infectious

Simple Febrile Seizure

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources3 sources

AAP Clinical Practice Guideline: Febrile Seizures 2011 · Egyptian National Drug Formulary, nervous system 2025, diazepam monograph, febrile convulsions (printed p. 12) · Febrile Seizure - StatPearls - NCBI Bookshelf - disease-level clinical article (febrile-seizure-simple-full.txt)

Verified against4 documents

AAP Clinical Practice Guideline: Febrile Seizures 2011
Egyptian National Drug Formulary, nervous system 2025, diazepam monograph, febrile convulsions (printed p. 12)
No dose - referral pathway, no medicine given in primary care
Febrile Seizure - StatPearls - NCBI Bookshelf - disease-level clinical article (febrile-seizure-simple-full.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (9)

One generalised tonic-clonic episode under 15 minutes, then a short spell of drowsiness [drowsiness]
The complex type instead: focal, one-sided, 15 minutes or longer, or repeating inside 24 hours
One-sided weakness or paralysis afterwards (Todd paralysis) marks the complex type [one-sided weakness · paralysis]
Either type may involve loss of consciousness, frothing, breathlessness and blue discolouration [breathlessness · cyanosis · loss of consciousness]
It is a generalised seizure in a child between 6 months and 5 years of age, with a fever above 38 °C [fever · seizures]
The diagnosis needs CNS infection, an electrolyte upset, low blood sugar, substance use and any earlier seizure without fever excluded first [hypoglycaemia · seizures]
There is no threshold temperature that sets one off, because the convulsive threshold differs from child to child
Red flag: past 30 minutes it is febrile status epilepticus, a rare subset that does worse than the simple kind [fever · status epilepticus]
Risk factors are existing neurological impairment, developmental delay, a family history of seizure, viral infection, low serum zinc and iron, and maternal smoking and stress [developmental delay · seizures]

Signs — what you find (6)

The child must be back to their own neurological baseline afterwards
Lingering headache, muddled thinking or weakness moves the diagnosis elsewhere [confusion · headache]
Hunt the fever source: red bulging drums, red pharynx, big inflamed tonsils, neck stiffness, tense fontanelle, Brudzinski sign [bulging fontanelle · fever · neck rigidity on testing · neck stiffness]
Include fundoscopy to look for raised intracranial pressure
A one-sided port-wine stain on the skin is a meaningful clue
Pale depigmented patches suggest tuberous sclerosis [pallor]

Tests (7)

A textbook simple febrile seizure needs no further investigation
A complex seizure earns a full work-up for structural or infectious causes, plus an EEG
Blood count, metabolic panel and urinalysis only where there is dehydration, poor intake, vomiting or diarrhoea
Lumbar puncture is unnecessary once the child is quickly back to baseline, but do it where CNS infection is a concern
Consider lumbar puncture under 12 months, if pneumococcal or Hib cover is incomplete, if the fit came 2 days after the fever began, or on antibiotics that could mask meningitis
Head CT or MRI is not routine after a febrile seizure
Image when there is raised intracranial pressure, a focal deficit, a suspected brain malformation, an enlarged head or serious head injury

If not this — what else fits (10)

Breath-holding spells
CNS infection: meningitis or encephalitis
Drug-induced seizure
Febrile delirium
Febrile myoclonus
Febrile infection-related epilepsy syndrome (FIRES)
Genetic epilepsy with febrile seizures plus (GEFS+)
Metabolic upset such as low sodium
Shaking chills or rigors
Tonic-clonic seizure not driven by fever

Scores

WHO Emergency Triage (sick child) — Is this sick child safe to wait?

SourceStatPearls "Febrile Seizure" - disease-level clinical article

Presentation findings are traced to the source above.

PARACETAMOL

1st line

Strength120 mg

Formoral.liquid

Adult dose and duration

Not applicable - pediatric entry x 2-3 days during febrile illness

Paediatric dose

15 mg/kg/dose [child max 500 mg]

(Give 15 mg/kg every 4-6 hours as needed (or rectal suppository if vomiting); max 60 mg/kg/day)

Dose by weight
3kg	45 mg/dose
4kg	60 mg/dose
5kg	75 mg/dose
6kg	90 mg/dose
7kg	105 mg/dose
8kg	120 mg/dose
9kg	135 mg/dose
10kg	150 mg/dose
11kg	165 mg/dose
12kg	180 mg/dose
13kg	195 mg/dose
14kg	210 mg/dose
15kg	225 mg/dose
16kg	240 mg/dose
17kg	255 mg/dose
18kg	270 mg/dose
19kg	285 mg/dose
20kg	300 mg/dose
21kg	315 mg/dose
22kg	330 mg/dose
23kg	345 mg/dose
24kg	360 mg/dose
25kg	375 mg/dose
26kg	390 mg/dose
27kg	405 mg/dose
28kg	420 mg/dose
29kg	435 mg/dose
30kg	450 mg/dose
31kg	465 mg/dose
32kg	480 mg/dose
33kg	495 mg/dose
34kg	500 mg/dose (capped)
35kg	500 mg/dose (capped)
36kg	500 mg/dose (capped)
37kg	500 mg/dose (capped)
38kg	500 mg/dose (capped)
39kg	500 mg/dose (capped)
40kg	500 mg/dose (capped)
41kg	500 mg/dose (capped)
42kg	500 mg/dose (capped)
43kg	500 mg/dose (capped)
44kg	500 mg/dose (capped)
45kg	500 mg/dose (capped)
46kg	500 mg/dose (capped)
47kg	500 mg/dose (capped)
48kg	500 mg/dose (capped)
49kg	500 mg/dose (capped)
50kg	500 mg/dose (capped)

