Febrile Seizures - 2015

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  • Febrile Seizures - 2015
When returning from an afternoon walk with his parents, a four-year-old boy weighing 14 kg (31 lbs) tells his mum he feels sick. He is restless, he has a sore throat, coughs slightly, and there is an apparent serous secretion from his nose. The parents take his temperature at 7 PM (37.7 °C or 99.9 °F) and administer him a Paralen 250 mg PO. At 11 PM they observe twitching in his face, spasming of the extremities, clenching his fists, holding his breath and rolling his eyes back for the first time. The condition progresses to a generalized tonic-clonic seizure. What steps do we take as parents to a boy whose older brother underwent similar spasms in early childhood?

Mother administers the child an anticonvulsant drug (Valproat PO) which she takes for her personal use.

Wrong answer

Wrong answer: It is not advisable to administer him a remedy specially prescribed and suitable for his mother's disease. In addition to that, during spasms is impossile and absolutely incorrect to administer whatever PO!


Back

It is undoubtedly an epileptic seizure. We lay the child down and remove all harmful objects nearby. It is not necessary to call an ambulance service because we are certain that the seizure will end spontaneously.

Wrong answer

This is a sign of acting too rashly! On the basis of symptoms and anamnesis, we cannot make a definite decision about epilepsy being the final diagnosis. It is necessary to apply the differential diagnosis of paroxysmal and spasmodic conditions. The first occurrence of spasms in a child of any etiology becomes an indication for further observation and searching for the causation.


Back

Mother has her own experience with the spasms and remembers her older son´s spasmodic seizure which he has once undergone in connection with an incipient cold. Due to this fact, she does not take any action and waits until the spasms stop because she believes this condition will not occur again.

Wrong answer

Maternal instinct will probably not allow mother to leave her baby to his fate despite the fact that she remembers this similar seizure in her older son in the past. But she does not know the etiological origin and she cannot assume that this condition will subside spontaneously. The first occurrence of spasms in a child of any etiology becomes an indication for further observation and searching for the causation. In addition, it is necessary to keep the child protected from injury and monitor his vital signs before the emergency service arrives.


Back

Now we are not able to judge this situation correctly that is why we call an emergency service immediately and mind protection of the child from injury.

Correct answer

Parents are in a stressful situation and the child is going through a serious life-threatening condition and urgently needs medical care. The best solution in such a tense situation is to dial emergency number 155 (112).


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Examination:
Anamnesis: FA: mother has epilepsy father is healthy boy's older brother had an attack of febrile seizures when he was 3 years old. PA: perinatal complications: spontaneous vaginal delivery, arrived at 33 weeks of gestational age, birth weight 2030g (4.47 lb), birth body length 45 cm, APGAR score 5-7-9, necessity for a 5-day incubator placement, physiologic neonatal jaundice not requiring phototherapy, exclusive breastfeeding for 4 month, postpartum adaptation, adjustment and psychomotor development with respect to perinatal complications meet the norm. Monitored by a neurologist for perinatal complications and his positive family anamnesis.

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