pediatrics
Febrile Seizures
Diagnosis of Febrile Seizures
Exclusion of other causes clinically or sometimes by testing (See also the American Academy of Pediatrics Subcommittee on Febrile Seizures'guidelines for the neurodiagnostic evaluation of the child with a simple febrile seizure[2011].) Seizures are diagnosed as febrile after exclusion of other causes. A fever may trigger seizures in children with previous afebrile seizures; such events are not termed febrile seizures because these children have an underlying tendency to have seizures. Routine testing is not required for simple febrile seizures other than to look for the source of the fever, but if children have complex febrile seizures, neurologic deficits, or signs of a serious underlying disorder (eg, Overview of Meningitis , Tests to exclude other disorders are determined clinically: Cerebrospinal fluid (CSF) analysis is done to rule out meningitis and encephalitis in younger infants, in those with meningeal signs or signs of CNS depression, or in those who have seizures after several days of febrile illness. CSF analysis must also be considered if children are not fully immunized or are taking antibiotics. Serum glucose, sodium, calcium, magnesium, and phosphorus and liver and kidney function tests are done to rule out metabolic disorders especially if the history includes recent vomiting, diarrhea, or impaired fluid intake; if there are signs of dehydration or edema; or if a complex febrile seizure occurs. Brain MRI is done if neurologic examination detects focal abnormalities, if focal features occur during the seizure or postictal period, or if the postictal depression of sensorium is prolonged. Electroencephalography (EEG) is done if febrile seizures have focal features or are recurrent. A diagnostic evaluation based on the underlying disorder is done if children have an already identified developmental or neurologic disorder (usually, the termfebrile seizureis not used in such cases). EEG typically does not identify specific abnormalities or help predict recurrent seizures, and it is not recommended after an initial simple febrile seizure in children with a normal neurologic examination. 