Materiały źródłowe

• #1 Treatment and prognosis of febrile seizures – UpToDate

  https://www.uptodate.com/contents/treatment-and-prognosis-of-febrile-seizures

  Treatment and prognosis of febrile seizures […] While simple febrile seizures have typically spontaneously resolved by the time the child is evaluated and do not need to be treated, prolonged seizures may require abortive treatment with benzodiazepines in the ambulance or in the emergency department. […] Prophylactic antiseizure medications can decrease the risk of recurrent febrile seizures, but given the benign nature of most seizures, the risks of side effects generally outweigh the benefits. […] This topic will review the treatment and prognosis of febrile seizures, including febrile status epilepticus.

• #2 Febrile Seizure – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK448123/

  No specific treatment for simple or complex febrile seizures is indicated other than supportive care and evaluation for possible underlying conditions causing the fever. Antipyretics have not been shown to prevent a recurrence of febrile seizures. In those who have recurrent febrile seizures, prevention is challenging. A few studies have examined the treatment with benzodiazepines as a bridging measure for a few days during subsequent febrile events; however, the adverse effects outweighed the potential benefits. Therefore, benzodiazepines are not a recommended preventative measure. […] In patients with febrile status epilepticus or seizures lasting longer than 5 minutes, intravenous benzodiazepines (eg, lorazepam), rectal diazepam, or intranasal midazolam can be used. […] Follow-up as an outpatient with their pediatrician and neurologist, as indicated.

• #3 Febrile Seizures: Risks, Evaluation, and Prognosis | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0401/p445.html

  A febrile seizure is a seizure occurring in a child six months to five years of age that is accompanied by a fever (100.4F or greater) without central nervous system infection. […] For seizures lasting more than five minutes, a benzodiazepine should be administered. […] Given the benign nature of febrile seizures, the routine use of antiepileptics is not indicated because of adverse effects of these medications. […] The use of antipyretics does not decrease the risk of febrile seizures, although rectal acetaminophen reduced the risk of short-term recurrence following a febrile seizure. […] Continuous or intermittent antiepileptic medications are not recommended after a first febrile seizure because of potential adverse effects. […] Antipyretic agents do not reduce recurrence of simple febrile seizures.

• #4 Febrile seizure – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/febrile-seizure/diagnosis-treatment/drc-20372527

  Most febrile seizures stop on their own within a couple of minutes. If your child has a febrile seizure, stay calm and follow these steps: […] Call for emergency medical attention if: […] A doctor may order medication to stop a seizure that lasts longer than five minutes. […] Your child’s doctor may hospitalize the child for observation if: […] But a hospital stay isn’t usually necessary for simple febrile seizures. […] For febrile seizures, some basic questions to ask your doctor include: […] What can I do to help my child during a febrile seizure? […] If your child has another febrile seizure: […] Seek emergency care for a seizure that lasts longer than five minutes.

• #5 Febrile Seizure: What It Is, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/febrile-seizure

  If your child has a history of this condition, their healthcare provider can guide you on seizure first aid and what to do to treat these at home. In general, you should do the following: Stay calm. Seeing your child having a seizure can be very frightening, but it’s important for you to keep as calm as possible. Track the time. Note how long your child’s seizure lasts. If the seizure lasts more than five minutes, you should immediately call 911 (or your local emergency services number). […] Febrile seizures happen unpredictably and aren’t usually preventable. Even if you treat your child’s fever, they’re still at risk of having one. […] All first-time febrile seizures need medical attention. You should contact a healthcare provider or emergency services if your child has a seizure for the first time. […] If your child has a history of seizures, your child’s pediatrician can offer the best guidance on what you can and should do to treat these. They can also tell you about any signs that you need to look out for.

• #6 Febrile Seizures: Home Care (for Parents) | Nemours KidsHealth

  https://kidshealth.org/en/parents/febrile-seizures-sheet.html

  Febrile seizures are convulsions that happen in some children with fevers. They affect kids 6 months to 5 years old and are most common in toddlers 12-18 months old. They usually happen on the first day that a child has a fever above 100.4F (38C). […] Most febrile seizures stop on their own after a few minutes and don’t cause any other health problems. […] If you think your child is having a seizure due to fever, try to stay calm and gently place your child on the floor or the ground. […] When the seizure is over, call your doctor. He or she probably will want to see your child. […] Get Emergency Medical Care if Your Child has a febrile seizure that lasts longer than 5 minutes. […] If your child is uncomfortable due to the fever, give acetaminophen or ibuprofen as directed by your doctor. It’s important to call the doctor so your child can be seen after a febrile seizure.

