Oct 11, 2009 ... From the Department of Pediatrics, Faculty of Medicine, King AbdulAziz
University, PO Box 80215, Jeddah 21589, Kingdom of Saudi Arabia.
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Multiple
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Febrile seizures
Mohammed M. Jan, MBChB, FRCPC, Ahmed K. Bamaga, MBBS.
From the Department of Pediatrics, Faculty of Medicine, King AbdulAziz University, PO Box 80215, Jeddah 21589, Kingdom of Saudi Arabia. Tel. +996 (2) 6401000 Ext. 20208. Fax. +996 (2) 6403975. E-mail:
[email protected]
Choose the most appropriate single answer. 1. Which statement is true regarding febrile status epilepticus? a. Accounts for 10% of febrile seizures b. Accounts for 20% of febrile seizures c. Accounts for 25% of all status epilepticus in young children d. Accounts for 40% of all status epilepticus in young children e. Accounts for 60% of all status epilepticus in young children 2. Regarding the timing of the febrile seizure during the febrile illness, when do most children have their seizure? a. Before the onset of the fever b. On the first day of illness c. On the second day of illness d. On the third day of illness e. No specific day 3. Which of the following febrile illnesses is least likely to be associated with a febrile seizure? a. Tonsillitis b. Otitis media c. Pneumonia d. Gastroenteritis e. Roseola (herpes virus 6) 4. Regarding the genetic role in febrile seizure, which of the following statements is correct? a. Females have a higher incidence than males b. Autosomal recessive inheritance with high penetrance c. Autosomal dominant inheritance with low penetrance and locus heterogeneity d. Sibling in an affected family has a 60% risk of having febrile seizure e. More common among dizygotic rather than monozygotic twins 5. Which of the following statements best describes the role of electroencephalography (EEG) in febrile seizure? a. Predicts the recurrence risk of febrile seizure b. Useful in both simple and complex types c. A set point to diagnose febrile convulsion d. Predicts the future risk of epilepsy e. Not recommended in febrile seizures 6. Febrile seizures can evolve to, or become associated with all of the following epilepsy syndromes, except: a. Lennox-Gastaut syndrome b. Hemiconvulsion hemiplegia syndrome c. Severe myoclonic epilepsy of infancy d. Hemiconvulsion hemiplegia epilepsy syndrome e. Temporal lobe epilepsy due to mesial temporal sclerosis 394
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Multiple choice questions
Answers: 1. c Complex febrile seizures are focal, prolonged (>15 minutes), and/or multiple within 24 hours of the same febrile illness.1 Febrile status epilepticus accounts for 5% of febrile seizures, and for up to 25% of all status epilepticus in children.2 2. b The majority of children have their febrile seizures on the first day of illness. In some cases the seizure is the first manifestation that the child is ill, namely, before the parents detect the fever.3 Although it is often contended that a febrile seizure is more likely to occur when temperature increases rapidly, there is no scientific data to support this belief.1-3 3. d Febrile seizures occur more commonly during viral than bacterial infections. Some viral infections, such as roseola (herpes virus 6), appear to be particularly prone to be associated with seizure activity in infants.1,2 Interestingly, when gastroenteritis is the cause of the fever, seizures are extremely uncommon, namely, has an inverse relationship.1 4. c Males generally have a higher incidence, with a male to female ratio of around 2:1.4 Among first-degree relatives of children with febrile seizures, up to 30% had history of febrile seizures. Other siblings of an affected family have a 20-30% risk of having febrile seizures. In addition, monozygotic twins have a much higher concordance rate than dizygotic twins, in whom the rate is similar to that of other siblings. Susceptibility to febrile seizures has been recently linked to several genetic loci in different families, including the long arm of chromosome 8q13-21, chromosome 19p, chromosome 2q23-24, and chromosome 5q14-15.1 The suggested mode of inheritance is autosomal dominant with low penetrance, variable expression, and locus heterogeneity. 5. e The yield of routine EEG is low in neurologically normal children with febrile seizures, even if the seizure is complex.5 Abnormal posterior slowing may occur shortly after the seizure and may be detected for as long as 10 days afterwards. This finding can serve to confirm the clinical impression that a seizure has occurred.5 However, EEG abnormalities are not predictive of recurrence or development of future epilepsy. This led to the conclusion that the routine practice of obtaining EEG in neurologically normal children with febrile seizures is not justified. 6. a Rarely, febrile seizures can evolve to, or become associated with, other epilepsy syndromes including; 1) generalized epilepsy with febrile seizures plus syndrome, 2) temporal lobe epilepsy due to mesial temporal sclerosis, 3) hemiconvulsion hemiplegia syndrome, 4) hemiconvulsion hemiplegia epilepsy syndrome, or 5) severe myoclonic epilepsy of infancy.1
References 1. Jan MM, Girvin JP. Febrile Seizures: Update and Controversies. Neurosciences 2004; 9: 235-242. 2. Callegaro S, Titomanlio L, Donegà S, Tagliaferro T, Andreola B, Gibertini GG, et al. Implementation of a febrile seizure guideline in two pediatric emergency departments. Pediatr Neurol 2009; 40: 78-83. 3. Al-Khathlan NA, Jan MM. Clinical profile of admitted children with febrile seizures. Neurosciences 2005; 10: 30-33. 4. Mohebbi MR, Holden KR, Butler IJ. FIRST: a practical approach to the causes and management of febrile seizures. J Child Neurol 2008; 23: 1484-1488. 5. Jan MM. Assessment of the utility of pediatric electroencephalography. Seizure 2002; 11: 99-103.
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