A generalized tonic-clonic seizure associated with a rapid rise in temperature due to an extracranial illness. It is a diagnosis of exclusion: specific conditions (cerebral malaria, meningitis, epilepsy) should be excluded. It commonly affects children from age 3 months to 6 years.
Causes
- Malaria
- Respiratory tract infections
- Urinary tract infections
- Other febrile conditions
Clinical features
- Elevated temperature (>38°C)
- Convulsions usually brief and self limiting (usually <5 minutes, always <15 minutes) but may recur if temperature remains high
- No neurological abnormality in the period between convulsions
- Generally benign and with good prognosis
Differential diagnosis
- Epilepsy, brain lesions, meningitis, encephalitis
- Trauma (head injury)
- Hypoglycaemia
- If intracranial pathology cannot be clinically excluded (especially in children <2 years) consider lumbar puncture or treat children empirically for meningitis
Investigations
- Blood: Slide/RDT for malaria parasites
- Random blood glucose
- Full blood count
- LP and CSF examination
- Urinalysis, culture and sensitivity
- Chest X-ray
Management
- Use tepid sponging to help lower temperature
- Give an antipyretic: paracetamol 15 mg/kg every 6 hours until fever subsides
If convulsing
- Give diazepam 500 micrograms/kg rectally (using suppositories/rectal tube or diluted parenteral solution)
- Maximum dose is 10 mg
- Repeat prn after 10 minutes
If unconscious
- Position the patient on the side (recovery position) and ensure airways, breathing and circulation (ABC)
If persistent convulsions
- see Mental, Neurological and Substance Use Disorders
Prevention
- Educate caregivers on how to control fever (tepid sponging and paracetamol)