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      Febrile Seizures: Four Steps Algorithmic Clinical Approach

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          Abstract

          Febrile seizures (FS) are the most common form of convulsive phenomena in human being and affect 2% to 14% of children. It is the most common type of seizures that every pediatrician is dealing with. It is the most benign type of all seizures occurring in childhood. There are many debates on how to approach to febrile seizures in pediatric neurology and there are many possible malpractices in this field. Some of the most common frequent queries are

          • How could we differentiate FS from seizures and fever associated with serious infections involving the central nervous system?

          • When should we refer the affected child for further investigations such as lumbar puncture, EEG, neuroimaging, and routine biochemical studies?

          • How should we treat FS in its acute phase?

          • How could we assess the risk for further recurrences as well as other risks threatening the child's health in future?

          • How could we select the patients for treatment or prophylaxis?

          • Which medication(s) should be selected for treatment or prophylaxis?

          Trying to answer the above-mentioned questions, this review article will present a four steps algorithmic clinical approach model to a child with febrile seizures based on the current medical literature.

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          Most cited references112

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          A prospective, population-based epidemiologic study of status epilepticus in Richmond, Virginia.

          This report presents the initial analysis of a prospective, population-based study of status epilepticus (SE) in the city of Richmond, Virginia. The incidence of SE was 41 patients per year per 100,000 population. The frequency of total SE episodes was 50 per year per 100,000 population. The mortality rate for the population was 22%, 3% for children and 26% for adults. Evaluation of the seizure types for adult and pediatric patients demonstrated that both partial and generalized SE occur with a high frequency in these populations. Based on the incidence of SE actually determined in Richmond, Virginia, we project 126,000 to 195,000 SE events with 22,200 to 42,000 deaths per year in the United States. The majority of SE patients had no history of epilepsy. These results indicate that SE is a common neurologic emergency.
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            Guidelines for epidemiologic studies on epilepsy. Commission on Epidemiology and Prognosis, International League Against Epilepsy.

            (2015)
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              Predictors of epilepsy in children who have experienced febrile seizures.

              We examined the frequency of development of afebrile seizures in 1706 children who had experienced at least one febrile seizure and were followed to the age of seven years. Epilepsy developed by seven years of age in 20 per 1000 (2 per cent), and another 10 per 1000 had at least one afebrile seizure that did not meet our definition of epilepsy. In children whose neurologic or developmental status was suspect or abnormal before any seizure and whose first seizure was complex (longer than 15 minutes, multiple or focal) epilepsy developed at a rate 18 times higher than in children with no febrile seizures (92 vs. 5 per 1000; P less than 0.001). In the largest group with febrile seizures, those previously normal with noncomplex first febrile seizures, epilepsy developed in 11 per 1000; this rate, although moderate, was greater than that for children with no febrile seizures (P = 0.027). Prior neurologic and developmental status and characteristics of the first febrile seizure are important predictors of epilepsy after febrile seizures.
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                Author and article information

                Journal
                Iran J Pediatr
                Iran J Pediatr
                IJPD
                Iranian Journal of Pediatrics
                Tehran University of Medical Sciences
                2008-2142
                2008-2150
                March 2010
                : 20
                : 1
                : 5-15
                Affiliations
                Department of Pediatrics and Pediatric Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, IR Iran
                Author notes
                [* ] Corresponding Author: Address: Pediatric Neurology Division, Children's medical center, Pediatric Excellence Center, Dr Gharib St, Tehran, IR Iran. E-mail: mohamadi@ 123456tums.ac.ir
                Article
                IJPD-20-005
                3445995
                23056677
                d7739490-7621-4f41-a9c2-9a7755fe0145
                © 2010 Iranian Journal of Pediatrics & Tehran University of Medical Sciences

                This is an open-access article distributed under the terms of the Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0), which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.

                History
                : 20 September 2008
                : 20 January 2010
                : 30 January 2010
                Categories
                Clinical Approach

                Pediatrics
                algorithms,clinical protocol,febrile convulsions,febrile seizures
                Pediatrics
                algorithms, clinical protocol, febrile convulsions, febrile seizures

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