FEBRILE SEIZURES
dr. Hadia Angriani, SpA
SUB. BAGIAN NEUROLOGI ANAK BIKA FK UNHAS / RS Dr. WAHIDIN SUDIROHUSODO
A. DEFINITIONS
Two operational definition of febrile seizure have been published:
1.
From a National Institutes of Health Consensus Conference (1980):
Febrile seizures : a febrile seizures is an event in infancy or
childhood, usually occurring between 3 month & 5 years of
age, associated with fever but without evidence of intracranial infection or defined cause
2. From International League Against Epilepsy Commission on epidemiology & prognosis (1993) : Febrile seizures : A seizures occurring in childhood after
age 1 month, associated with a febrile illness not caused
by an infection of the CNS without previous neonatal seizures or a previous unprovoked seizures, & not meeting criteria for other acute symptomatic seizures Neither definition includes a specific criteria on as to what temperature defines fever. A temperature of at least 38.40C (1010F) would probably be accepted by most authorities & Has been utilized in many epidemiological studies.
B. CLASSIFICATION & CLINICAL MANIFESTATIONS
Febrile seizures are typically divided into two types, simple & complex. 1. A complex febrile seizures has one or more of the following features (Commission 1993) : a. Partial onset or focal features during the seizures. b. Prolonged duration (> 10 minutes or > 15 minutes). c. Recurrent febrile seizures within 24 hours of the first episode.
2. A simple febrile seizures consist of less than 10 or 15
minutes of generalized tonic-clonic activity, resolving spontaneously, in the context of a febrile illness,
without focal features or recurrence during the subsequents
24 hours
C. DIAGNOSTIC PROCEDURE
1. Laboratory investigations : Many laboratory studies have been shown to be
unhelpful in the management of the child with
febrile seizures, except when specific symptoms or signs (e.g-vomiting or diarrhea) exist. Lab. study include : a complete blood count, blood sugar, serum electrolytes, serrex calcium,
phosphorus, magnesium, blood urea nitrogen
levels & urinalysis
2. Brain imaging CT scan or MRI is indicated in a child who has had a febrile seizures : a. When the history or examination indicates possible or hemotympanum) b. If the examination points to a possible structural brain Lession (e.g. microcephaly, spasticity) c. With evidence of increased intracranial pressure (persisting irritability or drowsiness recurrent vomiting,
Definite head trauma (e.g.scalp swelling & discoloration,
fullness of the anterior funtanelle in the young child,
cranial nerve VI palsies, or papilledema in the older child)
3. EEG Electroencephalopathy (EEG) is of limited value in the management of febrile seizures despite the fact that epilepsy form activity on an EEG is seen in 2 86 % (average 25%) of these children)
D. DIAGNOSIS
Diagnosis was made base on : History Examination Laboratory investigation Brain imaging and EEG
E. DIFERENTIAL DIAGNOSIS
CNS infection
Intracranial proses
Sinkop Children with high fever
BAGAN PEMBERANTASAN KEJANG
KEJANG
0-5 menit 1
(A) Diazepam IV : 0,2-0,5 mg/kgBB atau Diazepam rektal : BB < 10 kg = 5 mg BB > 10 kg = 10 mg
2
KEJANG (-)
KEJANG (+)
(A) Dapat diulang 2 kali interval 5 menit
5-10 menit (B) OAE sesuai kebutuhan : Kejang demam / infeksi SSP Epilepsi KEJANG (-) Fenitoin : 6 jam kemudian 5 7 mg/kg BB ditambah (B) 10-15 menit KEJANG (-) KEJANG (+) Phenobarbital IV/IM 12 jam kemudian 3-4 mg/kgBB ditambah (B) Phenobarbital IV/IM 10-20 mg/kgBB KEJANG (+) KEJANG (+)
Fenitoin Bolus IV 15-20 mg/kgBB Kecepatan : 25 mg/menit
ICU Midazolam : 0,2 mg/kgBB Phentobarbital 5-10 mg/kgBB
