Important Questions to Ask When Evaluating Febrile Seizures
When evaluating a patient with febrile seizures, a structured approach focusing on specific questions about seizure characteristics, fever details, and risk factors is essential for proper management and prognosis determination. The following questions should be asked to guide evaluation and management:
Seizure Characteristics
Duration of seizure: Was it less than or greater than 15 minutes? 1, 2
- Seizures lasting ≥15 minutes are classified as complex febrile seizures
Seizure pattern: Was the seizure generalized or focal? 1, 2
- Focal seizures suggest complex febrile seizures and may require more extensive evaluation
Recurrence within 24 hours: Did multiple seizures occur within a 24-hour period? 3
- Multiple seizures within 24 hours classify as complex febrile seizures
Description of the seizure: Ask for details about body movements, eye deviation, color changes, and breathing patterns 1
Post-ictal state: How long did it take for the child to return to baseline mental status? 1
- Prolonged post-ictal state may indicate a more serious underlying condition
Fever Details
Documented temperature: What was the highest recorded temperature? Was it ≥38°C (100.4°F)? 1, 2
Duration of fever: How long has the fever been present before the seizure? 1, 2
- Short duration of fever before seizure onset increases recurrence risk
Potential source of fever: Any identifiable source of infection (respiratory, gastrointestinal, urinary, etc.)? 1, 4
Risk Factors and History
Age of the child: Is the child between 6 months and 5 years? 3
Family history: Is there a family history of febrile seizures or epilepsy? 1, 2
- Family history increases recurrence risk
Previous febrile seizures: Has the child had febrile seizures before? 1, 5
- Previous history helps determine recurrence risk
Developmental history: Any developmental delays or neurological abnormalities? 1
- Abnormal development may suggest higher risk for complications
Recent immunizations: Any vaccinations within the past 1-2 weeks? 3
- Some vaccines are associated with increased risk of febrile seizures
Signs of Serious Illness
Signs of meningitis: Any neck stiffness, persistent lethargy, irritability, or bulging fontanelle? 1, 2, 4
- These signs warrant immediate evaluation for meningitis
Focal neurological findings: Any focal weakness or persistent neurological abnormalities? 1
- Focal findings suggest a more serious underlying condition
Current medications: Is the child on any medications, particularly those that might lower seizure threshold? 1
Management Questions
Home management: Do parents know how to manage fever and potential seizure recurrence? 1, 2
Use of antipyretics: What antipyretics have been used and at what dosages? 2
Emergency medications: Has rectal diazepam been prescribed previously, and do parents know how to administer it? 1, 2, 6
Diagnostic Considerations
For complex febrile seizures or concerning features:
Blood glucose: Was blood glucose checked during the seizure if possible? 1
Signs of dehydration: Any clinical signs of dehydration that might require intervention? 2
Need for lumbar puncture: Any signs suggesting meningitis, especially in infants under 12 months? 2, 4
- Lumbar puncture is strongly indicated in infants under 12 months with febrile seizures to rule out meningitis
Prognosis Discussion
Understanding of prognosis: Do parents understand that simple febrile seizures have excellent prognosis? 1, 2, 5
- Risk of subsequent epilepsy after simple febrile seizure is only about 2.5%
- Risk increases with complex seizures (up to 4-6%)
Recurrence risk: Do parents understand the 15-70% risk of recurrence within 2 years? 5
Home seizure management: Have parents been educated on seizure first aid and when to seek emergency care? 2
By systematically addressing these questions, clinicians can properly classify febrile seizures, identify children requiring more extensive evaluation, provide appropriate management, and offer evidence-based counseling to parents regarding prognosis and home care.