into 3 categories; simple,
complex and symptomatic febrile seizures. The signs and symptoms of each category may
overlap, but unique characteristics of each category will aid lead to an accurate diagnosis and
management. A common sign seen in all three categories of seizure is that usually the age and
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fever range is the same. It is common for “the majority of children with febrile seizures to be
between the ages of 6 months and 5 years, and also have rectal temperatures greater than 102
degrees Fahrenheit” (Baumann, 2013).
While identifying common trends of febrile seizures is important, it is equally essential to
note the differences in the 3 categories of febrile seizures to help the nurse practitioner in making
an accurate diagnosis and management. Generally, simple febrile seizures occur in a child who is
neurologically well developed by history, and the seizure episode lasts for less than fifteen
minutes. Simple febrile seizures occur without the presence of diseases such as “meningitis,
encephalitis, or any other illness affecting the brain. In this scenario, the seizure is described as
either a generalized clonic or a generalized tonic-clonic seizure” (Baumann, 2013). In contrast to
simple febrile seizures, complex febrile seizures may last longer than fifteen minutes, and the
patient may have several episodes of seizures within a close time period.
Unlike simple and complex febrile seizures in which the patient is generally
neurologically well developed, symptomatic febrile seizures occur in the presence of an
established neurological anomaly, and or an acute disease. A good history and physical
assessment will assist the nurse practitioner to identify neurological disorders, and or acute
illness contributing to the onset of the febrile seizure.
Literature Support
Numerous research studies have been undertaken to assess the causes of febrile seizures
in the pediatric population. Fetveit (2008) writes that “no specific level of fever is required to
diagnose a febrile seizure” (p. 17). Thus a febrile seizure may occur in a patient regardless of
how high the patient’s temperature gets. This is important to note because nurse practitioners can
educate their patients on the benefits or the lack of
use of prophylactic antipyretics. In fact,
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“there is little evidence to suggest that the use of antipyretics prevent recurrent febrile seizures”
(Fetveit, 2008).
Several research studies indicate that there is a familial association with patients who
have repeat febrile seizures. According to Prosad, Blaikley, and Chinthapalli (2012) “a positive
family history is seen in 25-40% of children, and frequency in siblings of children with febrile
convulsions ranges from 9-22%” (p.38). The familial link may explain why an otherwise
neurologically well-developed child may go on to develop epilepsy.
Although most febrile seizures are completely benign, the physical outlook of a patient
having a febrile seizure can leave on looking parents or family members skeptical about the long
term prognosis. An abundance of literature exists to inform and educate patients, family
members and healthcare providers of febrile seizures; pathophysiology and management. It is
essential that the nurse practitioner provides information to the parents/family members to
relieve the anxiety. On the other hand caution must be taken to not overwhelm the loved ones
with information. A recurrence of febrile seizures leads to the diagnosis of epilepsy.
Differential Diagnosis
Making an assessment of febrile seizure requires the nurse practitioner to review
pertinent history of the patient. A comprehensive assessment should include the chief compliant,
history of the presenting illness, allergies, medication use, as well as family and social history.
The information gathered would guide the nurse practitioner into arriving at an accurate
diagnosis. Differential diagnosis for the patient presenting with a febrile seizure may include but
not limited to the following;
-
Acute Disseminated Encephalomyelitis,
-
Acute Stroke
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-
Anterior Circulation Stroke
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Aseptic Meningitis
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Basilar Artery Thrombosis
-
Benign Childhood Epilepsy
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Complex Partial Seizures
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First Seizure: Pediatric Perspective
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Meningococcal Meningitis
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Neonatal Meningitis
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Neonatal Seizures
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Partial Epilepsies
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Posterior Cerebral Artery Stroke
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Seizures and Epilepsy: Overview and Classification
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Simple Partial Seizures
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Tonic-Clonic Seizures
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Viral Encephalitis
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Viral Meningitis
(Baumann, R. , 2013).
Management of Febrile Seizures by the Family Nurse Practitioner
The role of the nurse practitioner in managing febrile seizures is to identify the
underlying cause of the fever, and then treat the source of the fever. This may include ordering
laboratory procedures such as CBC with differential, to rule in or out bacteremia, or a urinalysis
with culture and sensitivity to determine if the child has a urinary tract infection. In essence, “no
specific studies are indicated for a simple febrile seizure” (Baumann, 2013).Based on the
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presenting symptoms and illness, the nurse practitioner can direct diagnostics and management
towards the underlying cause of the fever.
However, if a patient presents with persistent febrile seizures, and all diagnostic workup
fails to reveal the source of the fever, then the nurse practitioner can initiate a referral to a
neurology specialist. The nurse practitioner may forward previous diagnostic work up to the
neurologist, to help expedite a diagnosis. A referral to a specialist may heighten the parents of
the child’s anxiety that something more serious may be going. It is important therefore that the
nurse practitioner continues to provide assurance to the patient’s parents/guardian. For instance
providing data about local support groups could be a step in the right direction.
In the event that a neurologist decides to start the patient on seizure medications, the
nurse practitioner will still manage the overall care of the patient, but will work in collaboration
with the neurologist to ensure the optimal outcome for the patient. For instance, if the neurologist
starts the patient on phenobarbital or Depakote, then the nurse practitioner will ensure that serum
medication levels are drawn routinely to monitor efficacy of medication therapy.
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References
Baumann, R. (2013). Pediatric febrile seizures. Retrieved from http://emedicine.medscape
.com/article/1176205-overview
Febrile seizures fact sheet. (2013). Retrieved from http://wwwninds.nih.gov/disorders/febrile
_seizures/detail_febrile_seizures.htm
Fetveit, A. (2008). Assessment of febrile seizures in children. European Journal of Pediatrics
, 167(1), 17-27.
Sfaihi, L., Maaloul, I., Kmiha, S., Aloulou, H., Chabchoub, I., Kamoun, T., & Hachicha, M.
(2012). Febrile seizures: an epidemiological and outcome study of 482 cases. Child’s
Nervous System, 28(10), 1779-1784.
Prosad, P., S., Blaikley, S., & Chinthapalli, R. (2012). Clinical update: Febrile convulsion in
childhood. Community Practitioner, 85(7), 36-8.
Scanlon, A., & Cook, S. S. (2010). Febrile seizures, genetic (generalized) epilepsy with febrile
seizures plus, and dravet's syndrome. Journal for Specialists in Pediatric Nursing, 15(2),
154-9.
Febrile seizures fact sheet. (2013). Retrieved from http://www.ninds.nih.gov/disorders/febrile
_seizures/detail_febrile_seizures.htm
Fetveit, A. (2008). Assessment of febrile seizures in children. European Journal of Pediatrics
, 167(1), 17-27.
Prosad, P., S., Blaikley, S., & Chinthapalli, R. (2012). Clinical update: Febrile convulsion in
childhood. Community Practitioner, 85(7), 36-8.
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