Poster Presentations

P-18: Assessment of the Latest Evidence on Diagnosis, Management and Prognosis of Complex Febrile Seizures in Children

Kia Gilani, Diana De Santis, Natasha Mense-Dietrich

McMaster University WRC                                          

Introduction: Febrile seizures (FS) occur in 2-5% of children aged 6-60 months old, classified as simple (<15 minutes, generalized, 1 in 24 hours) (SFS), complex (15-30 minutes, focal, >1 in 24 hours) (CFS), or status epilepticus (> 30 minutes)(FSE). Unlike SFS, there are no AAP recommendations on CFS due to inconsistent evidence (1). This poster will review the evidence for diagnosis, treatment and prognosis of CFS. 

Diagnosis: CFS are diagnosed clinically after excluding alternate causes of seizures with associated fever (meningitis, encephalopathy). Foregoing lumbar puncture infrequently resulted in missed diagnoses, with 0.5-15% of lumbar punctures revealing CNS pathology. Postictal EEG has not proven to be useful in evaluation of CFS.

Management: Some evidence supports use of intermittent diazepam to prevent CFS recurrence, with adverse events in 30-40% of children. However, these studies did not distinguish CFS from SFS, prohibiting a cost-benefit analysis. Zinc deficiency has been linked to FS, and supplementation reduced recurrence with little side effect. 

Prognosis: There is no association between CFS and attention, impulsivity, working memory,  academic, intellectualor behavioural disturbances. Development of epilepsy after CFS was greater than SFS (6-32% vs 1.04-5.4%) with focality being the strongest predictor (29.5-45%). EEG abnormalities after 10 days may predict epilepsy, particularly in those with focal CFS. 

Conclusion: Diagnostic use of lumbar puncture or EEG is not supported by evidence. CFS were not linked to neurocognitive decline, but were more strongly linked to development of epilepsy. Further studies are required to determine the utility of diazepam prophylaxis, zinc supplementation and EEG in prognostication.