An child is brought to your emergency department following a seizure. Per the guardian, the patient recently developed a cold with congestion and fever prior to the seizure. Which of the following patients would require further work up? (scroll down for the answer)

a) A 12-month-old female with a single 6-minute tonic-clonic seizure.

b) A 3-year-old male with a 12-minute tonic clonic seizure the morning after developing a fever.

c) An 16-month-old male with a 2-minute seizure who had a seizure while sick when he was 7 months old.

d) A 4-month-old female with a 3-minute tonic clonic seizure that resolved spontaneously.

e) A 10-month-old female with a 9-minute tonic clonic seizure whose temperature is 103.5˚F

The correct answer is d) A 4 month old female with a 3 minute tonic clonic seizure that resolved spontaneously.  

Simple febrile seizures are those that occur in children 6 months – 5 years of age, are generalized tonic-clocic, last less than 15 minutes and occur only one in a 24 hour period (during the first 24 hour period of the fever.) Answer d) requires further work up as the patient is less than 6 months of age.

50% of children who are less than 12 months old will have another simple febrile seizure. A higher temperature does not make a febrile seizure more concerning or prompt a work up. In fact, a higher temperature is more likely to cause a febrile seizure. It is important to remind parents that children who experience a simple febrile seizure have the same risk as the general population of developing epilepsy.

References:¹ Stapczynski, J. Stephan,, and Judith E. Tintinalli. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 7th ed. New York, N.Y.: McGraw-Hill Education LLC., 2011. Page 894-895.