Distinguish from mimics:
- Lateralized tongue-biting (high specificity)
- Flickering eye-lids
- Dilated pupils with blank stare
- Lip smacking
- Increased heart rate and blood pressure during event
- Post-ictal phase
-if the seizure occurs >24hrs after the onset of fever, have higher suspicion for a bacterial cause of the fever (ie meningitis)
–older pts who return to baseline after a complex seizure and at no point displayed any focal neurologic symptoms usually do not require an extensive work-up
Risk of Epilepsy is 2% after a simple febrile seizure and 5 % after a complex febrile seizure (compared to 1% in the general population)
-most common cause in <6mo is overdilution of formula -> 3ml/kg hypertonic (3%) NS
- Have prolonged seizures,
- < 6 months of age (specifically for hyponatremia)
- History of diabetes, metabolic disorder, dehydration, or excess free water intake
- Altered LOC
CT head if:
- Focal seizure or persistent seizure activity
- Focal neurologic deficit
- VP shunt
- Neurocutaneous disorder
- Signs of elevated ICP and history of trauma or travel to an area endemic for cysticercosis.
- Patients who have immunocompromising diseases (malignancy or HIV),
- Hypercoagulable states (sickle cell disease), or bleeding disorders
<6 months of age – generally require a full workup and are usually admitted for observation.
6 months and 2 years of age – disposition will depend on blood work, reassessment and the ability to have close follow-up.
>2 years of age – those who have returned to baseline, have a normal neurological exam with normal workup are often safe to be discharged to close outpatient follow-up. Otherwise, admit.
*note that the first dose of benzo should NOT be given iv (other routes just as efficacious, and early time to benzo is more likely to stop the seizure)
*note that fosphenytoin is a precursor to phenytoin with fewer side effects