• #7 What to Do if Your Baby Has a Febrile Seizure: Tips for Parents – BuzzRx Select permission for Location

  https://www.buzzrx.com/blog/febrile-seizure

  Can You Treat a Febrile Seizure At Home? […] You should not treat a child’s first febrile seizure at home. Seek immediate medical care if you think your child has had a febrile seizure. […] What To Do If My Baby Has A Febrile Seizure? […] If your child has had febrile seizures before, the healthcare provider will guide you on how to treat any future febrile seizures at home. Follow these instructions carefully. The general recommendations are as follows: […] Remain calm. It can be frightening to see your child having a seizure but try to stay as calm as possible. […] Time the seizure. Make a note of the time the seizure starts and stops. If the seizure lasts for 5 minutes or longer, call 911 for emergency medical assistance. […] Gently place your child on the floor. Do not place them on a bed or table or hold them in your arms – this can increase the risk of injuries.

• #8 Febrile seizure – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/febrile-seizure/diagnosis-treatment/drc-20372527

  Most febrile seizures stop on their own within a couple of minutes. If your child has a febrile seizure, stay calm and follow these steps: […] Call for emergency medical attention if: […] A doctor may order medication to stop a seizure that lasts longer than five minutes. […] Your child’s doctor may hospitalize the child for observation if: […] But a hospital stay isn’t usually necessary for simple febrile seizures. […] For febrile seizures, some basic questions to ask your doctor include: […] What can I do to help my child during a febrile seizure? […] If your child has another febrile seizure: […] Seek emergency care for a seizure that lasts longer than five minutes.

• #9 Febrile seizures | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/brain-nerves-and-spinal-cord/febrile-seizures/

  Treating febrile seizures […] In many cases, febrile seizures do not need to be treated, although care should be taken to deal with a seizure as it happens. […] If your child is having a febrile seizure, place them in the recovery position. Lay them on their side, on a soft surface, with their face turned to one side. This will stop them swallowing any vomit, and will keep their airway open and help prevent injury. […] Stay with your child while they’re having a seizure, and make a note of when the seizure started to keep track of how long it lasts. If the seizure lasts for less than five minutes, phone your GP or call the NHS 24 111 service. […] If it’s your child’s first seizure, or if it lasts longer than five minutes, take your child to the nearest hospital as soon as possible.

• #10 Febrile Seizure: Treatment, Symptoms, and Causes

  https://www.healthline.com/health/febrile-seizure

  While febrile seizures often dont cause any lasting issues, there are important steps to take when your child has one. […] Always contact a doctor or medical professional in the emergency department immediately following a seizure. The doctor will want to make sure your child doesnt have meningitis, which can be serious. This is especially true for children under 1 year of age. […] While your child is having a febrile seizure: Roll them onto their side. […] Have your child take medication to lower their fever, like ibuprofen (Advil) if theyre over 6 months old or acetaminophen (Tylenol). Dose the medication based on your childs weight. […] Treatment of recurrent febrile seizures includes all of the above plus taking a dose of diazepam (Valium) gel thats administered rectally. You can be taught to give the treatment at home if your child has recurrent febrile seizures. Note that this medication can only be prescribed to your child by a doctor. […] Febrile seizures cant be prevented, except in some cases of recurrent febrile seizures. […] However, these preventative medications may be given if your child has recurrent febrile seizures or other risk factors.

