Pediatric Febrile Seizures Treatment & Management

Updated: Nov 09, 2018
  • Author: Robert J Baumann, MD; Chief Editor: Amy Kao, MD  more...
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Medical Care

On the basis of risk/benefit analysis, neither long-term nor intermittent anticonvulsant therapy is indicated for children who have experienced 1 or more simple febrile seizures.

  • Continuous therapy with phenobarbital or valproate decreases the occurrence of subsequent febrile seizures.

    • Both therapies confer significant risks and potential adverse effects, whereas additional simple febrile seizures have no proven risk.

    • These medications are not recommended, since the potential benefits do not outweigh the potential risks.

  • No evidence suggests that any therapy administered after a first simple febrile seizure will reduce the risk of a subsequent afebrile seizure or the risk of recurrent afebrile seizures (ie, epilepsy).

  • Oral diazepam can reduce the risk of subsequent febrile seizures. Because it is intermittent, this therapy probably has the fewest adverse effects. If preventing subsequent febrile seizures is essential, this would be the treatment of choice. [4]

  • Although it has been felt that antipyretic therapy cannot prevent simple febrile seizures, it is desirable for other reasons, for instance comfort. A randomized controlled trial published in 2018 suggested that rectal acetaminophen 10 mg/kg given every 6 hours may prevent febrile seizure recurrence within the same febrile episode. [5]

Febrile status epilepticus (duration ≥30 minutes) occurs in 5 to 9% of children with first febrile seizure. Patients with febrile status epilepticus are at greater risk for subsequent febrile status epilepticus. [9]  Many practitioners have prescribed rectal diazepam for patients with febrile seizures, particularly those with febrile seizures lasting more than 5 minutes. There is some literature supporting the safety and efficacy towards truncating the seizures. Following a review of 7 randomized studies, investigators concluded that the benzodiazepine midazolam, administered intranasally, is as safe and effective as intravenous or rectal diazepam in the treatment of acute pediatric seizure emergencies. Results were based on the administration of 0.2 mg/kg of intranasal midazolam versus 0.2-0.5 mg/kg of either intravenous (4 trials) or rectal (3 trials) diazepam, for the treatment of seizure emergencies having an onset of action of less than 5 minutes. Patients in the study were aged 18 years or younger. The 3 types of treatment produced only a few reports of respiratory depression. [10, 11, 12]



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