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Long term outcome of prophylaxis for febrile convulsions
F U Knudsen1, A Paerregaard, R Andersen
1Department of Paediatrics, Glostrup University Hospital, Denmark.
Insights
Long-term follow-up of children with febrile convulsions shows that early childhood treatment with diazepam prophylaxis does not impact epilepsy risk or developmental outcomes. Both treatment strategies yielded similar results at 14 years.
Area of Science:
- Pediatrics
- Neurology
- Developmental Psychology
Background:
- Febrile convulsions are common in childhood.
- Treatment strategies include intermittent prophylaxis (diazepam at fever) or no prophylaxis (diazepam at seizures).
- Long-term outcomes of these strategies require further investigation.
Purpose of the Study:
- To evaluate the 12-year prognosis of children with febrile convulsions.
- To compare the occurrence of epilepsy and neurological, motor, intellectual, cognitive, and scholastic achievements between two treatment groups.
- To determine if early childhood treatment influences long-term outcomes.
Main Methods:
- A cohort of 289 children with febrile convulsions was randomized to either intermittent diazepam prophylaxis or no prophylaxis.
- Follow-up occurred at 14 years of age.
- Assessments included epilepsy occurrence, neurological examinations, motor development (Stott motor test), intellectual performance (Wechsler intelligence scale), cognitive abilities (neuropsychological test battery), and scholastic achievement.
Main Results:
- At 14 years, the two groups showed no significant differences in age, weight, height, or head circumference.
- Epilepsy occurrence was similar (0.7% vs 0.8%).
- Neurological, motor, intellectual (Verbal IQ, Performance IQ, Full Scale IQ), cognitive, and scholastic outcomes were also very similar between groups.
Conclusions:
- The long-term prognosis for children with febrile convulsions is not influenced by early childhood treatment strategies.
- Both preventing new febrile convulsions and abbreviating them appear to have similar long-term benefits.
- Children with simple and complex febrile convulsions demonstrated a benign long-term outcome regardless of treatment.
Abstract:
A cohort of 289 children with febrile convulsions who had been randomised in early childhood to either intermittent prophylaxis (diazepam at fever) or no prophylaxis (diazepam at seizures) was followed up 12 years later. The study focused on the occurrence of epilepsy and on neurological, motor, intellectual, cognitive, and scholastic achievements in the cohort. At follow up the two groups were of almost identical age (14.0 v 14.1 years), body weight (58.2 v 57.2 kg), height (168.2 v 167.7 cm), and head circumference (55.9 v 56.2 cm). The occurrence of epilepsy (0.7% v 0.8%), neurological examination, fine and gross motor development on the Stott motor test, intellectual performance on the Wechsler intelligence scale for children verbal IQ (105 v 105), performance IQ (114 v 111), and full scale IQ (110 v 108), cognitive abilities on a neuropsychological test battery, including short and long term, auditory and visual memory, visuomotor tempo, computer reaction time, reading test, and scholastic achievement were also very similar. Children with simple and complex febrile convulsions had the same benign outcome. The long term prognosis in terms of subsequent epilepsy, neurological, motor, intellectual, cognitive, and scholastic ability was not influenced by the type of treatment applied in early childhood. Preventing new febrile convulsions appears no better in the long run than abbreviating them.