FEBRILE CONVULSIONS

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)