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[Febrile convulsions, Treatment and prognosis]
1Børneafdeling L, Amtssygehuset i Glostrup.
Insights
Febrile seizures in children generally have a good long-term outlook. Acute treatment with rectal diazepam effectively stops seizures, but long-term outcomes are likely unaffected by treatment type.
Area of Science:
- Neurology
- Pediatrics
- Clinical Medicine
Context:
- Febrile seizures affect a significant number of children.
- Long-term prognosis is typically good, but recurrence and parental distress are concerns.
- Central nervous system (CNS) damage is a potential risk with febrile status.
Purpose:
- To review current treatment strategies for febrile seizures in children.
- To evaluate the effectiveness and long-term impact of various interventions.
- To provide guidance on managing febrile seizures and their recurrence.
Summary:
- Daily prophylaxis with certain medications is reserved for select cases.
- Antipyretics do not lower recurrence rates; intermittent diazepam's long-term benefits are unproven.
- Acute treatment with rectal diazepam is effective and parent-friendly for aborting seizures.
Impact:
- Rectal diazepam offers effective acute seizure control with a favorable safety profile.
- Treatment choice in early childhood appears to have minimal influence on long-term outcomes.
- Further research is needed to establish the superiority of benzodiazepine treatment over placebo.
Abstract:
Epidemiological data indicate that the long-term prognosis in the vast majority of children with febrile seizures is good. Three main problems are important for the treatment: febrile seizures are extremely upsetting for the parents, the recurrence rate is 30-40% and the febrile status occurs unpredictably and is potentially damaging to the CNS. There is universal agreement that daily prophylaxis with valproate, primidone, or phenobarbital should only be used in highly selected cases, if at all. The effectiveness of phenytoin and carbamazepine has not been documented. Antipyretic treatment does not reduce the recurrence rate. Intermittent diazepam prophylaxis at times of fever may or may not reduce the recurrence rate significantly, but there is no data to suggest that it improves the long-term outcome, as compared with short-term seizure control, in terms of IQ, cognition, academic progress, motor control, and subsequent epilepsy. Acute anticonvulsive treatment with rectal diazepam in solution or other benzodiazepines is effective in aborting recurrent seizures with almost the effectiveness of i.v. treatment and is safe, simple, and easy to use for the parents. The long-term prognosis is probably uninfluenced by the type of treatment given in early childhood. It has not been established that acute anticonvulsive treatment with benzodiazepine is better than placebo.