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Prophylactic diazepam or phenobarbitone in febrile convulsions: a prospective, controlled study
Insights
For children experiencing febrile convulsions, intermittent diazepam is as effective as long-term phenobarbital in preventing recurrence. Both treatments showed similar efficacy in reducing the risk of further febrile seizures over one year.
Area of Science:
- Pediatric Neurology
- Clinical Pharmacology
Background:
- Febrile convulsions are common in young children.
- Preventing recurrence is a key clinical concern.
Purpose of the Study:
- To compare the efficacy of diazepam versus phenobarbital in preventing recurrent febrile convulsions.
- To assess the long-term benefits of prophylactic treatment.
Main Methods:
- A randomized controlled trial involving 195 children aged 6-30 months after their first febrile convulsion.
- Children received either intermittent diazepam or daily phenobarbital for one year.
- Recurrence rates, duration, and severity of new convulsions were monitored.
Main Results:
- No significant difference in recurrence rates between diazepam and phenobarbital groups at one year (15-16%).
- Similar recurrence rates at 6 months (11% diazepam vs. 9% phenobarbital).
- Convulsion duration and severity were comparable across both treatment arms.
Conclusions:
- Intermittent diazepam is a viable alternative to long-term phenobarbital for preventing febrile convulsion recurrence.
- Long-term phenobarbital offers no significant advantage over intermittent diazepam in this patient population.
Abstract:
After their first episode of febrile convulsions, 195 previously healthy children, aged 6--30 months, were given either diazepam or phenobarbitone for a year. Each child was assigned at random to one of the two medications: children admitted on even days were given a suppository containing 5 mg diazepam every 8 hours when the rectal temperature was greater than or equal to 38.5 degree C. Children admitted on odd days were given treatment with phenobarbitone, 3.5 +/- 1 mg/kg per day. 156 children completed treatment and outpatient control for a year, 83 in the diazepam and 73 in the phenobarbitone group. The rate of recurrence was independent of the prophylactic and 15--16 % of the children in both groups had new febrile convulsions within a year. The recurrence rate after 6 months was also similar, 11% in the diazepam group and 9% in the phenobarbitone group. New convulsions were of similar duration and severity in both groups. In both groups 6% of all febrile episodes led to new convulsions. Long-term treatment with phenobarbitone thus offered no advantage over intermittent diazepam.