Prophylactic drug management for febrile seizures in children

Abstract

BACKGROUND: Febrile seizures occurring in a child older than one month during an episode of fever affect 2% to 4% of children in Great Britain and the United States and recur in 30%. Rapid-acting antiepileptics and antipyretics given during subsequent fever episodes have been used to avoid the adverse effects of continuous antiepileptic drugs. independently applied pre-defined criteria to select trials for inclusion and extracted the pre-defined relevant data, recording methods for randomization, blinding and exclusions. Outcomes assessed were seizure recurrence at 6, 12, 18, 24, 36 months and at age 5 to 6 years in the intervention and non-intervention groups, and adverse medication effects. The presence of publication bias was assessed using funnel plots. MAIN RESULTS: Thirty-six articles describing 26 randomized trials with 2740 randomized participants were included. Thirteen interventions of continuous or intermittent prophylaxis and their control treatments were analyzed. Methodological quality was moderate to poor in most studies. We could not do a meta-analysis for 8 of the 13 comparisons due to insufficient numbers of trials. No significant benefit for valproate, pyridoxine, intermittent phenobarbitone or ibuprofen versus placebo or no treatment was found; nor for diclofenac versus placebo followed by ibuprofen, acetominophen or placebo; nor for intermittent rectal diazepam versus intermittent valproate, nor phenobarbitone versus intermittent rectal diazepam. AUTHORS' CONCLUSIONS:No clinically important benefits for children with febrile seizures were found for intermittent oral diazepam, phenytoin, phenobarbitone, intermittent rectal diazepam, valproate, pyridoxine, intermittent phenobarbitone or intermittent ibuprofen, nor for diclofenac versus placebo followed by ibuprofen, acetominophen or placebo. Adverse effects were reported in up to 30% of children. Apparent benefit for clobazam treatment in one recent trial needs to be replicated to be judged reliable. Given the benign nature of recurrent febrile seizures, and the high prevalence of adverse effects of these drugs, parents and families should be supported with adequate contact details of medical services and information on recurrence, first aid management and, most importantly, the benign nature of the phenomenon. COMMENTSOut of 79 potential articles, only 36 met the inclusion criteria for the present systematic review. From these 36 papers, 26 original studies were analyzed and 2740 children were included in the systematic review. The drugs used were antiepileptics (phenytoin, phenobarbitone, valproate, diazepam and clobazam), antipyretics (diclofenac, acetaminophen and ibuprofen) and pyridoxine. The treatments were compared with each other, or with non-treatment or placebo. Studies with non-treatment controls were more frequent than those with placebo groups.The following outcomes were measured: a) Efficacy: any type of seizure (febrile/non-febrile) at certain time points (recurrence at 6, 12, 24, 48, 60 and 73 months, respectively); b...

Comparing the effect of intermittent diazepam and continuous phenobarbital in preventing recurrent febrile seizures among children under 6 years old: A systematic review and meta-analysis

“…Due to the benign nature of FC and the high rate (30%) of side effects of anticonvulsant drugs, it was recommended that only patients’ parents or families should be supported to receive medical counseling services, information about primary services, recurrent rate of febrile seizure, and nature of the febrile seizure. [ 33 ] However, in the Cochrane review 2017, it was reported that the intermittent use of diazepam or continuous use of phenobarbital could be effective in the recurrence rate of FS. [ 7 ] The results of this systematic review and meta-analysis were also consistent with the results of Cochrane Review 2017.…”

Commentary on ‘Prophylactic drug management for febrile seizures in children’

“…Since 1990, more than 300 articles have been published on the use of prophylactic antiepileptic and/or antipyretic medications to treat children susceptible to frequent or complicated seizures (6). Opinions have been divided as to whether regular medication is effective, and/or whether its benefits outweigh the potential for adverse effects on behaviour and cognitive development-particularly as only 3% of children who have febrile seizures ever develop epilepsy (1).…”

“…While the quality of the studies reviewed is reportedly only mediocre to poor (6), the meta-analysis of eligible studies indicates that there are no clinically significant benefits to be gained from regular administration of antiepileptic or antipyretic medications to children at risk of febrile seizures. Only clobazam has been seen to reduce the risk of febrile seizures when compared with diazepam (7), but this study needs to be repeated with a larger study population to confirm these benefits.…”

Febrile children’s convulsions

“…Следует иметь в виду и объяснять родителям, что при-ем ПЭП при лихорадке не может гарантировать полной защиты от возникновения ФП и не предохраняет от даль-нейшей трансформации ФП в эпилепсию [2,16]. Во-первых, при пероральном приеме препараты всасываются относительно медленно, и в течение примерно 30 мин по-сле их приема пациент остается «незащищенным».…”

“…Вместе с тем профилактический прием ПЭП при лихорадке в значительном числе случаев защищает детей от возникновения тяжелых продолжи-тельных ФП, способных вызвать повреждение мозга [11,12,17]. Имеется достаточно убедительных данных о том, что применение жаропонижающих препаратов не снижа-ет риск повторных ФП [16,[18][19][20][21][22][23].…”