Last Updated on August 19, 2026
History Taking
Fitting
Pre-ictal e.g. sleeping, playing phone, sitting etc. e.g. uprolling of eyeballs, urinary / bowel incontinence / jerky movements of upper and lower limbs, not responding to call or touch etc. To differentiate simple VS complex febrile fit To differentiate simple febrile seizure VS complex febrile seizure • Active? Crying? Drowsy / Sleepy? Shivering? etc.
•
What did the patient do
Ictal
• What are the
features suggestive of seizure
•
Duration
• What did the care taker do to stop the seizure? Seizure aborted spontaneously?
• How many
episodes
Post-ictal
• How was patient’s condition
post-ictally
Other history
• Any documented temperature? • Reduced oral intake e.g. in acute tonsillopharyngitis / when patient is sick • TRO electrolyte imbalance causing seizure may be suggestive of photophobia
•
Oral intake
• Reduced oral intake may lead to hypoglycaemia, causing seizure
• Reduced urine output?
• Active?
• Any
vomiting / loose stool
• Projectile vomiting may suggest raised ICP as in meningitis
• Features may be suggestive of meningitis:
Crying when exposed to light
Notes
• It’s important to differentiate true fitting from shivering
• It’s important to differentiate simple febrile seizure from complex febrile seizure. Some literature mentioned that complex febrile seizure is at higher risk of developing epilepsy later on, compared to simple febrile seizure.
Simple VS complex febrile seizure
Simple Febrile Seizure | Complex Febrile Seizure |
• Duration <15 mins | • Duration >15 mins |
• Generalized tonic-clonic seizure | • Focal seizure |
• Doesn't recur during febrile episode | • >1 episode during febrile episode |
• Residual neurological deficit post-ictally, e.g. Todd's paralysis |
Physical Examination
• Neck stiffness? Dehydration
• Signs of
dehydration
Neurological Examination
• Tone, presence of clonus
• Power
• Reflex
• Babinski
Investigations
Bedside
•
Capillary blood glucose
Hypoglycaemia can present as seizure too! Hypoglycaemia on the other hand could be caused by poor oral intake e.g. in the setting of acute tonsillopharyngitis. So correction would be required either encouraged orally then re-check capillary blood glucose
Blood Investigations
• FBC, RP, electrolytes
Diagnosis
Differential diagnosis
• Meningitis / encephalitis Abbreviation: NAI Non-accidental injury
• Hypoglycaemia
• Electrolyte imbalance e.g. hypo/hypernatraemia, hypomagnesaemia
• Head trauma (may suspect
NAI
• Poisoning
Notes
• Remember that febrile seizure is NOT a standalone diagnosis. The underlying cause must be found out and treated.
• Points that must be included in a complete diagnosis: (i) simple or complex (ii) underlying cause
Example
• Simple febrile seizure secondary to acute tonsillopharyngitis, with mild
dehydration
Dehydration
Take Home Message
1. Never forget to check the capillary blood glucose on arriva
2. Not all febrile seizure requires ward admission