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FIRST: A Practical Approach to the Causes and Management of Febrile Seizures

Department of Neurology University of Texas Medical School at Houston

Kenton R. Holden, MD

Departments of Neurosciences (Pediatric Neurology) and Pediatrics, Medical University of South Carolina, Charleston, and Greenwood Genetic Center, Greenwood, South Carolina

Ian J. Butler, MB, BS, FRACP

Division of Child & Adolescent Neurology, Department of Pediatrics, University of Texas Medical School at Houston, ian.j.butler{at}uth.tmc.edu

During almost 4 decades of clinical practice of pediatrics and pediatric neurology, the senior authors have rarely made a formal presentation on the topic of "febrile seizures." In any large pediatric teaching hospital, questions regarding the diagnosis and management of febrile seizures are raised by medical students, pediatric residents, and adult and pediatric neurology residents. The acronym FIRST was developed as a teaching tool to present a simple and pragmatic clinical approach to children presenting with a single seizure or cluster of seizures in 1 day associated with a febrile illness before, during, or after the seizure event(s). FIRST refers to Febrile, Illness, Related, Seizure(s) and Template, with the latter representing an outline of the basic cause(s). The authors propose the use of the Table as a tool to help determine the underlying etiology of febrile seizures because this is the major factor affecting the choice of treatment.

Key Words: FIRST • management • febrile • seizures

Journal of Child Neurology, Vol. 23, No. 12, 1484-1488 (2008)
DOI: 10.1177/0883073808319317


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