Beruflich Dokumente
Kultur Dokumente
Neuropaediatric Division
Paediatry Department
Medical Faculty - Udayana University
Sanglah General Hospital,
Denpasar
DEFINITION OF SEIZURE
Fever
Anatomis K+
,Phisiolog
y
biokimia
SEIZURE
Seizure process in the brain
Focal seizure
Focal become generalized
Generalized
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Seizure that accompanied by fever
Febrile seizure
Simple
Complex
Note
Commonly between 6 month old - 5 year old
Not included:
Electrolyte disturbance
Below 1 month old (Neonatal seizure)
History of seizure not due to fever
(ILAE,1993)
Think of Central Nervous System Infection or Epilepsy
if it happens out of that age range.
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Epidemiology
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.classification
continue
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Febrile seizure plus (FS+)
Fixed FS until > 6 year old
FS associated with seizure without fever or epilepsy
Frequent seizure, 13 times per year
Phenotype: Febrile seizure
Genotype : mutation in sodium channel and GABA
FS+ disappear at 12 year old
When undergo EEG, the result is same with normal febrile
seizure, nothing specific can be found
One of the spectrum from GEFS+ epilepsy syndrome
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Diagnosis
Diagnosis of FS not always easy
Encephalopathy accompanied with fever,
encephalitis, and meningitis.
Shivering during fever (peribucal cyanosis)
Agitation or delirium during fever
Epilepsy precipitated by fever
Diagnosis
Anamnesis :
Confirm: Seizure or non seizure/Pseudoseizur
Type, duration and frequency of seizure
Find the cause of fever
Find the risk factor
Physical examination:
Evaluate post ictal consciousness is very
important
Neurological examination is in normal range
= tods paresis when long duration seizure
Find the extracranial infection sign
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Supporting examination
Laboratory : Not routine, on
indication only
Complete blood count, electrolyte, blood
sugar
(Level II-2, recommendation D)
(Gerber dan Berliner, 1981; AAP, 1996)
Electroencephalography(EEG): not
routine
Unable to predict the recurrence of
seizure and probability of becoming
epilepsy
(Level II-2, recommendation E)
(Millichap,1991; AAP,1996)
1. During seizure
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ALGORYTHM OF HANDLING ACUTE SEIZURE AND STATUS CONVULSIVE
Diazepam 5-
Prehospital 10mg/rect max 2x 0-10min
5 Minute gap
Phenobarbitone 30-60min
20mg/kg/iv
Note : (rate >5-10min; max 1g)
Jika preparat (+)
ICU Refracter
I. Intermmitent Prophylaxis
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I. Intermmitent Prophylaxis
Consider:
Recurrent multiple seizure within 24 hour
Infant < 12 month old
Recurrent complex febrile seizure > 4
times/year
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Prognosis
2. Epilepsy (2-5 %)
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Risk factor of recurrence and Epilepsy
Recurrence of febrile seizure
Onset of recurrence :
12 months 75%
2 years 90%
Risk factor for Epilepsy
7 years 25 years
Simple febrile seizure 0.9% 2.4%
Febrile seizure
Risk factor (-) 2% 6-8%
Risk factor (1) 10% 17-22%
Risk factor (2 atau >) 13% 49%