Technical report: Treatment of the child with simple febrile seizures

Overview. Simple febrile seizures that occur in children ages 6 months to 5 years are common events with few adverse outcomes. Those who advocate ther apy for this disorder have been concerned that such seizures lead to additi onal febrile seizures, to epilepsy, and perhaps even to brain injury. Moreo ver, they note the potential for such seizures to cause parental anxiety. W e examined the literature to determine whether there was demonstrable benef it to the treatment of simple febrile seizures and whether such benefits ex ceeded the potential side effects and risks of therapy. The therapeutic app roaches considered included continuous anticonvulsant therapies, intermitte nt therapy, or no anticonvulsant therapy. Methods. This analysis focused on the neurologically healthy child between 6 months and 5 years of age whose seizure is brief (<15 minutes), generaliz ed, and occurs only once during a 24-hour period during a fever. Children w hose seizures are attributable to a central nervous system infection and th ose who have had a previous afebrile seizure or central nervous system abno rmality were excluded. A review of the current literature was conducted usi ng articles obtained through searches in MEDLINE and additional databases. Articles were obtained following defined criteria and data abstracted using a standardized literature review form. Abstracted data were summarized int o evidence tables (Tables 1 through 7). Results. Epidemiologic studies demonstrate a high risk of recurrent febrile seizures but a low, though increased, risk of epilepsy. Other adverse outc omes either don't occur or occur so infrequently that their presence is not convincingly demonstrated by the available studies. Although daily anticon vulsant therapy with phenobarbital or valproic acid is effective in decreas ing recurrent febrile seizures, the risks and potential side effects of the se medications outweigh this benefit. No medication has been shown to preve nt the future onset of recurrent afebrile seizures (epilepsy). The use of i ntermittent diazepam with fever after an initial febrile seizure is likely to decrease the risk of another febrile seizure, but the rate of side effec ts is high although most families find the perceived benefits to be low. Al though antipyretic therapy has other benefits, it does not prevent addition al simple febrile seizures. Conclusions. The Febrile Seizures Subcommittee of the American Academy of P ediatrics' Committee on Quality Improvement used the results of this analys is to derive evidence-based recommendations for the treatment of simple feb rile seizures. The outcomes anticipated as a result of the analysis and dev elopment of the practice guideline include: 1) to optimize practitioner und erstanding of the scientific basis for using or avoiding various proposed t reatments for children with simple febrile seizures; 2) to improve the heal th of children with simple febrile seizures by avoiding therapies with high potential for side effects and no demonstrated ability to improve children 's eventual outcomes; 3) to reduce costs by avoiding therapies that will no t demonstrably improve children's long-term outcomes; and 4) to help the pr actitioner educate caregivers about the low risks associated with simple fe brile seizures.