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[Discontinuous selective prophylaxis of febrile convulsions at home with rectal diazepam]
Insights
Episodic rectal diazepam effectively prevents febrile seizures in children when administered at the first sign of fever. This approach offers a safe alternative to long-term oral anticonvulsant drugs.
Area of Science:
- Pediatrics
- Neurology
- Pharmacology
Context:
- Febrile convulsions are common in children.
- Continuous oral anticonvulsant therapy carries risks.
- Alternative prophylactic strategies are needed.
Purpose:
- To evaluate the efficacy and side effects of selective episodic home treatment with rectal diazepam for febrile convulsions.
- To assess if this approach reduces the need for long-term anticonvulsant medication.
Summary:
- 15 children with a history of febrile convulsions received rectal diazepam (0.6 mg/kg) every 8-12 hours when their temperature reached 38°C or higher.
- Over a mean follow-up of 7.73 months, only 2 seizures occurred in patients not receiving treatment.
- Mild, transient side effects were observed in 46.6% of patients and 32.0% of febrile episodes.
Impact:
- Episodic rectal diazepam appears to be an effective and appropriate alternative to continuous oral anticonvulsant therapy for managing febrile convulsions.
- This strategy may reduce the risks associated with long-term drug exposure in children.
- Further research with larger cohorts is warranted to confirm these findings and explore risk factors.
Abstract:
Selective episodic prophylactic home treatment with rectal diazepam in children with febrile convulsions should reduce the risks of permanent long term anticonvulsive drug therapy. To evaluate this approach and its side effects, selective prophylaxis (rectal diazepam, 0.6 mg x kg at 8 to 12 hour intervals) was given to 15 children with previous febrile convulsions whenever their axillary temperature raised to 38 C degrees or over. They were followed up for a mean of 7.73 months (range 3 to 20 months). In a total of 27 febrile episodes only 2 seizures occurred, each to a different patient and in both cases when treatment was inadvertently withheld. No recurrences were observed in the remaining 13 patients involving 25 treated febrile crisis. The small number of patients precluded evaluation of the effects of risk factors in recurrence rates. Mild and transient collateral effects were detected in 46.6% patients and in 32.0% of the observed febrile periods. In spite of the small number of patients and short follow-up period these results suggest, that episodic, non permanent, treatment with rectal diazepam is an appropriate alternative to traditional continuous oral anticonvulsive therapy for children with febrile convulsions.