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Recurrence risk after first febrile seizure and effect of short term diazepam prophylaxis
Insights
Short-term diazepam prophylaxis significantly reduced febrile seizure recurrence in children with risk factors. Prophylaxis was most effective in high-risk children, lowering recurrence rates to 12%.
Area of Science:
- Pediatric Neurology
- Clinical Pharmacology
Background:
- Febrile seizures affect young children, with recurrence posing a significant concern.
- Identifying risk factors for recurrent febrile convulsions is crucial for effective management.
Purpose of the Study:
- To evaluate the efficacy of short-term diazepam prophylaxis in preventing febrile seizure recurrence.
- To assess the impact of prophylaxis across different risk factor profiles in children.
Main Methods:
- Prospective randomized study of 289 children with their first febrile seizure.
- Allocation to either short-term diazepam prophylaxis or no prophylaxis for 18 months.
- Identification and analysis of five major risk factors for recurrence.
Main Results:
- Recurrence rates varied from 12% (no risk factors) to 80-100% (3-5 risk factors) in untreated children.
- Diazepam prophylaxis uniformly lowered recurrence rates to a mean of 12% across all risk groups.
- Prophylaxis significantly reduced recurrence in high-risk (80% to 12%) and intermediate-risk (50% to 12%) children.
Conclusions:
- Short-term diazepam prophylaxis is effective in preventing febrile seizure recurrence, particularly in children with multiple risk factors.
- Prophylaxis offers significant benefit for high and intermediate-risk groups, normalizing recurrence rates.
- Diazepam prophylaxis demonstrated limited benefit in very low-risk children.
Abstract:
In a prospective randomised study, 289 children admitted consecutively to hospital with their first febrile seizure were allocated, by date of admission, to short term diazepam prophylaxis (n = 152) or to no prophylaxis (n = 137) and followed for 18 months. In untreated children, five major risk factors for recurrent febrile convulsions were identified: age 15 months or less at the time of the first febrile seizure, epilepsy in first degree relatives, febrile convulsions in first degree relatives, a first complex febrile seizure, and day nursery care. The 18 month recurrence rate was 80 to 100% if three to five risk factors were present, 50% if two factors were identified, 25% where one factor was found, and 12% if there were no predictors. During prophylaxis the recurrence rate was uniformly low (mean 12%) in all risk groups. In high (three or more factors) and intermediate (two factors) risk children prophylaxis provided effective seizure control and reduced the recurrence rate from 80%, or more, to 12% and 50% to 12%, respectively. In children with one risk factor 50% of all recurrences were prevented (25% to 12%). Prophylaxis was ineffective in very low risk children (12% to 12%).