First Afebrile Fits (Seizure)
This information is aimed at children who may have had a first fit without a fever and are currently well. This does not cover febrile seizures, or children who are currently fitting.
Please note that seizures associated with a fever (>38oC) would not be covered by this and are usually seen urgently in PAU or Children’s ED. To refer these children, please call the PAU phone via switchboard or ask them to bleep the Paediatric Registrar out of hours.
A detailed history of the event, directly from the witness is important. If possible, parents should be encouraged to video any events they see as this is very helpful when seen in clinic.
It is helpful to ask about any associations with preceding events, including illness. Any pre warning before an event, including aura, palpitations, dizziness or unusual sensations should be documented. Recording the length of time it takes to return to normal, including any post ictal phase is useful.
It is helpful to know of any family history of seizures. Please also document any history of learning difficulties or developmental concerns.
A neurological and cardiac examination should also be done.
Children who have had a fit that is accompanied by a fever are not covered in this advice and are usually reviewed urgently via Paediatric ED or PAU.
Children may be referred having had a suspected first seizure.
Complex seizures (lasting > 15 minutes, focal or recurrent) should be seen urgently via PAU or Paeds ED – please refer via the Paediatrics on call telephone urgently via switchboard.
Similarly, if the child has not returned to normal (still semi-conscious, drowsy, unusual behaviour) following the seizure, please send urgently to Paediatrics as above.
If the child is still having a seizure/fit for > 5 minutes, please call 999 for urgent hospital transfer.
Open the airway, give oxygen via facemask if available
Do not put anything in their mouth; ensure there is nothing close by they may be injured by.
Medication for seizures should not be started in primary care and we would expect to see these children in clinic for assessment. EEG is not always appropriate as it is not always diagnostic. Children requiring EEG will be selected by the Paediatrician seeing the child in outpatients.
We see all children with a suspected first, afebrile seizure in clinic. It is useful to record the following information when making a referral:
– Detailed description of the event (video if possible), including any triggers, incontinence, tongue biting and post ictal phase
– Past medical history, including any recent illnesses, previous seizures, learning difficulties
– Family history of seizures, what type and age of onset
– Neurological and cardiac examination
If possible, please do an ECG looking for arrhythmia and include with your referral.
Parents should be given safety and first aid advice which can be found under ‘Supporting information’.
In the meantime, parents should be given the following advice:
• Young people should let parents know where they are, if going out (e.g. cycling),
• Young people should preferably be with friends who would know how to contact the parents
• They should not shower with bathroom door locked
• The young person should not go out unaccompanied
• They must have a supervising person when swimming
• Where appropriate safety equipment e.g. cycle helmets should be used, ensuring a good fit.
In the event of a further seizure:
Do not put anything in the mouth if fitting.
Clear the area of dangerous objects
Position child on side / recovery position with head tilted back to open the airway
Call 999 and stay with the child
Try to time the event (> 5minutes definitely requires an ambulance via 999)