Effective short-term diazepam prophylaxis in febrile convulsions

The efficacy of short-term diazepam prophylaxis in febrile convulsions was evaluated in a prospective, controlled study. A total of 289 consecutive children admitted with their first febrile seizure were randomized into two groups. One group received short-term prophylaxis for 18 months with rectally administered diazepam in solution whenever the temperature was greater than or equal to 38.5 degrees C. The control group received no prophylaxis, but diazepam rectally in the event of new seizures. The short-term prophylaxis, a mean of five doses of diazepam per child per year, afforded effective seizure control; the 18-month recurrence rate was reduced from 39% to 12% (P less than 0.001), the total number of recurrences from 77 to 23 (P less than 0.001), the long-lasting recurrences from 5.0% to 0.7% (P less than 0.05). The risk of subsequent epilepsy within the first 2 years was the same, regardless of receiving prophylaxis (3%) or not (3%); it was low after simple febrile convulsions (no cases of epilepsy in 230 children) but considerable after complex febrile seizures (20%) or seizures associated with severe interictal EEG abnormalities (50%).     

Intermittent oral diazepam prophylaxis in febrile convulsions: its effectiveness for febrile seizure recurrence.

In order to evaluate the effectiveness of diazepam for the reduction in the recurrence of febrile seizures we carried out a prospective study in two groups of children; Group A: 45 children (25 female, 20 male), receiving oral prophylaxis with diazepam, and Group B: 65 children (35 female, 30 male) who did not receive any oral prophylaxis. All subjects of both groups were followed for at least 4 years and finally re-evaluated at the mean age of 6.7+/-1.4 years. Among the patients of Group A, recurrent febrile seizures (FS) occurred in five of the 45 children (11.1%). Among the 65 children of Group B, 20 (30.7%) went on to have one or more additional episodes. In conclusion, our study demonstrates that oral diazepam, given only when fever is present, is an effective means of reducing the risk of recurrences of FS.     

Long term outcome of prophylaxis for febrile convulsions

A cohort of 289 children with febrile convulsions who had been randomised in early childhood to either intermittent prophylaxis (diazepam at fever) or no prophylaxis (diazepam at seizures) was followed up 12 years later. The study focused on the occurrence of epilepsy and on neurological, motor, intellectual, cognitive, and scholastic achievements in the cohort. At follow up the two groups were of almost identical age (14.0 v 14.1 years), body weight (58.2 v 57.2 kg), height (168.2 v 167.7 cm), and head circumference (55.9 v 56.2 cm). The occurrence of epilepsy (0.7% v 0.8%), neurological examination, fine and gross motor development on the Stott motor test, intellectual performance on the Wechsler intelligence scale for children verbal IQ (105 v 105), performance IQ (114 v 111), and full scale IQ (110 v 108), cognitive abilities on a neuropsychological test battery, including short and long term, auditory and visual memory, visuomotor tempo, computer reaction time, reading test, and scholastic achievement were also very similar. Children with simple and complex febrile convulsions had the same benign outcome. The long term prognosis in terms of subsequent epilepsy, neurological, motor, intellectual, cognitive, and scholastic ability was not influenced by the type of treatment applied in early childhood. Preventing new febrile convulsions appears no better in the long run than abbreviating them.     

Indications for intermittent diazepam prophylaxis in febrile seizures

BACKGROUND: In a prospective controlled study we evaluated the efficacy of intermittent diazepam prophylaxis in the recurrence rate of febrile seizures (FS). PATIENTS: A total of 139 children aged between 6 and 36 months, who had a first FS, were enrolled in the study and were randomly allocated to two groups: group (A) that received diazepam prophylaxis and group (B) without prophylaxis. METHODS: All children were followed up for at least 3 years after their first FS. The prophylaxis group (n = 68) received rectal diazepam the first two days of a febrile illness, whenever the temperature was > 38 degrees C (0.33 mg/kg every 8 h on the first day, and 0.33 mg/kg every 12 h on the second day of fever, max. dosage 7.5 mg). The no-prophylaxis group (n = 71) did not receive any prophylaxis at all. Each group was stratified to low, intermediate and high risk subgroups according to the following clinical data: age at the first febrile seizure 相似文献   

Sodium valproate in the prophylaxis of simple febrile convulsions.

