Febrile Seizures – Common dilemmas

1. When do we need a Lumbar puncture?
   • Clinical sign and symptom of meningitis
   • Seizure with fever in a child who has received antibiotics earlier during that illness
   • Infants between age group 6-12 month who are NOT immunized for H Influenza and S. Pneumococcus
2. Do we need neuroimaging ? And what is the right time to do it?
   • Neuroimaging should not be performed as a routine for a simple febrile seizure
   • Urgent neuroimaging is not recommended for patients with complex febrile seizures. A MRI can be planed later  on a OPD basis for cases with focal and prolonged febrile seizures. 
   • CT head is unlikely to give good information
3. Role of EEG in febrile seizure
   • EEG Is not advised as a routine in simple febrile seizures
   • EEG is useful in febrile seizures which are focal or prolonged (>10 minutes) and in those patients who have abnormal neurological examination. 
   • Urgent EEG is advisable for prolonged loss of consciousness after a seizure with fever.
   • In cases of complex febrile seizures, an early EEG (<7 days) has been shown to pick up abnormalities more commonly than late EEG. In case the early EEG is abnormal, a repeat the EEG is done after one to three months. 

Coming up …. Family Counseling issues on 15/12/19.