• #11 Febrile Seizures – Pediatrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pediatrics/neurologic-disorders-in-children/febrile-seizures

  Seizures lasting 5 minutes are treated with IV lorazepam, rectal diazepam, or intranasal midazolam and, if persistent, IV fosphenytoin, phenobarbital, valproate, or levetiracetam. […] Management of febrile seizures is supportive if seizures last 5 minutes. […] Seizures lasting 5 minutes may require medications to terminate them, with careful monitoring of circulatory and respiratory status. […] Medication is usually administered by IV, with a short-acting benzodiazepine (eg, lorazepam repeated every 5 to 10 minutes for up to 3 doses). […] If IV access is not available or the child is in a prehospital setting and older than 2 years, diazepam rectal gel or intranasal midazolam may be given. […] Phenobarbital, valproate, or levetiracetam can also be used to treat a persistent seizure. […] Some clinicians prescribe diazepam rectal gel for children with recurrent febrile seizures to be given by the parents at home for a prolonged febrile seizure.

• #12 Febrile Seizures Treatment & Management: Prehospital Care, Emergency Department Care, Further Care

  https://emedicine.medscape.com/article/801500-treatment

  Patients with active seizures should be treated with airway management, high-flow oxygen, supportive care, and anticonvulsants as necessary. Acute treatment such as rectal diazepam (0.5 mg/kg) and buccal (0.4-0.5 mg/kg) or intranasal (0.2 mg/kg) are effective and can be given at home for a seizure lasting longer than 5 minutes. […] Patients who are postictal should receive supportive care and antipyretics as appropriate. […] Patients presenting with status epilepticus should be treated with airway management and anticonvulsants as necessary. […] Antipyretics should be considered. Acetaminophen (Tylenol) and ibuprofen (Motrin) are often used. […] Arrange for medical reevaluation of discharged patients and parental education in a follow-up appointment within 24-48 hours. […] The decision to admit should be individualized, but admission usually is not necessary for patients with febrile seizure.

• #13 Best practices for the management of febrile seizures in children | Italian Journal of Pediatrics | Full Text

  https://ijponline.biomedcentral.com/articles/10.1186/s13052-024-01666-1

  The ideal BDZ to be used in an early phase of seizure control should have an easy and socially acceptable route of administration, a rapid onset but at the same time limited adverse events (in terms of respiratory depression). […] With this in mind, buccal midazolam (MDZ) and rectal diazepam (DZP) are the first choice as rescue therapy. […] The recommendation is to prefer rectal DZP for children aged less than 3 years (at a dose of 5 mg) with a subsequent switch to buccal MDZ. […] After a first dose of BDZ, a second one could be administered after 5 min if the FS has not stopped. Administering more than two doses of benzodiazepines is not recommended due to the potential risk of inducing respiratory depression. […] If intravenous access is available, other BDZs could be considered.

• #14 Best practices for the management of febrile seizures in children | Italian Journal of Pediatrics | Full Text

  https://ijponline.biomedcentral.com/articles/10.1186/s13052-024-01666-1

  The ideal BDZ to be used in an early phase of seizure control should have an easy and socially acceptable route of administration, a rapid onset but at the same time limited adverse events (in terms of respiratory depression). […] With this in mind, buccal midazolam (MDZ) and rectal diazepam (DZP) are the first choice as rescue therapy. […] The recommendation is to prefer rectal DZP for children aged less than 3 years (at a dose of 5 mg) with a subsequent switch to buccal MDZ. […] After a first dose of BDZ, a second one could be administered after 5 min if the FS has not stopped. Administering more than two doses of benzodiazepines is not recommended due to the potential risk of inducing respiratory depression. […] If intravenous access is available, other BDZs could be considered.

• #15 The management of febrile seizures | British Columbia Medical Journal

  https://bcmj.org/articles/management-febrile-seizures

  Most febrile seizures are brief and the seizure has usually ended prior to the child being assessed. If the seizure has not stopped, treatment with intravenous lorazepam (0.1 mg/kg over 1 min; maximum dose 4 mg), intravenous diazepam (0.3 mg/kg over 2 min; maximum dose 5 mg in infants and 10 mg in older children) or buccal midazolam (0.5 mg/kg; maximum dose 10 mg) is indicated. […] Rectal diazepam (0.5 mg/kg; maximum dose 10 mg) may also be administered, but is less effective than buccal midazolam. […] Treatment with antiepileptic drugs does not abort the cluster in most children. […] All parents should be informed that there is no evidence that treatment with antiepileptic drugs influences the risk of developing epilepsy. […] Febrile seizures are a common disorder in children between 3 months and 6 years of age, and are associated with an excellent prognosis. The risk of developing epilepsy is very small and neurological development and school progress are unaffected by the seizures. EEG and neuroimaging are not helpful and treatment with an antiepileptic drug is rarely indicated. […] Use of prophylactic antiepileptic medication is not recommended.

