A 3-year-old child has a 4-minute focal clonic seizure of the left arm associated with a fever of 39.8°C. He had a prior febrile seizure at age 2. His EEG between episodes is normal. Which feature MOST RELIABLY distinguishes a complex febrile seizure from simple febrile seizure in this child?

• A Temperature exceeding 39°C at seizure onset
• B Age under 5 years at first febrile seizure
• C Focal onset (unilateral clonic activity) of the seizure ✓
• D Positive family history of febrile seizures in a first-degree relative

Explanation

Complex febrile seizures are defined by one or more of: (1) focal onset or focal features during the seizure, (2) duration >15 minutes, or (3) recurrence within 24 hours during the same febrile illness. Focal onset (left arm clonic activity in this case) is the distinguishing feature making this a complex febrile seizure. Temperature level, age under 5, and family history are risk factors for recurrence of febrile seizures but do NOT define the seizure as complex versus simple. Simple febrile seizures are generalized, last <15 minutes, and do not recur within 24 hours.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.