Convulsions febrile

One of the oldest antiepileptic drugs, bromide, has been repotted to boost inhibition by an unknown mechanism. Bromide is still in use in certain cases of tonic-clonic seizures and in pediatric patients with recurrent febrile convulsions and others. The mechanism of action may include a potentiation of GABAergic synaptic transmission, although the precise target is not known. 

VanLandingham, K. E., Heinz, E. R., Cavazos, J. E. and Lewis, D. V. Magnetic resonance imaging evidence of hippocampal injury after prolonged focal febrile convulsions. Ann. Neurol. 43 413-426,1998. 

The normal body temperature is 36.8°C. Babies under 6 months of age who have a higher temperature than 37.7°C should be referred on the same day. Babies over 6 months should be referred if their temperature is above 38.2°C. Babies who have had a temperature-related convulsion lasting 15 minutes or longer should receive pharmacotherapy in the form of either lorazepam, diazepam or clonazepam. Febrile convulsions in children usually cease spontaneously within 5-10 minutes and are rarely associated with significant sequelae and therefore long-term anticonvulsant prophylaxis is rarely indicated. Parents should be advised to seek professional advice when the child develops fever so as to prevent the occurrence of high body temperatures. 

Q18 The dose of diazepam for children in febrile convulsions is 250 pg/kg. What is the appropriate dose for a child v/eighing 25 kg ... 

Q52 Wh ich of the following is (are) recognised treatments for prolonged febrile convulsions ... 

Prolonged febrile convulsions can be treated by administration of diazepam (benzodiazepine) as a slow intravenous infusion or rectally. 

A splice-site mutation in GABRG2 associated with childhood absence epilepsy and febrile convulsions. Arch Neurol 59 1137-1141... 

Carbamazepine has been shown to be better tolerated as long-term monotherapy than DVP in children with epilepsy or febrile convulsions (Herranz et ah, 1988). Nevertheless, a comparison of the adverse effect profile in the Kowatch sample (Kowatch et ah, 2000) shows that nausea (46%), rash (8%), and dizziness (8%) were more prevalent in youngsters taking CBZ, compared to children on DVP, who experienced overall less nausea (20%), rash (0%), and dizziness (0%). 

Phenobarbitone is useful in grandmal, focal and temporal lobe epilepsy and sometimes petitmal also. It is also useful in the treatment of febrile convulsions. 

Adverse effects include fever which may be accompanied by skin rash, malaise, cough, headache and rarely febrile convulsions. 

A 2-year-old boy is brought into your pharmacy by his parents. He is well wrapped up for the cold weather but they say he has a temperature. He has a cough which he picked up at nursery. The parents want to know if they can have something to prevent febrile convulsions. They are particularly worried as they have an older child with epilepsy. On questioning the parents say that they took his temperature this morning and it was 38°C, but his head still feels very hot. 

There is no evidence that reducing the temperature with antipyretics reduces the chances of having a febrile convulsion. Reducing the temperature makes the child feel more comfortable, but has little clinical benefit apart from that. 

Febrile convulsions generally occur between six months and 3 years of age. A family history of epilepsy is not definitely associated with an increased risk of febrile convulsions, but if they happen they are more likely to recur. The younger the age group the higher the risk of recurrence (especially <1 year). By the age of 8 years only 3% of children who have had a febrile convulsion will have developed epilepsy and the two events seem unrelated. 

No. Antipyretics may make the child feel more comfortable, but there is no evidence that they reduce the incidence or severity of febrile convulsions. Anticonvulsants certainly have no role to play. If a febrile convulsion does happen they are generally tonic or tonic-clonic and last just a couple of minutes. If they were to continue for longer than 5 minutes then conventional treatment for status epilepticus should be used (rectal diazepam or buccal midazolam). 

Predisposing factors to neuroleptic drug-induced seizures include an abnormal electroencephalogram, preexisting CNS abnormalities, parenteral administration of high doses, and a family history of seizures or febrile convulsions (168). 

When a child has febrile convulsions the decision to embark on continuous prophylaxis is serious for the child, and depends on an assessment of risk factors, e.g. age, nature and duration of the fits. Most children who have febrile convulsions do not develop epilepsy. Prolonged drug therapy, e.g. with phenytoin or phenobarbitone, has been shown to interfere with cognitive development, the effect persisting for months after the drug is withdrawn. Parents may be supplied with a specially formulated solution of diazepam for rectal administration (absorption from a suppository is too slow) for easy and early administration, and advised on managing fever, e.g. use paracetamol at the first hint of fever, and tepid sponging. 

Sodium valproate is effective for a wide range of seizure disorders, including generalised and partial epilepsy, and the prophylaxis of febrile convulsions and post-traumahc epilepsy. 

Neuralgic amyotrophy (12), febrile convulsions (13), and Guillain-Barre sjmdrome (14) have been attributed to hepatitis B vaccine. Fatal inflammatory polyradiculoneuropathy has been reported in temporal relation to hepatitis B administration (15). 

Pyrogenic reactions result from contamination of antivenom by endotoxin-like compounds. High fever develops 1-2 hours after treatment and is associated with rigors, followed by vasodilatation and a fall in blood pressure. Febrile convulsions can occur in children. Patients should be cooled and given antipyretic drugs by mouth, powdered and washed down a nasogastric tube, or by suppository. 

Khaya ivorensis A. Chem. Meliaceae Afr stem bark febrile convulsions in children +PTZ 70% ethanolic ext. 120... 

Generalized epilepsy with febrile convulsions (GEES) SCNl B (P1 subunit) Cysteine to glycine Slowed inactivation of sodium channel a-subunits... 

Evidence in mice indicates that the fetus may be particularly susceptible to compromised immunocompetence due to altered stem cell populations of key immunoactive cells (Barnett et al. 1990a, 1990b). Infants may be unusually susceptible to a chronic seizure disorder following exposure to chlordane, particularly if they have a hereditary predisposition, such as a positive familial history of febrile convulsions (Bernad 1989). 

Lewis, DV (1999) Febrile convulsions and mesial temporal sclerosis. Curr Opin Neurol, 12 197-201. 

The child who died was admitted in the morning with a seizure. I had seen her before in the outpatient clinic and during a previous admission with an atypical febrile convulsion, when she had been noted to be hypoglycaemic and had had further tests. We initially checked her electrolytes, gave her rectal then intravenous diazepam, and did an infection screen in view of a low grade fever. She was hypoglycaemic on admission, which we corrected. 

History of seizure disorder other than early febrile convulsions. 

An 18-year-old man with a history of childhood febrile convulsions received a combined axil-lary/interscalene brachial plexus block with two doses of ropivacaine 150 mg 15 minutes apart, and 2 minutes after the second dose developed generalized tonic-clonic seizure, which were successfully treated with oxygen, ventilation, and intravenous midazolam. The arterial plasma concentration ropivacaine at the time of the convulsions was only 2.1 mg/1. 

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