The neurologically abnormal child has never appeared in the exam, with the exception of Question 5 from the first paper of 2014 where febrile convulsions became the subject of detailed interrogation. By the most recently attempted definition, febrile convulsions are "a seizure occurring in childhood after one month of age, associated with a febrile illness that is not caused by an infection of the central nervous system". There are actually two definitions, which differ slightly. In brief summary, these are seizures which occur in the presence of fever and in the absence of any other good reason for seizures, in an age range variably described as under 6 years, 1 month to five years, 3 months to five years, and six months to six years.
International League Against Epilepsy (ILAE) definitionDefinition: "a seizure occurring in childhood after one month of age, associated with a febrile illness not caused by an infection of the central nervous system, without previous neonatal seizures or a previous unprovoked seizure, and not meeting criteria for other acute symptomatic seizures" |
NIH consensus statement:Definition: "an event in infancy or childhood usually occurring between three months and five years of age, associated with fever but without evidence of intracranial infection or defined cause for the seizure" |
The Royal Children's Hospital Clinical Guidelines has a slightly different age range to both of the above, and closely resembles the college answer. Clearly, both must have the same source.
The list of criteria for the diagnosis of simple febrile convulsions:
Additionally, the following is a list of criteria for the diagnosis of complex febrile convulsions:
In Question 5 from the first paper of 2014, the college asked for five drugs with which to manage seizures in the paediatric population – one from each class, as well as their dose, their advantages and disadvantages. Such a question lends itself well to a tabulated answer.
| Drug | Class | Dose | Advantages | Disadvantages |
| Lorazepam | Benzodiazepines | 0.05-0.1 mg/kg |
Can be given as buccal, IM, PR dose Rapid onset |
Respiratory depression Sedation Need for airway control |
| Diazepam | Benzodiazepines | 0.1-0.3 mg/kg |
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| Midazolam | Benzodiazepines | 0.1-0.3 mg/kg |
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| Phenytoin | Hydantoin | 20mg/kg | Minimal sedation No respiratory depression Prevents seizures over a prolonged period |
Not suitable for neonates Numerous interactions Levels need to be monitored |
| Levetiracetam | Racetam | 5-30mg/kg | Very safe Few interactions No need for monitoring |
Relatively new agent; efficacy unproven |
| Sodium valproate | Organic acid | 20-40 mg/kg | Effective in refractory cases | Hepatotoxic Levels need to be monitored |
| Propofol | Phenol | 1-3 mg/kg | Quick onset and offset | Respiratory depression Sedation Haemodynamic instability Need for airway control |
| Phenobarbitone | Barbiturate | 10-20 mg/kg |
More effective than phenytoin | |
| Thiopentone | Barbiturate | 2-3mg/kg | More effective than phenobarbitone (most effective of all available agents) |
Much of this information can be found it its raw untreated form in Slater's chapter on neurological emergencies in children, from Oh's Manual.
Oh's Intensive Care manual: Chapter 109 (pp. 1121) Neurological emergencies in children by Anthony J Slater.
Waruiru, C., and R. Appleton. "Febrile seizures: an update." Archives of Disease in childhood 89.8 (2004): 751-756.
Syndi Seinfeld, D. O., and J. M. Pellock. "Recent Research on Febrile Seizures: A Review." J Neurol Neurophysiol 4 (2013): 165.
Commission on Epidemiology and Prognosis, International League Against Epilepsy. "Guidelines for epidemiologic studies on epilepsy." Epilepsia 34.4 (1993).
Freeman JM. Febrile seizures: a consensus of their significance, evaluation, and treatment. Consensus development conference of febrile seizures. 1980. National Institute of Health. Pediatrics 1980;66: 1009–12.
Ventura, Alessandro. "From the American Academy of Pediatrics: Clinical Practice Guideline: Febrile Seizures: Guideline for the Neurodiagnostic Evaluation of the Child With a Simple Febrile Seizure." Pediatrics 127.2 (2011): 389-394.
Wright, Chanin, et al. "Clinical pharmacology and pharmacokinetics of levetiracetam." Frontiers in neurology 4 (2013).