Management of febrile seizures: current concepts and recommendations for phenobarbital and the electroencephalogram

Recent emphasis in the medical and lay press on phenobarbital-induced cognitive deficits and failure to obtain satisfactory compliance and benefit from long-term anticonvulsant therapy has fueled the controversy concerning current concepts of management of febrile seizures and prompted alternative recommendations. A survey of pediatricians in Central and Southern Illinois showed the mean number of febrile seizures treated in an office practice in a 12-month period was 7.56 +/- 7.4, of which 20% were of the complex type. Complex febrile seizures, affecting an estimated 5000 children in Illinois, were treated with phenobarbital by 90% of respondents, and therapy was continued for an average of 2 years. The electroencephalogram (EEG) was used in determining the need for phenobarbital prophylactic therapy by 52% of respondents. An alternative approach to treatment is outlined in light of the questionable benefits and potential side effects of long-term phenobarbital. Parental education and counseling in the management of fever and convulsions and intermittent methods of prophylaxis are emphasized, and the more limited use and careful monitoring of phenobarbital therapy in selected high-risk patients is suggested. The value of the EEG in prognosis and prediction of epilepsy in children with febrile seizures deserves further study.