For treatment of acute seizures/status epilepticus see Convulsion

Febrile convulsions (3-4 % of all children)


Definition: sudden change in cortical electrical activity, manifested through motor, sensory, or behavioral changes and/or an alteration in consciousness

Epilepsy is considered when any of the following exists:
  • Diagnosis of an epilepsy syndrome
  • Types

    Important points in history

    Detailed description of the seizures, including duration and onset, bowel/ bladder incontinence, tongue bites, automatisms

    Seizures in epilepsy are usually stereotyped (each one is like the previous one), random (occur at any time of the day or night), and are rarely precipitated by specific environmental, psychological, or physiological events

    Important points on examination

    Full neurological exam



    4 to 8 per 1,000 population


    In neonates and infancy most seizures are symptomatic of an identifiable etiology - HIE, metabolic disturbances metabloic: hypoglycaemia, hypocalcaemia, vit b 6 deficiency, phenylketonuria, central nervous system or systemic infection.

    In HIV/Aids consider CNS Toxoplasmosis, Crzptococcal meningitis, Herpes encephalitis, bacterial meningitis, CNS lymphoma, neurosyphilis

    Differential diagnosis


    acute: see Convulsion

    Long term treatment:

    start if
    - more than 2 afebrile seizure
    - ongoing febrile seizures

    Monotherapy prefered

    if seizures not controlled switch

    in generalised seizures:

    in focal seizures (rarely controlled with Phenobarbital):

    1. Carbamazepine 20-30 mg//kg/day devided in two doses, start with 15mg/kg, increase in second week. Side effects include – fatigue, Vision impairement, Emesis, constipation, diarrhoea, dermatitis, increased LFTs, Thrombopenia
    2. Valproate. s. above

    Consider to stop treatment if two years without seizures

    Follow up

    general clinic if uncomplicated, neuro clinic in more complex cases