Related Experiment Videos
Prevention and management of febrile seizures
1Department of Neurology, College of Medicine, University of Kentucky, Lexington 40536-0284, USA. neu101@ukcc.uky.edu
Insights
Febrile seizures are common in children but generally benign. Preventative therapies offer limited long-term benefits and carry risks, with diazepam potentially useful in specific distressing cases.
Area of Science:
- Pediatrics
- Neurology
- Epidemiology
Background:
- Febrile seizures are the most common seizure type in childhood.
- Extensive research exists on preventative measures and the natural history of febrile seizures.
- Simple febrile seizures typically have a benign long-term prognosis.
Purpose of the Study:
- To review the literature on febrile seizures, focusing on preventative measures and long-term outcomes.
- To evaluate the risks and benefits of therapies for simple febrile seizures.
- To discuss the appropriateness of interventions in specific clinical contexts.
Main Methods:
- Review of epidemiological and clinical research literature on febrile seizures.
- Analysis of studies on the efficacy and adverse effects of preventative therapies like phenobarbital and valproic acid.
- Consideration of guidelines and practice parameters from pediatric organizations.
Main Results:
- Epidemiological studies show a generally benign natural history for simple febrile seizures.
- Daily phenobarbital or valproic acid can reduce seizure recurrence but risks may outweigh benefits.
- Evidence does not support altering the slight increased risk of epilepsy with current therapies.
Conclusions:
- Preventative measures are unlikely to improve long-term outcomes for most children with simple febrile seizures.
- Adverse effects of daily antiepileptic therapy often outweigh the benefits of preventing short-term recurrence.
- Oral diazepam during febrile illnesses may be considered for families experiencing significant distress from recurrent seizures.
Abstract:
Febrile seizures are the most common seizures in childhood and, like all seizures, can be frightening to witness. Therefore, it is not surprising that febrile seizures have been the focus of intense research with an extensive literature describing various preventative measures. In addition, there is also an extensive and sophisticated epidemiological literature delineating the natural history of this disorder in American and British children. For simple febrile seizures, the most common form of this disorder, the epidemiological studies demonstrate a generally benign natural history, making it unlikely that any preventative measure could improve the long term outcome for most children. Children with simple febrile seizures have a slight increased risk of epilepsy, but there are no studies that demonstrate that phenobarbital or other therapy can alter this risk. Daily therapy with phenobarbital or valproic acid can reduce the number of subsequent simple febrile seizures. However, as a recent Practice Parameter from the American Academy of Paediatrics concludes, the risk of adverse effects from daily therapy appears to outweigh the benefit of preventing the short term recurrence of simple febrile seizures. It is possible that in some families, where the occurrence of an additional simple febrile seizure would be particularly distressing, the routine use of oral diazepam during febrile illnesses might be appropriate.