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Intermittent prophylaxis in febrile convulsions: diazepam or valproic acid?
1Department of Paediatrics, Glostrup Hospital, Denmark.
Insights
Valproic acid and diazepam showed similar recurrence rates for febrile seizures in children. Valproic acid may be effective, but complex seizures were more frequent, and parental compliance was a challenge.
Area of Science:
- Pediatrics
- Neurology
- Pharmacology
Background:
- Febrile seizures are common in children.
- Intermittent prophylaxis aims to prevent seizure recurrence.
- Diazepam and valproic acid are used for seizure management.
Purpose of the Study:
- To compare the efficacy and safety of intermittent diazepam versus valproic acid for preventing febrile seizure recurrence.
- To assess recurrence rates and types of seizures in children receiving prophylaxis.
Main Methods:
- An open, prospective, randomized, hospital-based study.
- 219 children were enrolled; 169 received 1-year intermittent prophylaxis.
- Diazepam (rectal) or valproic acid (suppositories) administered at times of fever.
Main Results:
- 12-month recurrence rates were similar: 27% for diazepam vs. 20% for valproic acid.
- Complex recurrences were significantly higher in the valproic acid group.
- Parental non-compliance was noted; 69 children had side-effects with diazepam vs. 37 with valproic acid (none serious).
Conclusions:
- Intermittent valproic acid may be effective in reducing febrile seizure recurrence, though further research is needed.
- Valproic acid was associated with more complex recurrences, while diazepam had more frequent side-effects.
- Parental compliance is a critical factor in the effectiveness of intermittent prophylaxis for febrile seizures.
Abstract:
In an open, prospective, randomized, and hospital-based study, comprising 219 consecutive children, 169 were given intermittent prophylaxis for one year, receiving either diazepam or valproic acid after their first febrile convulsion. Children admitted on odd dates (n = 89) were given rectal diazepam in solution every 12 h, whenever the temperature was 38.5 degrees C or more. Children admitted on even dates (n = 80) were given valproic acid as suppositories at times of fever. Twenty-three children in the diazepam group had a recurrence within 1 year versus 14 in the valproic acid group. On an intention-to-treat basis the 12-month recurrence rates in the 2 groups were similar, 27% vs 20%. The latter is well below figures for untreated controls from Denmark (32%), suggesting that intermittent valproic acid at times of fever may be effective, but further studies are needed. The number of complex recurrences, however, were significantly higher in the valproic acid group than in the diazepam group. Parental non-compliance was a major problem, and in the 2 study groups only 5 and 12 children, respectively, with recurrences were treated adequately. Sixty-nine children receiving diazepam had side-effects vs 37 receiving valproic acid. None were serious.