Prophylactic Treatment with Valproic Acid or Diazepam in Children with Febrile Convulsions

Abstract

The purpose of this study was to limit prophylactic treatment of children with febrile convulsions to patients who have the highest risk of recurrence. Two hundred and thirty-one children with a first febrile seizure were divided into high- and low-risk groups according to estimated risk of recurrence. All high-risk children were offered treatment with valproic acid. If this was declined they were offered treatment with diazepam instead. Low-risk children were untreated. Valproic acid and diazepam were found to be equally effective in reducing the risk of recurrence of febrile convulsions. By selecting for prophylactic treatment according to estimated risk of recurrence it is possible to reduce the rate of recurrence of febrile seizures in children at high-risk (60%) to the same level as that of untreated low-risk children (23%). Only about half of all children with febrile convulsions need treatment and follow-up according to these criteria.

Intermittent prophylaxis in febrile convulsions: diazepam or valproic acid?

“…Significantly more children in the diazepam group were not treated before an attack than in the valproic acid group, making a reliable comparison of the potential efficacy of the 2 drugs difficult. In previous studies diazepam has been shown to be effective (1)(2)(3)(4) and in one study from Glostrup the 12-month recurrence rate of an untreated group was found to be 32% (4), suggesting that valproic acid used intermittently at times of fever may be effective (32% vs 20%, p: 0.03).…”

“…Intermittent prophylaxis by rectally administered diazepam in febrile convulsions is effective both as suppositories (1)(2)(3) and in solution (4). A controlled study has shown that the 18-month recurrence rate was reduced from 39% to 12% (4).…”

“…A controlled study has shown that the 18-month recurrence rate was reduced from 39% to 12% (4). Continuous treatment with valproic acid (3,5) or phenobarbitone (6) is also effective. During the last few years, however, it has been established that long-term, anticonvulsive prophylaxis for febrile convulsions is not indicated, except in selected cases, (7) due to the favourable long-term outcome and the side-effects of continuous prophylaxis.…”

Febrile Seizures in Children

“…Both treatments were equally effective -or ineffective because there was no placebo -and adverse effects were minimal. In the study by Lee et al (1986), intermittent diazepam prophylaxis 0.5 mg/kg administered as a rectal suppository every 8 h for up to 48 h when the temperature exceeded 38.5 °C, was found to be as effective as continuous oral sodium valproate. Again, in this study there was no placebo group.…”