From the Guidelines
A neurology consult is not necessarily recommended for a 15-month-old with a new febrile seizure, as the risk of long-term effects is low and most febrile seizures are simple and do not require intensive intervention. According to the American Academy of Pediatrics clinical practice guideline 1, simple febrile seizures are defined as brief generalized seizures that occur once during a 24-hour period in a febrile child who does not have an intracranial infection, metabolic disturbance, or history of afebrile seizures. The guideline emphasizes that the risk of developing epilepsy in these patients is extremely low, and no data suggest that prophylactic treatment would reduce this risk.
Some key points to consider in managing a child with a febrile seizure include:
- The child's overall health and whether the seizure was simple or complex
- The presence of any neurologic deficits or return to baseline after the seizure
- The need for emergent neuroimaging, which is generally not recommended for simple febrile seizures 1
- The potential benefits and risks of anticonvulsant therapy, which is not recommended for children with simple febrile seizures due to the potential toxicities associated with these agents 1
In terms of imaging, the policy statement from Pediatrics 1 recommends that emergent neuroimaging is not necessary for simple febrile seizures, and advanced imaging may often be deferred to outpatient or nonurgent settings in the absence of high-risk historical or clinical examination findings. Therefore, a neurology consult may not be immediately necessary for a 15-month-old with a new febrile seizure, but rather a thorough evaluation by a pediatrician to determine the best course of action.
From the Research
Neurology Consult Recommendation
- A neurology consult is recommended for a 15-month-old with a new febrile seizure if certain conditions are met, as stated in the study 2.
- According to 2, a neurological consultation should be requested for any child who has experienced a prolonged febrile seizure before the age of 1 year, for children who have experienced prolonged and focal febrile seizures or repetitive (within 24h) focal febrile seizures, for children who have experienced multiple complex (focal or prolonged or repetitive) febrile seizures, or for children with an abnormal neurological exam or abnormal development experiencing a febrile seizure.
- However, for children who present with simple febrile seizures, no additional evaluation typically is needed, as stated in 3.
- It is essential to determine whether the febrile seizure was simple or complex, as this will guide the need for further evaluation and potential neurology consult, as discussed in 2 and 3.
Factors Influencing Neurology Consult
- The decision to request a neurology consult may depend on various factors, including the child's age, seizure characteristics, and presence of underlying medical conditions, as mentioned in 2 and 4.
- For example, a child with a history of febrile seizures, status epilepticus, a family history of epilepsy, developmental delay, or abnormal neurologic examination results may be at higher risk for developing epilepsy and may benefit from a neurology consult, as stated in 3.
- The study 4 also emphasizes the importance of considering the child's overall clinical presentation and medical history when deciding whether to request a neurology consult.
Additional Evaluation and Management
- If a neurology consult is recommended, the child may undergo further evaluation, including electroencephalogram (EEG), neuroimaging studies, or other diagnostic tests, as discussed in 3, 2, and 4.
- The management of febrile seizures and potential underlying conditions should be guided by evidence-based guidelines and recommendations, as outlined in 4, 5, and 6.