Thirty children with simple febrile convulsions were treated with sodium valproate following their second convulsion. Twenty-two of the 30 (73%) had no further convulsions during the one-year period of observation compared with 17 of 28 in the control group (61%). This was not a statistically significant difference. Side effects attributed to sodium valproate treatment were noted in 7 patients (23%), although 4 of these showed only mild transient gastrointestinal symptoms at high dosage. The study did not confirm any advantage in the use of sodium valproate as a prophylaxis for febrile convulsions, although compliance was good and significant side effects infrequent.     

Use of diazepam in the preventive home treatment of recurrent febrile convulsions

Parents with children who had presented with a simple febrile convulsion were advised to give their children rectal diazepam, in case of fever. The results (21 families with an average follow-up of 2 years) were compared with those in two groups of controls. The efficacy and inocuousness of prophylactic treatment are remarkable. However, its indication should be more precisely stated, after a better information of families and practitioners, since the expected effect on familial apprehension was not satisfactorily obtained.     

Prophylactic treatment with valproic acid or diazepam in children with febrile convulsions

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.     

Prophylactic diazepam or phenobarbitone in febrile convulsions: a prospective, controlled study.

After their first episode of febrile convulsions, 195 previously healthy children, aged 6--30 months, were given either diazepam or phenobarbitone for a year. Each child was assigned at random to one of the two medications: children admitted on even days were given a suppository containing 5 mg diazepam every 8 hours when the rectal temperature was greater than or equal to 38.5 degree C. Children admitted on odd days were given treatment with phenobarbitone, 3.5 +/- 1 mg/kg per day. 156 children completed treatment and outpatient control for a year, 83 in the diazepam and 73 in the phenobarbitone group. The rate of recurrence was independent of the prophylactic and 15--16 % of the children in both groups had new febrile convulsions within a year. The recurrence rate after 6 months was also similar, 11% in the diazepam group and 9% in the phenobarbitone group. New convulsions were of similar duration and severity in both groups. In both groups 6% of all febrile episodes led to new convulsions. Long-term treatment with phenobarbitone thus offered no advantage over intermittent diazepam.     

Pre-eclampsia and febrile convulsions

An association between pre-eclampsia and febrile convulsions has been reported, but the association may not be causal. We compared the risk of febrile convulsions in 14 974 children who had been exposed to pre-eclampsia in fetal life with that of 39 210 unexposed children. Children exposed to pre-eclampsia had a slightly increased risk of febrile convulsions, but the association was apparently caused by a shorter gestation in pre-eclamptic women.     

Viruses and febrile convulsions

In 276 children admitted to hospital with febrile convulsions a wide range of virus types was identified by means of nasopharyngeal secretions and cough/nasal swabs. The overall virus identification rate was 49%. Analysis of age, sex, family history, and past history showed no marked differences between the virus-positive and the virus-negative children. More than 80% had symptoms of respiratory infection in association with their convulsions, whether or not a virus was identified. Convulsions were not apparently more severe in the virus-positive group. Rapid virus diagnosis was found helpful in the management of children with febrile convulsions. The virus aetiology of many febrile convulsions has implications both for hospital cross-infection and for research into methods of prevention.     

Treatment of febrile convulsions]

Information and reassurance of parents are essential before considering therapeutic measures following a first febrile seizure. It must be emphasized that, although impressive, febrile convulsions are essentially benign, and that in the majority of cases there will be no recurrence. Apart from that, therapeutic measures are of limited efficacy in order to prevent reocurrence. The correct use of antipyretic treatment during febrile episodes must be specified. Due to its several inconveniences, oral diazepam as an intermittent prophylaxis should be only considered in case of multiple reoccurrences. There is little place for continuous anticonvulsant treatment.