• #16 Febrile Seizures – Pediatrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pediatrics/neurologic-disorders-in-children/febrile-seizures

  Seizures lasting 5 minutes are treated with IV lorazepam, rectal diazepam, or intranasal midazolam and, if persistent, IV fosphenytoin, phenobarbital, valproate, or levetiracetam. […] Management of febrile seizures is supportive if seizures last 5 minutes. […] Seizures lasting 5 minutes may require medications to terminate them, with careful monitoring of circulatory and respiratory status. […] Medication is usually administered by IV, with a short-acting benzodiazepine (eg, lorazepam repeated every 5 to 10 minutes for up to 3 doses). […] If IV access is not available or the child is in a prehospital setting and older than 2 years, diazepam rectal gel or intranasal midazolam may be given. […] Phenobarbital, valproate, or levetiracetam can also be used to treat a persistent seizure. […] Some clinicians prescribe diazepam rectal gel for children with recurrent febrile seizures to be given by the parents at home for a prolonged febrile seizure.

• #17 Evaluation and Treatment of the Child with Febrile Seizure | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/0515/p1761.html

  The use of intermittent oral diazepam also has been found to reduce the risk of recurrent febrile seizures, but the effectiveness is limited. […] For patients who have an ongoing seizure at the time of assessment (i.e., febrile status epilepticus), intravenous diazepam (0.2 to 0.5 mg per kg of weight intravenously every 15 minutes for a cumulative dosage of 5 mg in children one month to five years of age) often is effective. […] If the seizure continues after an adequate dose of diazepam (or other benzodiazepine) is administered, a full status epilepticus treatment protocol is indicated.

• #18 Febrile Seizure – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK448123/

  No specific treatment for simple or complex febrile seizures is indicated other than supportive care and evaluation for possible underlying conditions causing the fever. Antipyretics have not been shown to prevent a recurrence of febrile seizures. In those who have recurrent febrile seizures, prevention is challenging. A few studies have examined the treatment with benzodiazepines as a bridging measure for a few days during subsequent febrile events; however, the adverse effects outweighed the potential benefits. Therefore, benzodiazepines are not a recommended preventative measure. […] In patients with febrile status epilepticus or seizures lasting longer than 5 minutes, intravenous benzodiazepines (eg, lorazepam), rectal diazepam, or intranasal midazolam can be used. […] Follow-up as an outpatient with their pediatrician and neurologist, as indicated.

• #19 Febrile Seizures: Risks, Evaluation, and Prognosis | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0401/p445.html

  A febrile seizure is a seizure occurring in a child six months to five years of age that is accompanied by a fever (100.4F or greater) without central nervous system infection. […] For seizures lasting more than five minutes, a benzodiazepine should be administered. […] Given the benign nature of febrile seizures, the routine use of antiepileptics is not indicated because of adverse effects of these medications. […] The use of antipyretics does not decrease the risk of febrile seizures, although rectal acetaminophen reduced the risk of short-term recurrence following a febrile seizure. […] Continuous or intermittent antiepileptic medications are not recommended after a first febrile seizure because of potential adverse effects. […] Antipyretic agents do not reduce recurrence of simple febrile seizures.

• #20 Best practices for the management of febrile seizures in children | Italian Journal of Pediatrics | Full Text

  https://ijponline.biomedcentral.com/articles/10.1186/s13052-024-01666-1

  The use of antipyretic medications may provide relief for a feverish child but it does not prevent FS. […] Well-constructed randomized trials of appropriate doses of acetaminophen, ibuprofen, and rectal diclofenac have failed to show any benefit in preventing FS. […] However, reduced recurrence rates were seen for intermittent diazepam and continuous phenobarbital, with adverse effects in up to 30% of children. […] When considering the use of chronic anti-seizure medication (ASM), studies have demonstrated the effectiveness of phenobarbital, primidone, and valproic acid in preventing the recurrence of simple FS; however, the side effects of each ASM outweighed the benefits. […] Chronic prophylactic ASM for both simple and complex FS is not routinely recommended. […] Finally, parents/caregivers should avoid co-sleeping with children, as it may be dangerous for their children and does not prevent FS.

