Febrile Seizures: Clinical Practice Guideline for the Long-term Management of the Child With Simple Febrile Seizures

Abstract

Febrile seizures are the most common seizure disorder in childhood, affecting 2% to 5% of children between the ages of 6 and 60 months. Simple febrile seizures are defined as brief (Ͻ15-minute) generalized seizures that occur once during a 24-hour period in a febrile child who does not have an intracranial infection, metabolic disturbance, or history of afebrile seizures. This guideline (a revision of the 1999 American Academy of Pediatrics practice parameter [now termed clinical practice guideline] "The Long-term Treatment of the Child With Simple Febrile Seizures") addresses the risks and benefits of both continuous and intermittent anticonvulsant therapy as well as the use of antipyretics in children with simple febrile seizures. It is designed to assist pediatricians by providing an analytic framework for decisions regarding possible therapeutic interventions in this patient population. It is not intended to replace clinical judgment or to establish a protocol for all patients with this disorder. Rarely will these guidelines be the only approach to this problem. Pediatrics 2008;121:1281-1286The expected outcomes of this practice guideline include:1. optimizing practitioner understanding of the scientific basis for using or avoiding various proposed treatments for children with simple febrile seizures;2. improving the health of children with simple febrile seizures by avoiding therapies with high potential for adverse effects and no demonstrated ability to improve children's long-term outcomes; 3. reducing costs by avoiding therapies that will not demonstrably improve children's long-term outcomes; and 4. helping the practitioner educate caregivers about the low risks associated with simple febrile seizures.The committee determined that with the exception of a high rate of recurrence, no long-term effects of simple febrile seizures have been identified. The risk of developing epilepsy in these patients is extremely low, although slightly higher than that in the general population. No data, however, suggest that prophylactic treatment of children with simple febrile seizures would reduce the risk, because epilepsy likely is the result of genetic predisposition rather than structural damage to the brain caused by recurrent simple febrile seizures. Although antipyretics have been shown to be ineffective in preventing recurrent febrile seizures, there is evidence that continuous anticonvulsant therapy with phenobarbital, primidone, or valproic acid and intermittent therapy with diazepam are effective in reducing febrile-seizure recurrence. The potential toxicities associated with these agents, however, outweigh the relatively minor risks associated with simple febrile seizures. As such, the committee concluded that, on the basis of the risks and benefits of the effective therapies, neither continuous nor intermittent anticonvulsant therapy is recommended for children with 1 or more simple febrile seizures. INTRODUCTIONFebrile seizures are seizures that occur in febrile children between the ages of 6 and 6...

Risk factors for subsequent febrile seizures in the FEBSTAT study

“…Children with initial FSE were frequently prescribed rectal diazepam gel as abortive therapy to prevent the risk for another prolonged FS 25; 26 . This was not the case for children with an initial SFS where, in line with the Academy of Pediatrics guidelines 27 no rescue medications were prescribed. Parents of children whose initial FS was FSE used abortive therapy even for a brief FS; thus, resulting in shorter seizure duration 28 .…”

Febrile seizure recurrence reduced by intermittent oral levetiracetam

“…However, 21% of the children experienced seizures prior to or within 1 h of the onset of fever, 57% had a seizure after 1–24 h of fever, and 22% experienced FS more than 24 h after the onset of fever 19. The fever of a child is not always recognized on time; this situation is one of the drawbacks of intermittent prophylaxis 20. FS is mostly caused by a variety of common infectious diseases.…”

Prevention and Control of Seasonal Influenza with Vaccines

“…At least one febrile seizure is experienced by 2%-5% of children aged 6-60 months; nearly all children who have a febrile seizure recover quickly and are healthy afterward (286). Prior to the 2010-11 influenza season, an increased risk for febrile seizures following receipt of IIV3 had not been observed in the United States (278,287).…”