Febrile seizures are the most common cause of seizures in children, accounting for about 60% of neurological disorders in children.
Many pediatricians often scratch their heads when they see a child with convulsions: Is it febrile seizures? What are the key points for diagnosis and identification? What auxiliary inspections should be improved? Do you want to do it?
Lilac Open Class specially invited Ye Sheng, chief physician of Zhejiang University Children's Hospital, to summarize the 4 key points of the diagnosis of febrile convulsions for your reference.
I. Key points in the diagnosis of febrile seizures:
1. Age: it occurs between the ages of 6 months and 5 years, and the peak age of onset is 12 to 24 months of age; the probability of febrile seizures above this age is small;
2. Associated with fever: during convulsive attacks, the temperature exceeds 38.5 °C or the axillary temperature exceeds 38 °C;
3. Exclusive diagnosis: intracranial infection must be ruled out, there is a clear cause and a previous history of "no febrile seizures", as long as there is a history of no febrile seizures, febrile seizures cannot be diagnosed.
Note: Febrile seizures occur after more than 24 hours and are carefully diagnosed as febrile seizures, and febrile seizures occur after more than 72 hours to exclude febrile seizures, and the cause of the seizures needs to be found.
Second, a skill to distinguish the classification
After a definitive diagnosis, to distinguish between complexity and simple convulsions, just remember "a love".
"—": only 1 convulsion in 1 day (within 24 hours) (mostly within 12 hours of fever);
"Short": Short time, no more than 15 minutes
"Full": Total seizures
Simple febrile seizures that meet the above 3 points are complex for partial episodes (local tics), duration 15 to 30 minutes, and multiple episodes (more than two convulsions during a febrile illness).
3. What laboratory tests are recommended for improvement?
Patients >1 year of age who are clearly simple febrile seizures are generally in good condition and may not be tested.
Complex febrile seizures are generally recommended to have an EEG checked after 2 weeks;
Imaging is recommended for complex febrile seizures, particularly in the presence of abnormal head circumference, abnormal pigmented spots of the skin, focal neurologic signs, neurodevelopmental defects, or persistence of neurological abnormalities following a seizure;
Choice of Cranial CT and CRAN MRI: Cranial CT is better than Cranial MRI for hemorrhage, calcification, cerebral edema, and bone damage, but MRI is better for brain structural development, white matter damage, and cranial fossa, posterior fossa lesions, and encephalitis.
Other: blood routine, urine routine and blood biochemistry (including blood glucose, electrolyte, blood gas analysis): it can initially assess the risk of infection and provide a basis for differential diagnosis.
Note:
The choice of EEG and imaging tests is generally based on the type of febrile seizures, and it is especially important to grasp the difference between the choice of cranial CT and Cranial MRI based on the combination of medical history and signs.
Urinary tract infections are a common cause of fever that tends to be overlooked, and the clinical significance of urinalysis in febrile seizures should be noted.
4. What are the indications for lumbar puncture?
Any child with suspected intracranial infection, or with meningeal irritation or positive pathological signs;
Those who have not been vaccinated against influenza, streptococcus pneumoniae vaccine or have an unknown history of vaccination at 6 to 12 months of age;
treatment with antibacterial drugs, especially at less than 18 months of age;
After the specimen is removed, routine, biochemical, and culture tests of cerebrospinal fluid are routinely carried out, and the PCR testing of cerebrospinal fluid specimens of suspected special pathogen infection is recommended, such as rotavirus, herpes simplex virus, enterovirus, etc.
Note: Lumbar puncture examination in most primary medical institutions is limited to routine examinations such as cerebrospinal fluid routine + biochemistry + culture, and the clinical significance of specific etiological examination is often overlooked.
So, when the diagnosis is unclear, how should convulsions be treated? After a febrile seizure is clearly identified, do I need long-term drug prophylaxis? How to instruct family members to follow up and precautions?
What are the diagnostic techniques and treatment points for the clinical diagnosis and treatment of fever, abdominal pain and vomiting?
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