Febrile Seizures: Treatment and Prognosis

Abstract

Summary: Recent epidemiologic data indicate that the vast majority of children with febrile seizures have a normal long‐term outcome. A precise knowledge of the short‐ and long‐term outcome with or without treatment, and short‐ and long‐term side effects is an important prerequisite for assessing the various treatment strategies. We focus on the impact of short‐term or prophylactic treatment on the short‐ and long‐term outcome of various types of febrile seizures. There is universal agreement that daily prophylaxis with antiepileptic agents should never be used routinely in simple febrile seizures, but only in highly selected cases, if at all. Intermittent diazepam (DZP) prophylaxis at times of fever may or may not reduce the recurrence rate, but it does not appear to improve the long‐term outcome as compared with short‐term seizure control. The treatment may be used to reduce the recurrence rate for a small arbitrarily defined group with multiple simple febrile seizures, complex febrile seizures, especially focal, prolonged or both, febrile status, and when parental anxiety is severe. However, there is no evidence that treatment of simple febrile seizures can prevent the rare cases of later epilepsy, and many children with complex febrile seizures have a benign long‐term outcome, even without treatment. Many prefer a “wait and see” policy. An attractive alternative is to treat new febrile seizures with rectal DZP in solution at seizure onset, given by the parents at home to prevent febrile status. Newer, less well documented short‐term strategies include nasal, oral, or rectal administration of other benzodiazepines. Short‐term seizure control of febrile status and careful parental counseling are the two most important targets of treatment.

Demographic and Clinical Findings of Epilepsy Patients who Underwent Follow-up at the Newly Established Clinic of the Muğla Sıtkı Koçman University Faculty of Medicine

“…[6,8] Febril konvülziyon öyküsü olan hastalarda epilepsi gelişme riski yaklaşık %3'tür. [9] Epilepsi gelişim riski en çok komplike febril nöbette artar. [9,10] Febril konvülziyon sırasında gelişen hipoksi ve beyin ödemi, nöronal yıkım ve mezial temporal skleroza yol açarak temporal lob epilepsisi gelişme riskini artırabilir.…”

“…[9] Epilepsi gelişim riski en çok komplike febril nöbette artar. [9,10] Febril konvülziyon sırasında gelişen hipoksi ve beyin ödemi, nöronal yıkım ve mezial temporal skleroza yol açarak temporal lob epilepsisi gelişme riskini artırabilir. [4,11,12] Bir başka görüşe göre de, febril konvülziyon-epilepsi ilişkisi neden-sonuç ilişkisi değil; genetik zeminde gelişen bir durumdur.…”

Febrile Seizure Prevalence in Children in the Erzurum Provincial Center

“…Bu nedenle günümüzde hiç tedavi vermeksizin "bekle ve gör" politikasının izlenmesi tartışılmaktadır. 4 Tedavide yaklaşımın amacı; akut konvülsiyonu durdurmak, rekürrensi önlemek ve aileyi bilgilendirerek ateş fobisini azaltmaktır. Bu nedenlerden dolayı FK'lerde; antiepileptik ajanlarla uzun süreli tedavi, vücut ısı-sının yükseldiği dönemlerde intermittent tedavi ve profilaksi uygulanmaksızın nöbetlerin tedavi edilmesi gibi çeşitli tedavi seçenekleri uygulanmaktadır.…”

Management of simple febrile seizures

“…Further, this too causes effects on cognition and behaviour. Therefore there is no evidence to support treatment of simple FS with continued prophylaxis 22,27 . Level B evidence, Strong recommendation, overwhelming observational studies.…”

“…Considering all the above reasons, all guidelines on management of simple FS as well as the latest Cochrane review do not recommend use of intermittent prophylaxis routinely 8,22,23,26,27 . Level B Evidence.…”