Dose source

AAP Clinical Practice Guideline: Febrile Seizures 2011

Why

Antipyretic and analgesic given for the child's comfort during the febrile illness; it does not prevent febrile seizure recurrence and is not given to treat the seizure itself.

Cautions

CRITICAL COUNSELING: Antipyretics improve child comfort but DO NOT prevent febrile seizure recurrence per AAP 2011 guidelines.
A simple febrile seizure is defined as generalized tonic-clonic, <15 minutes duration, non-recurrent within 24 hours in a neurologically normal child aged 6-60 months.
Reassure parents: simple febrile seizures carry no increased risk of brain damage or mortality.
Antipyretics relieve fever distress but do NOT reduce the risk of febrile seizure recurrence.
500 mg is the per-dose ceiling used here for a child. 1000 mg is the adult dose and does not belong in a weight calculation - the daily 60 mg/kg limit is the one that binds first in any case.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
CETAMOL 120MG/5ML PEDIATRIC SYRUP 120 ML	MEMPHIS	8.50 EGP
PARAGESIC BABY 120MG/5ML 120ML SUSP.	AMRIYA	36.00 EGP
PARAMOL 120MG/5ML SYRUP 125ML	MISR	36.00 EGP
FEBRIMOL ORAL DROPS 20 ML? strength differs? different route - not oral liquid	PHARCO	4.00 EGP
THERA-LO 3.2G/100ML ORAL SUSP. 100 ML? strength differs? different route - not oral liquid	PHAROPHARMA	5.00 EGP

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line

Dose source

No dose - referral pathway, no medicine given in primary care

Why

Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.

Cautions

RED FLAG - The lumbar puncture criteria to rule out meningitis or CNS infection after a febrile seizure are age under 12 months, inadequate Strep pneumoniae/Hib immunization, seizure occurring 2 days after fever onset, or current antibiotic use that may mask meningitis.
RED FLAG - Counsel that antipyretics (including paracetamol) do not prevent febrile seizure recurrence, so their use should not be framed as seizure prevention.
Manage the fever with paracetamol, not aspirin.
A child who has not returned to their neurological baseline - persisting headache, cognitive change or weakness on examination - should prompt a search for a diagnosis other than a febrile seizure.
A complex febrile seizure needs a full evaluation to rule out structural and infectious causes, including an EEG.
Omitting lumbar puncture is only safe when the seizure was simple and the child has returned rapidly to baseline.
Head imaging after a febrile seizure is warranted only for raised intracranial pressure, a focal neurological abnormality, a suspected structural brain defect, an enlarged head, or severe head injury.
Examine deliberately for the source of the fever and for meningism: bulging red eardrums, red pharynx, enlarged inflamed tonsils, neck stiffness, a bulging or tense fontanelle, and Brudzinski sign.
Benzodiazepines are not recommended as a preventative measure between febrile episodes.

DIAZEPAM

add-on - not a substitute

Strength5 mg

Forminjection

Adult dose and duration

Not applicable - pediatric entry - Single rescue dose

Paediatric dose

(Child 1 month–1 year: 5 mg rectally; Child 1–5 years: 5 mg rectally; Child 6–11 years: 10 mg rectally. Repeat once after 5 minutes if seizure continues. Administer as emergency rescue for seizure lasting >5 minutes. In Egypt, use IV diazepam ampoule content drawn into a syringe (without needle) and instilled rectally)

Dose by age
1 month to 5 years:	5 mg rectally. Repeat once after 5 minutes if the seizure continues.
6 to 11 years:	10 mg rectally. Repeat once after 5 minutes if the seizure continues.

Dose source

Egyptian National Drug Formulary, nervous system 2025, diazepam monograph, febrile convulsions (printed p. 12)

Why

Home rescue medication for prolonged seizure (>5 minutes)

Cautions

Indicated ONLY as emergency rescue for seizure lasting >5 minutes.
There is a risk of respiratory depression; call emergency services immediately if seizure continues after 5 minutes post-diazepam.
There is no rectal tube among the packs registered here - only ampoules and tablets. Rectal dosing means drawing the injection solution up and instilling it, which is normal practice locally but is worth knowing before you go looking for a preparation that does not exist.
The formulary's route for a febrile convulsion is intravenous, 0.2-0.4 mg/kg with a second dose after ten minutes if needed, never more than 10 mg in one dose. Where a line can be got, that is the dose to use.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
VALPAM 5 MG/ML 3 AMP.	AMOUN	6.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.