• #21 Febrile Seizure: What It Is, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/febrile-seizure

  If your child has a first-time febrile seizure, they may recover from it fairly quickly. But you should contact your child’s healthcare provider or visit the emergency room to verify that this seizure is, in fact, a febrile seizure and not caused by something more serious. […] A provider may offer treatment recommendations or supportive care for the cause of the fever. This may include taking age-safe acetaminophen (Tylenol), ibuprofen (Motrin) or other medications as directed. […] Complex febrile seizures (a seizure that lasts longer than five minutes or if your child has more than one seizure in 24 hours) are more likely to need treatment. Your child’s provider may recommend the following medications: Intranasal (given through the nose) midazolam. Intravenous (injection into a vein) benzodiazepines. Rectal (given through the rectum) diazepam.

• #22 Febrile Seizures Treatment & Management: Prehospital Care, Emergency Department Care, Further Care

  https://emedicine.medscape.com/article/801500-treatment

  Patients with active seizures should be treated with airway management, high-flow oxygen, supportive care, and anticonvulsants as necessary. Acute treatment such as rectal diazepam (0.5 mg/kg) and buccal (0.4-0.5 mg/kg) or intranasal (0.2 mg/kg) are effective and can be given at home for a seizure lasting longer than 5 minutes. […] Patients who are postictal should receive supportive care and antipyretics as appropriate. […] Patients presenting with status epilepticus should be treated with airway management and anticonvulsants as necessary. […] Antipyretics should be considered. Acetaminophen (Tylenol) and ibuprofen (Motrin) are often used. […] Arrange for medical reevaluation of discharged patients and parental education in a follow-up appointment within 24-48 hours. […] The decision to admit should be individualized, but admission usually is not necessary for patients with febrile seizure.

• #23 Patient education: Febrile seizures (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/febrile-seizures-beyond-the-basics

  Fever treatment – After the seizure has stopped, treatment for the fever is started, usually by giving oral or rectal acetaminophen or ibuprofen and sometimes by sponging with room temperature (not cold) water. […] Home treatment – Parents who witness their child’s febrile seizure should take a number of steps to prevent the child from harming him or herself. […] Parents of a child who is at risk of having a recurrent febrile seizure can be taught to give treatment at home for seizures that last longer than five minutes. Treatment usually involves giving one dose of diazepam gel (brand name: Diastat) into the rectum. […] Preventive treatment – In most cases, treatment to prevent future seizures is not recommended; the risks and potential side effects of daily antiseizure medications outweigh their benefit. […] Treatment for fever (temperature greater than 100.4°F or 38°C) is acceptable but not always required; parents should speak with their health professional for help in deciding when to treat a child’s fever.

• #24 Reddit – The heart of the internet

  https://www.reddit.com/r/daddit/comments/xnxjvf/febrile_seizures_what_can_we_do/

  we know the research (at least here in UK via NHS) is its difficult to prevent another seizure. And to instead focus on reducing the fever […] damp towel on forehand (maybe wrists?) for when his temperature increases […] paracetomol and ibuprofen (calpol and nurofen here in UK) to reduce fever. We plan to start this from when his temp hits 37.5C (99.5F) […] we know if it happens again to put him into the recovery position […] better quality baby monitor (ours is ok but the night vision isnt great) […] owlet sock (to measure heart rate although I dont know if HR is significantly impacted by a seizure)

• #25 Evaluation and Treatment of the Child with Febrile Seizure | AAFP

  https://www.aafp.org/pubs/afp/issues/2006/0515/p1761.html

  Current guidelines do not recommend the use of continuous or intermittent therapy with neuroleptics or benzodiazepines after a simple febrile seizure. […] No medication has been shown to reduce the risk of an afebrile seizure (i.e., epilepsy) after a simple febrile seizure. […] Intense routine use of antipyretic agents has been no more effective in reducing the incidence of recurrent febrile seizures than the intermittent use of the antipyretic agents when a febrile episode is noted. […] Although valproic acid (Depakene), diazepam (Valium), lorazepam (Ativan), and fosphenytoin (Cerebyx) are indicated for the management of seizures, they have not been indicated explicitly for the management of febrile seizures. […] The use of phenobarbital (5 to 8 mg per kg of weight per day for children two to 24 months of age, and 3 to 5 mg per kg per day for children older than two years) and valproic acid (10 to 15 mg per kg per day in divided doses, with a maximal dosage of 60 mg per kg per day) on a continuous basis reduces the risk of recurrent febrile seizures but has significant side effects.

