Summary
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.
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References
Aicardi J, Chevrie J-J. Febrile convulsions: neurological sequelae and mental retardation. In Brazier & Coceani (Eds) Brain dysfunction in infantile febrile convulsions, Raven Press, New York, 1976
Annegers JF, Hauser WA, Elveback LR, Kurland LT. The risk of epilepsy following febrile convulsions. Neurology 29: 297, 1979
Fowler PD. Aspirin, paracetamol and non-steroidal anti-inflammatory drugs. A comparative review of side effects. Medical Toxicology 2: 338–366, 1987
Annegers JF, Hauser WA, Shirts SB, Kurland LT. Factors prognostic of unprovoked seizures after febrile convulsions. New England Journal of Medicine 316: 493, 1987
Bacon C, Scott D, Jones P. Heatstroke in well-wrapped infants. Lancet 1: 422, 1979
Bacon CJ, Mucklow JC, Rawlins MD, Hierons AM, Webb JKG. et al. Placebo-controlled study of phenobarbitone and phenytoin in the prophylaxis of febrile convulsions. Lancet 2: 600, 1981
Benchet ML, Tardieu M, Landrieu P, Taburet AM, Singlas E. Prévention des convulsions fébriles et cinétique du diazépam per os. Archivès Françaises de Pédiàtrie 41: 587, 1984
Camfield PR, Camfield CS, Shapiro SH, Cummings C. The first febrile seizure — antipyretic instruction plus either phenobarbital or placebo to prevent recurrence. Journal of Pediatrics 97: 16–21, 1980
Dianese G. Prophylactic diazepam in febrile convulsions. Archives of Disease in Childhood 54: 244, 1979
Dreifuss FE, Santilli N, Langer DH, Sweeney KP, Moline KH, et al. Valproic acid hepatic fatalities: a retrospective review. Neurology 37: 379–1987
Echenne B, Cheminai R, Martin P, Peskine F, Rodière M, et al. Utilisation du diazépam dans le traitement préventif à domicile des récidives de convulsions fébriles. Archives Françaises de Pédiàtrie 40: 499, 1983
Falconer MA. Surgical treatment of sequelae of severe febrile convulsions. In Brazier & Coceani (Eds) Brain dysfunction in infantile febrile convulsions, Raven Press, New York, 1976
Garcia FO, Campos-Castello J, Maldonado JC. Fenobarbital oral continuado o diazepam rectal intermitente para la prevencion de la crisis febriles. Anales Espa`noles de Pediatria 20: 763, 1984
Hirts DG, Lee YJ, Ellenberg JH, Nelson KB. Survey on the management of febrile seizures. American Journal of Diseases in Children 909: 140, 1986
Jailing B. Plasma and cerebrospinal fluid concentrations of phenobarbital in infants given single doses. Developmental Medicine and Child Neurology 16: 781, 1974
Knudsen FU. Plasma diazepam in infants after rectal administration in solution and by suppository. Acta Paediatrica Scandinavica 66: 563–567, 1977
Knudsen FU. Rectal administration of diazepam in solution in the acute treatment of convulsions in infants and children. Archives of Disease in Childhood 54: 855, 1979
Knudsen FU. Recurrence risk after first febrile seizure and effect of short term diazepam prophylaxis. Archives of Disease in Childhood 60: 1045–1049, 1985a
Knudsen FU. Effective short-term diazepam prophylaxis in febrile convulsions. Journal of Pediatrics 106: 487–490, 1985b
Knudsen FU, Vestermark S. Prophylactic diazepam or phenobarbitone in febrile convulsions: a prospective controlled study. Archives of Disease in Childhood: 660–663, 1978
Lee K, Taudorf K, Hvorslev V. Prophylactic treatment with valproic acid or diazepam in children with febrile convulsions. Acta Paediatrica Scandinavica 75: 593, 1986
Minagawa K, Miura H, Mizuno S, Shirai H. Pharmacokinetics of rectal diazepam in the prevention of recurrent febrile convulsions. Brain Development 8: 53–59, 1986
Munthe-Kaas AW. Rectal administration of rectal diazepam: theoretical basis and clinical experience. In Johannesen et al. (Eds) Antiepileptic therapy: advances in drug monitoring, Raven Press, New York, 1980
Nelson KB, Ellenberg JH. Predictors of epilepsy in children who have experienced febrile seizures. New England Journal of Medicine 295: 1029, 1976
Nelson KB, Ellenberg JH. Prognosis in children with febrile seizures. Pediatrics 61: 720, 1978
Nelson KB, Ellenberg JH. Febrile seizures, Raven Press, New York, 1981
Ngwane E, Boewer B. Continuous sodium valproate or phenobarbitone in the prevention of ‘simple’ febrile convulsions. Archives of Disease in Childhood 55: 171, 1980
Ramakrishnan K, Thomas K. Long term prophylaxis of febrile seizures. Indian Journal of Pediatrics 53: 397, 1986
Ross EM, Peckham CS, West PB, Butler NR. Epilepsy in childhood: findings from the national child development study. British Medical Journal 280: 207, 1980
Rylance GW, Poulton J, Cherry RC, Cullen RE. Plasma concentrations of clonazepam after simple rectal administration. Archives of Disease in Childhood 61: 186–188, 1986
Vanasse M, Masson P, Geoffroy G, Larbrisseaú A, David PC. Intermittent treatment of febrile convulsions with nitrazepam. Canadian Journal of Neurological Sciences 11: 377–379, 1984
Van den Berg BJ, Yerushalmy J. Studies on convulsive disorders in young children I. Pediatric Research 3: 298, 1969
Ventura A, Basso T, Bortolan G, Gardini A, Guidobaldi G, et al. Home treatment of seizures as a strategy for the long term management of febrile convulsions in children. Helvetica Paediatrica Acta 37: 58i, 1982
Verity CM, Butler NR, Colding J. Febrile convulsions in a national cohort followed up from birth. I. Prevalence and recurrence in the first five years of life. British Medical Journal 290: 1307, 1985a
Verity CM, Butler NR, Colding J. Febrile convulsions in a national cohort followed up from birth. II. Medical history and intellectual ability at 5 years of age. British Medical Journal 290: 1311, 1985b
Wallace SJ, Smith JA. Successful prophylaxis against febrile convulsions with valproic acid or phenobarbitone. British Medical Journal 280: 353, 1980
Wolf MS, Carr A, Davis DC, Davidson S, Dale EP, et al. The value of phenobarbital in the child who has had a simple febrile seizure: a controlled prospective study. Pediatrics 59: 378, 1977
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Knudsen, F.U. Optimum Management of Febrile Seizures in Childhood. Drugs 36, 111–120 (1988). https://doi.org/10.2165/00003495-198836010-00007
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DOI: https://doi.org/10.2165/00003495-198836010-00007