A previously healthy 13-month-old boy is brought to the emergency department by ambulance after an episode of "jerky movements all over" that lasted 2 minutes. The movements occurred when the patient's father had just put him in his crib at naptime. The child has had fever, nasal congestion, and "eye redness" for the past day. Review of systems is otherwise negative. The patient was born full term, takes no medications, and has received all recommended vaccinations. His father has a history of a febrile seizure during childhood and a cousin with developmental delays. Temperature is 39.2 C (102.5 F), pulse is 120/min, and respirations are 22/min. Examination shows an awake, well-appearing boy resting on his father's lap. The anterior fontanelle is closed, and there is clear rhinorrhea and nasal congestion. The neck is supple with full range of motion. Auscultation reveals no adventitious sounds and no murmurs. The abdomen is soft and nontender. The extremities have full range of motion, and deep tendon reflexes are 2+ throughout. The soles of the feet are firmly stroked, causing the big toe to move upward, and the other toes fan out. Which of the following is the most accurate statement regarding this patient's prognosis?

Question

A previously healthy 13-month-old boy is brought to the emergency department by ambulance after an episode of "jerky movements all over" that lasted 2 minutes.  The movements occurred when the patient's father had just put him in his crib at naptime.  The child has had fever, nasal congestion, and "eye redness" for the past day.  Review of systems is otherwise negative.  The patient was born full term, takes no medications, and has received all recommended vaccinations.  His father has a history of a febrile seizure during childhood and a cousin with developmental delays.  Temperature is 39.2 C (102.5 F), pulse is 120/min, and respirations are 22/min.  Examination shows an awake, well-appearing boy resting on his father's lap.  The anterior fontanelle is closed, and there is clear rhinorrhea and nasal congestion.  The neck is supple with full range of motion.  Auscultation reveals no adventitious sounds and no murmurs.  The abdomen is soft and nontender.  The extremities have full range of motion, and deep tendon reflexes are 2+ throughout.  The soles of the feet are firmly stroked, causing the big toe to move upward, and the other toes fan out.  Which of the following is the most accurate statement regarding this patient's prognosis?

Quizplus · Accepted Answer

Explanation: 11ec2b69_bff4_45e4_8f63_718b5f253714_MD0005_00 This child had a febrile seizure, a condition that occurs exclusively in infants and young children, likely due to nervous system immaturity. Patients present between age 3 months and 6 years and often have a family history of febrile seizure. Febrile seizures are a common complication of high fever associated with a viral infection (eg, human herpes virus-6, influenza). These seizures usually occur during the first day of the illness and are frequently the initial manifestation of infection. Febrile seizures are diagnosed clinically. Patients have findings consistent with infection (eg, rhinorrhea, tachycardia, tachypnea); however, they have no history of afebrile seizures and no abnormal neurologic findings (eg, nuchal rigidity, bulging fontanelles). Febrile seizures typically have a benign course, do not require therapy, and have no long-term impact on development (Choice A). However, children who experience a febrile seizure have a ~30% chance of at least one recurrence and are at increased risk for subsequent development of epilepsy (eg, afebrile seizures) (Choice C). (Choice D) This child had a typical febrile seizure (eg, short, generalized, single, minimal postictal lethargy). Workup for febrile seizures is generally unnecessary as it is not cost-effective and is typically normal. Electroencephalography is of limited value in the prediction of future epilepsy and is not predictive of recurrent febrile seizures. (Choice E) Lumbar puncture is not indicated as there is no evidence of intracranial infection (eg, no bulging fontanelles, no neck stiffness) and vaccinations are up to date (eg, Haemophilus influenza type b, Streptococcus pneumoniae). A positive Babinski sign is normal until age 2. Educational objective: Febrile seizures typically occur as a complication of viral infection. Diagnosis is clinical and patients have normal development. However, patients with febrile seizures are at an increased risk of recurrence as well as epilepsy. References: Neurodiagnostic evaluation of the child with a simple febrile seizure. (http://www.ncbi.nlm.nih.gov/pubmed/21285335) Utility of lumbar puncture for first simple febrile seizure among children 6 to 18 months of age. (http://www.ncbi.nlm.nih.gov/pubmed/19117854) Update on the management of simple febrile seizures: emphasis on minimal intervention. (http://www.ncbi.nlm.nih.gov/pubmed/22327951)

A Previously Healthy 13-Month-Old Boy Is Brought to the Emergency