• #26 Pediatric Febrile Seizures Treatment & Management: Medical Care, Activity

  https://emedicine.medscape.com/article/1176205-treatment

  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.

• #27 Febrile seizure – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/febrile-seizure/symptoms-causes/syc-20372522

  You can help by keeping your child safe during a febrile seizure and by offering comfort afterward. Call your doctor to have your child evaluated as soon as possible after a febrile seizure. […] Giving your child infants’ or children’s acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others) at the beginning of a fever may make your child more comfortable, but it won’t prevent a seizure. […] Rarely, prescription anticonvulsant medications are used to try to prevent febrile seizures. However, these medications can have serious side effects that may outweigh any possible benefit. […] Rectal diazepam (Diastat) or nasal midazolam might be prescribed to be used as needed for children who are prone to long febrile seizures. These medications are typically used to treat seizures that last longer than five minutes or if the child has more than one seizure within 24 hours. They are not typically used to prevent febrile seizures.

• #28 Pediatric Febrile Seizures Treatment & Management: Medical Care, Activity

  https://emedicine.medscape.com/article/1176205-treatment

  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.

• #29 Treatment and prognosis of febrile seizures – UpToDate

  https://www.uptodate.com/contents/treatment-and-prognosis-of-febrile-seizures

  Treatment and prognosis of febrile seizures […] While simple febrile seizures have typically spontaneously resolved by the time the child is evaluated and do not need to be treated, prolonged seizures may require abortive treatment with benzodiazepines in the ambulance or in the emergency department. […] Prophylactic antiseizure medications can decrease the risk of recurrent febrile seizures, but given the benign nature of most seizures, the risks of side effects generally outweigh the benefits. […] This topic will review the treatment and prognosis of febrile seizures, including febrile status epilepticus.

• #30 Febrile Seizures

  https://www.uspharmacist.com/article/febrile-seizures

  Multiple studies have shown that daily administration of phenobarbital is effective for preventing subsequent febrile seizures. In a randomized study of 79 children, phenobarbital 5 mg/kg/day was more effective than placebo for preventing seizure recurrence (5% vs. 25% had recurrence). Irritability and transient sleep disturbances were more common in the phenobarbital group during the first year of treatment. There was no difference in IQ testing between the groups after 8 to 12 months of treatment. […] In summary, the continuous prophylactic use of phenobarbital or valproic acid to prevent febrile seizure recurrence, although effective, is not recommended because of the potential risk of side effects and the usually benign course of febrile seizures. […] Although antipyretics may provide overall comfort to the febrile child, they do not reduce the risk of febrile seizures. Compared with placebo, neither acetaminophen nor nonsteroidal anti-inflammatory drugs reduced the recurrence of febrile seizures.

• #31 Pediatric Febrile Seizures Treatment & Management: Medical Care, Activity

  https://emedicine.medscape.com/article/1176205-treatment

  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. […] 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.

• #32 Febrile Seizures

  https://www.uspharmacist.com/article/febrile-seizures

  Several studies have shown that oral diazepam administered at fever onset significantly reduces the recurrence of febrile seizures compared with placebo. In a large randomized, placebo-controlled trial of oral diazepam (0.33 mg/kg every 8 hours) given during febrile illness, there was an 82% reduction in the risk of febrile seizures in the diazepam group. […] Because of the excellent long-term prognosis and minimal complications of simple febrile seizures and the risk of potential medication toxicities, the AAP does not recommend the use of continuous or intermittent anticonvulsants to treat simple febrile seizures. However, anticonvulsant prophylaxis may be considered in cases of complex febrile seizures, in the presence of abnormal neurologic development, or in the case of a history of nonfebrile seizures of genetic origin in a parent or sibling. […] It has been suggested that intermittent oral or rectal diazepam at the onset of febrile illness could be considered in situations in which parental anxiety associated with febrile seizures is severe. Parents should be reminded, however, about the potential short-term side effects.

