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Febrile seizures: treatment and prognosis
1Pediatric Department, Glostrup University Hospital, Denmark.
Insights
Most children with febrile seizures have normal long-term outcomes. Treatment strategies, including daily or intermittent diazepam (DZP) prophylaxis, have limited impact on long-term results, with seizure control and counseling being key.
Area of Science:
- Pediatric Neurology
- Clinical Pharmacology
Background:
- Febrile seizures are common in children, with most experiencing normal long-term outcomes.
- Assessing treatment strategies requires understanding short- and long-term outcomes and side effects.
Purpose of the Study:
- To evaluate the impact of short-term or prophylactic treatment on the outcome of various febrile seizure types.
- To review current evidence on the efficacy and necessity of antiepileptic agents for febrile seizures.
Main Methods:
- Review of epidemiologic data and clinical evidence regarding febrile seizure treatments.
- Analysis of the effects of daily prophylaxis, intermittent diazepam (DZP), and other short-term interventions.
Main Results:
- Daily antiepileptic prophylaxis is not recommended for simple febrile seizures.
- Intermittent DZP may reduce recurrence but does not improve long-term outcomes compared to seizure control.
- No evidence suggests febrile seizure treatment prevents later epilepsy; many complex cases have benign outcomes without treatment.
Conclusions:
- A 'wait and see' approach is often preferred for simple febrile seizures.
- Home-administered rectal DZP at seizure onset can prevent febrile status epilepticus.
- Short-term seizure control and parental counseling are primary treatment goals.
Abstract:
Recent epidemiologic data indicate that the vast majority of children with febrile seizures have a normal longterm outcome. A precise knowledge of the short- and long-term outcome with or without treatment, and short- and long-term side effects is an important prerequisite for assessing the various treatment strategies. We focus on the impact of short-term or prophylactic treatment on the short- and long-term outcome of various types of febrile seizures. There is universal agreement that daily prophylaxis with antiepileptic agents should never be used routinely in simple febrile seizures, but only in highly selected cases, if at all. Intermittent diazepam (DZP) prophylaxis at times of fever may or may not reduce the recurrence rate, but it does not appear to improve the long-term outcome as compared with short-term seizure control. The treatment may be used to reduce the recurrence rate for a small arbitrarily defined group with multiple simple febrile seizures, complex febrile seizures, especially focal, prolonged or both, febrile status, and when parental anxiety is severe. However, there is no evidence that treatment of simple febrile seizures can prevent the rare cases of later epilepsy, and many children with complex febrile seizures have a benign long-term outcome, even without treatment. Many prefer a "wait and see" policy. An attractive alternative is to treat new febrile seizures with rectal DZP in solution at seizure onset, given by the parents at home to prevent febrile status. Newer, less well documented short-term strategies include nasal, oral, or rectal administration of other benzodiazepines. Short-term seizure control of febrile status and careful parental counseling are the two most important targets of treatment.