An 18-month-old child develops a 3-minute generalised tonic-clonic seizure during a febrile illness (temperature 39.2°C). He returns to normal neurological baseline after the seizure. This is his first seizure. EEG is normal. What is the risk of recurrence and appropriate management?

• A Risk of recurrence ~30%; initiate long-term anti-epileptic therapy with valproate
• B Risk of recurrence 60%; recommend EEG and MRI before discharge
• C Risk of recurrence ~5%; no further management needed
• D Risk of recurrence ~30%; no long-term AED; parental education and rescue benzodiazepine prescription ✓

Explanation

Simple febrile seizures (generalised, <15 minutes, single episode within 24 hours in a febrile child aged 6 months–5 years without neurological abnormality) have a recurrence risk of approximately 30%. They do not increase the risk of subsequent epilepsy significantly. Management is parental reassurance, education about seizure first aid, and a prescription for rectal diazepam or buccal midazolam as rescue medication for future prolonged seizures. Routine EEG and MRI are not recommended after a first simple febrile seizure. Long-term AED prophylaxis is not indicated.

Reference: Ghai Essential Pediatrics, 10th ed.

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Written and medically reviewed by the StethoPrep medical team.