• #33 Prophylactic drug management for febrile seizures in children | Cochrane

  https://www.cochrane.org/CD003031/EPILEPSY_prophylactic-drug-management-febrile-seizures-children

  Seizures occurring with a fever (febrile seizures) in children are common and affect about one in 30 children under the age of six years. […] We reviewed the evidence about the effect of drugs to prevent seizures (antiepileptics), drugs to lower temperature (antipyretics), and zinc in children with febrile seizures. […] We wanted to know in how many children these drugs would prevent a recurrence of febrile seizures or cause unwanted effects. […] The study design and evidence quality in the studies of antiepileptic drugs was often low or very low. […] Zinc therapy was found to provide no benefit. We also found no benefit in treating children just at the time of the fever with either antipyretic drugs or most antiepileptic drugs. […] A significant result was noted in some instances. For example, at times between 6 and 48 months follow-up, intermittent diazepam (an antiepileptic drug) led to a reduction in the number of recurrent seizures by about a third.

• #34 Febrile Seizures – Pediatrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pediatrics/neurologic-disorders-in-children/febrile-seizures

  Seizures lasting 5 minutes are treated with IV lorazepam, rectal diazepam, or intranasal midazolam and, if persistent, IV fosphenytoin, phenobarbital, valproate, or levetiracetam. […] Management of febrile seizures is supportive if seizures last 5 minutes. […] Seizures lasting 5 minutes may require medications to terminate them, with careful monitoring of circulatory and respiratory status. […] Medication is usually administered by IV, with a short-acting benzodiazepine (eg, lorazepam repeated every 5 to 10 minutes for up to 3 doses). […] If IV access is not available or the child is in a prehospital setting and older than 2 years, diazepam rectal gel or intranasal midazolam may be given. […] Phenobarbital, valproate, or levetiracetam can also be used to treat a persistent seizure. […] Some clinicians prescribe diazepam rectal gel for children with recurrent febrile seizures to be given by the parents at home for a prolonged febrile seizure.

• #35 What to Do if Your Baby Has a Febrile Seizure: Tips for Parents – BuzzRx Select permission for Location

  https://www.buzzrx.com/blog/febrile-seizure

  What Is The Basic Treatment For a Child’s First Febrile Seizure? […] Simple febrile seizures don’t usually require any treatment. They are short-lived, and the child quickly makes a full recovery. You can give your child fever-reducing medications, such as acetaminophen (Tylenol) or ibuprofen (Motrin), to keep them comfortable. However, these medications do not prevent febrile seizures. Giving the child a lukewarm bath or placing a cold cloth on their head or body also cannot prevent febrile seizures. […] Children who have complex febrile seizures or prolonged febrile seizures may need to have the febrile seizures treated with a medication such as rectal diazepam (Diastat), diazepam nasally or orally, or midazolam liquid given nasally. […] Your child’s healthcare provider will tell you how to use these medications at home. Treatment with Diastat (rectal diazepam) is typically recommended for febrile seizures lasting more than 5 minutes or if the child has more than one seizure in 24 hours. This medication can cause side effects such as irritability, sleepiness, and poor coordination for several days afterward.

• #36 Febrile Seizures | Information & Resources | Epilepsy Foundation New England

  https://epilepsynewengland.org/knowledge-center/types-of-seizures/febrile-seizures

  Most children who have febrile seizures do not require daily treatment with seizure medicines. […] Some children who have repeated episodes of multiple febrile seizures are treated with medication to reduce the risk of having more seizures. […] Children who have had unusually long febrile seizures and children who live in a remote area with poor access to medical care may also be considered for treatment with medication. […] Rarely, some children with prolonged febrile seizures or frequent episodes of febrile seizures are treated prophylactically. […] Other medications can be given at the time of a febrile seizure: Diastat (diazepam) gel or liquid diazepam can be given by rectum. […] Klonopin (clonazepam) wafers can be placed on the tongue or a tablet form of diazepam or lorazepam can be crushed and put between the cheek and the gum. […] Giving the child diazepam/valium when illness or fever begins can reduce the risk of recurrent febrile seizures.

