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Scenario 1: A 12-month-old child has been irritable and lethargic for the last 12 hours . He feels warm to the touch and has been placed in lukewarm water baths . Suddenly, he stiffens and then becomes limp with fine shaking of all extremities for less than 1 minute. Within approximately 15 minutes, he returns to his pre-seizure status .
Scenario 2: Same scenario as above except that the shaking involves the left arm and leg, and persists for 20 minutes .
A febrile seizure (FS) is usually defined as a seizure related to fever (often defined as a temperature >38 .4°C) in a child between 1 to 6 months and up to 5 years of age, and in the absence of an intracranial infection There is some variation in the literature with regard to the minimum and maximum ages, degree of temperature elevation, and requirement for neurological normalcy. A complex febrile seizure (CFS) is distinguished from a simple FS (SFS) by a seizure duration of greater than 10-15 minutes, symptoms or signs of focality, and two or more events within 24 hours Febrile status epilepticus may be seen in about 5% of patients with febrile seizures
The differential diagnosis of any type of potential seizure should include consideration of relevant paroxysmal, nonepileptic events In the age range considered for FSs, possibilities include rigors associated with illness, gastroesophageal reflux, and breathholding spells The latter entities usually do not occur in the context of fever but certainly could do so either by coincidence or with fever as a provoking factor Recently, the entity of afebrile seizures occurring in Asian and Caucasian children in the context of gastroenteritis has been reported with a prognosis similar to that of FSs . However, the critical differential diagnostic entities are meningitis, encephalitis, and cerebral abscess, as these are potentially life-threatening disorders
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