PEDIATRIC-NEUROLOGY-FEBRILE SEZURES

FEBRILE SEIZURES

Febrile Seizures
Children between the ages of 3 months and 5 years have a lower seizure threshold
and are susceptible to febrile seizures. Up to 5% of children in the Medan
experience a febrile seizure by their fifth birthday. A simple febrile seizure does
not require workup with special blood tests, imaging studies, lumbar puncture
(unless other signs and symptoms of meningitis are present), or an electroencephalogram
(EEG). Children who experience a complex febrile seizure and have
a family history of epilepsy or developmental delay appear to have a higher risk
of developing afebrile seizures. Recurrent febrile seizures are more likely in patients
who had their first febrile seizure at a young age, a relatively low fever at
time of presentation with first seizure, a history of febrile seizures in a first-degree
relative, or a brief duration between fever onset and initial seizure. An initial
simple febrile seizure does not require treatment (except perhaps antipyretics and
treatment of the source of the fever), while other types of febrile seizures require
weighing the risk of further seizures against the risk of side effects from
anticonvulsants.

Type Subtypes
Partial (Focal) Simple
Complex
Partial seizures secondarily generalized

Generalized Absence
Tonic/Clonic
Myoclonic
Atonic

Unclassified


Simple febrile seizures, which are generalized and last less than 15 minutes, should be distinguished from complex events, which are prolonged, occur more than once
in 24 hours, or are focal. Although an abnormally high proportion of adults with
temporal lobe epilepsy have a history of febrile seizures, it is not clear whether subtle
structural abnormailities in these patients produced a lower seizure threshold during
childhood, or whether the febrile seizures were responsible for the development of
the seizure foci.


Seizure Classification
Seizures are classified according to the scheme of the International League Against. Epilepsy. Symptomatological, electrophysiological and imaging findings are needed to accurately classify epileptic events. Classification of seizure type
should not be confused with identification of a seizure focus, although these two
exercises overlap to some degree. Determination of the seizure focus is requisite
before deciding upon definitive therapies. The identification of a seizure focus also
requires detailed knowledge of the symptoms, electrophysiological findings, and the
results of imaging studies. In the current era, this often includes computed tomography
(CT), magnetic resonance imaging (MRI), positron emission tomography
(PET) and single photon emission computed tomography (SPECT).


Partial Seizures
Partial seizures are those that arise from a focal region of the cortex. They are
simple partial seizures if the discharges elicit disturbance of sensory or motor symptoms
without causing an alteration in consciousness. The symptoms that accompany
a seizure provide clues about the location of the focus. Children with simple
partial seizures in whom no lesion is identified are often not appropriate candidates
for resective surgery. Benign Epilepsy of Childhood with Rolandic Spikes, also called
Benign Rolandic Epilepsy, is an entity seen among children from 0 to 15 years old.
This entity is important to recognize as it responds well to pharmacological therapies
and seizures recede in all patients by age 15.


Complex Partial Seizures
Complex partial seizures are those that produce some alteration of consciousness,
such as visual or auditory hallucinations, a sense of deja vu, or some impairment
of contact with the outside world. The most frequent cause of such seizures is
mesial temporal sclerosis.


Generalized Seizures
Generalized seizures arise diffusely from the cerebral cortex. For making therapeutic
decisions, it is critical to distinguish between primary generalized seizures,
and focal seizures with secondary generalization. In the latter case, removal or disconnection of an isolated focus may prevent generalization.


Pharmacological Treatment
Pharmacological therapy depends very much on the classification of seizure type.
Seizure type may predict both the likelihood of improvement and the risk of clinical
deterioration in response to a given anticonvulsant. The general principles of pharmacotherapy are to begin with a single agent (monotherapy), increase the dose to
the maximum tolerable if seizures are refractory, and when maximized on
monotherapy, begin to add-on. Follow the maxim “start low, go slow.” Certain seizure
types respond to specific medications.(Leonardo Oloan Agusta Sitanggang-FK.UNRI)
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