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Optimum management of febrile seizures in childhood
1Department of Pediatrics, Glostrup Hospital, Denmark.
Insights
Febrile seizures in children have a good long-term outlook with minimal risk of lasting issues. Routine continuous medication is unnecessary; intermittent rectal diazepam is a safe alternative for high-risk children or after the first febrile seizure.
Area of Science:
- Pediatrics
- Neurology
Background:
- Febrile seizures are common in childhood.
- Previous assumptions suggested a poorer long-term prognosis for children experiencing febrile seizures.
Purpose of the Study:
- To evaluate the long-term prognosis for children with febrile seizures.
- To assess the necessity of continuous prophylactic anticonvulsant medication.
- To explore alternative prophylactic strategies.
Main Methods:
- Comprehensive cohort studies were analyzed.
- Long-term outcomes including neurological deficits, epilepsy, and behavioral changes were assessed.
- The efficacy and safety of continuous versus intermittent prophylaxis were compared.
Main Results:
- The long-term prognosis for children with febrile seizures is significantly better than previously assumed.
- There is a very low risk of neurological deficit, epilepsy, mental retardation, or altered behavior following febrile seizures.
- Continuous phenobarbitone or valproic acid prophylaxis is not indicated for simple febrile seizures and rarely for complex ones.
Conclusions:
- Routine continuous prophylaxis for febrile seizures is not warranted.
- Intermittent rectal diazepam offers a rational and safe alternative for prophylaxis in select cases or for all children after the first febrile seizure.
- Parents can be equipped with rectal diazepam for home use to manage new seizures, avoiding continuous medication.
Abstract:
According to comprehensive cohort studies the long term prognosis for children with febrile seizures is far better than previously assumed. There is very little risk of neurological deficit, epilepsy, mental retardation, or altered behaviour as sequelae to febrile seizures. As a natural consequence of the good long term prognosis, the routine use of continuous phenobarbitone or valproic acid prophylaxis is not indicated in simple febrile seizures and only rarely in complex febrile seizures. A rational alternative is intermittent prophylaxis by rectally administered diazepam in solution in the event of fever or acute treatment during continuing convulsions. This prophylaxis may be used selectively for children at high risk of new febrile seizures, or routinely for all children after the first attack of febrile seizure. The treatment is almost devoid of major side effects. If prophylaxis is to be avoided altogether, parents should be supplied with a diazepam solution for rectal use to deal with new seizures.