Treatment of febrile seizures with intermittent clobazam
M L Manreza1, J L Gherpelli, L R Machado-Haertel
1Serviço de Neurologia Infantil, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (FMUSP), Brasil.
Insights
Clobazam effectively prevents febrile seizure (FS) recurrence in children. This intermittent therapy shows significantly lower recurrence rates compared to antipyretics alone, offering a safe alternative.
Area of Science:
- Pediatric Neurology
- Clinical Pharmacology
Background:
- Febrile seizures (FS) are common in children, with recurrence posing a significant concern for families and clinicians.
- Intermittent therapy aims to prevent FS recurrence during febrile episodes, but optimal drug choices require ongoing research.
Purpose of the Study:
- To evaluate the efficacy and safety of intermittent clobazam therapy in preventing the recurrence of febrile seizures in children.
- To compare the recurrence rate of FS treated with clobazam versus antipyretic measures alone.
Main Methods:
- A prospective study involving 50 children (6-72 months) with a history of at least one FS.
- Children received oral clobazam (5-20 mg/day) during febrile episodes (temperature > 37.8°C) based on weight.
- FS recurrence was compared between episodes treated with clobazam and those treated solely with antipyretics.
Main Results:
- Clobazam significantly reduced FS recurrence: 1.7% (3/171 episodes) with clobazam vs. 22.9% (11/48 episodes) with antipyretics alone (p < 0.0001).
- Overall FS recurrence during the study was 20% (10 children).
- Adverse effects (vomiting, somnolence, hyperactivity) occurred in 35.7% of treated patients, usually mild and transient.
Conclusions:
- Intermittent clobazam therapy is safe and highly efficacious in preventing febrile seizure recurrence in children.
- Clobazam presents a viable alternative to diazepam for intermittent treatment of recurrent febrile seizures.
Abstract:
Fifty children, 24 female and 26 male, with ages varying from 6 to 72 months (mean = 23.7 m.) that experienced at least one febrile seizure (FS) entered a prospective study of intermittent therapy with clobazam. Cases with severe neurological abnormalities, progressive neurological disease, afebrile seizures, symptomatic seizures of other nature, or seizures during a central nervous system infection were excluded. Seizures were of the simple type in 25 patients, complex in 20 and unclassified in 5. The mean follow-up period was 7.9 months (range = 1 to 23 m.), and the age at the first seizure varied from 5 to 42 months (mean = 16.8 m.). Clobazam was administered orally during the febrile episode according to the child's weight: up to 5 kg, 5 mg/day; from 5 to 10 kg, 10 mg/day; from 11 to 15 kg, 15 mg/day, and over 15 kg, 20 mg/day. There were 219 febrile episodes, with temperature above 37.8 degrees C, in 40 children during the study period. Twelve children never received clobazam and 28 received the drug at least once. Drug efficacy was measured by comparing FS recurrence in the febrile episodes that were treated with clobazam with those in which only antipyretic measures were taken. Ten children (20%) experienced a FS during the study period. Of the 171 febrile episodes treated with clobazam there were only 3 recurrences (1.7%), while of the 48 episodes treated only with antipyretic measures there were 11 recurrences (22.9%), a difference highly significant (p < 0.0001). Adverse effects occurred in 10/28 patients (35.7%), consisting mainly in vomiting, somnolence and hyperactivity. Only one patient had recurrent vomiting which lead to drug interruption. These effects did not necessarily occurred in every instance the drug was administered, being present in one febrile episode and not in the others. We conclude that clonazepam is safe and efficacious in preventing FS recurrence. It may be an alternative to diazepam in the intermittent treatment of FS recurrence.
Related Concept Videos
01:22Methods of reducing fever
Pharmacological Methods of Reducing Fever:
01:24Epilepsy and Seizures: Overview
Various factors can trigger epilepsy, including genetic factors, brain damage, metabolic causes, and unknown etiology. Diagnosis of epilepsy involves electroencephalography (EEG), which...
01:13Seizures: Classification
Seizures are typically classified into two main categories: focal and generalized seizures.
Focal Seizures
Focal seizures originate from specific regions of the brain. These seizures are further sub-classified into two types:
01:18Antiepileptic Drugs: GABAergic Pathway Potentiators
The key GABA pathway potentiators used in epilepsy management are as follows.
Benzodiazepines are a well-known class of drugs used for their...
01:20Seizures l: Introduction
01:19Seizures ll: Types