• #37 New Therapy for Fever-Induced Seizures in Children Targets Calcium Channels – News Center

  https://news.feinberg.northwestern.edu/2013/06/12/martina_toddler_seizures/

  Fever-induced childhood seizures, known as febrile seizures, can be terrifying for parents to witness. Currently, children are not treated with daily anticonvulsant medication to prevent these seizures even when they recur repeatedly because toxic side effects of existing treatments outweigh potential benefits. […] Now, in a new study appearing in the June 12 issue of The Journal of Neuroscience, a team of Northwestern Medicine researchers has identified a new key factor in the generation of febrile seizures, leading to a new therapeutic target for humans. […] The team further found that nimodipine, a commonly available L-type calcium-channel blocker, dramatically reduced the incidence and duration of febrile seizures in animals. […] Consequently, we can develop better treatments for toddlers and reduce the risk of negative outcomes.

• #38 New Therapy for Fever-Induced Seizures in Children Targets Calcium Channels – News Center

  https://news.feinberg.northwestern.edu/2013/06/12/martina_toddler_seizures/

  This observation provides an alternative therapeutic target for febrile seizures that is distinct from current epilepsy drug therapy, which commonly focuses on blocking sodium channels. […] Once the team identified L-type calcium channels in neurons as the likely culprit, scientists took the finding one step further to test their hypothesis, administering the calcium channel blocker nimodipine in an animal model as a treatment for febrile seizures. […] The results were striking: nimodipine dramatically reduced both the incidence and duration of febrile seizures in rat pups. […] Therefore, if proven effective in clinical trials, this could be an important advance in clinical care. […] Because L-type calcium channel blockers such as nimodipine are safe drugs, every toddler with febrile seizures can potentially be treated to stop or prevent seizures triggered by high fever and reduce the risk of long-term neurological consequences of uncontrolled recurrent or prolonged febrile seizures. […] These findings could be helpful for one group of children in particular: those with genetic epilepsy syndromes whose seizures are triggered by fever, and for whom most anticonvulsants acting on sodium channels are harmful.

• #39 New Therapy for Fever-Induced Seizures in Children Targets Calcium Channels – News Center

  https://news.feinberg.northwestern.edu/2013/06/12/martina_toddler_seizures/

  This observation provides an alternative therapeutic target for febrile seizures that is distinct from current epilepsy drug therapy, which commonly focuses on blocking sodium channels. […] Once the team identified L-type calcium channels in neurons as the likely culprit, scientists took the finding one step further to test their hypothesis, administering the calcium channel blocker nimodipine in an animal model as a treatment for febrile seizures. […] The results were striking: nimodipine dramatically reduced both the incidence and duration of febrile seizures in rat pups. […] Therefore, if proven effective in clinical trials, this could be an important advance in clinical care. […] Because L-type calcium channel blockers such as nimodipine are safe drugs, every toddler with febrile seizures can potentially be treated to stop or prevent seizures triggered by high fever and reduce the risk of long-term neurological consequences of uncontrolled recurrent or prolonged febrile seizures. […] These findings could be helpful for one group of children in particular: those with genetic epilepsy syndromes whose seizures are triggered by fever, and for whom most anticonvulsants acting on sodium channels are harmful.

• #40 Intermittent clobazam therapy and febrile seizure recurrence – A follow up study – IJMPO

  https://www.ijmpo.com/html-article/13454

  Intermittent clobazam therapy has definite role in preventing febrile seizure recurrence. […] The risk factors for considering intermittent prophylaxis from this study are family history of febrile seizure and complex febrile seizure. […] Children presenting with acute febrile seizures are started on intermittent clobazam therapy. […] Those who took clobazam had considerable reduction in recurrence (8.3% in clobazam group compared to 56.8% in those who were not on intermittent clobazam therapy). […] Out of the 80 children, 36 children took intermittent clobazam therapy as advised. Among them only 3 children developed febrile seizure during the one year follow up period. […] This was observed to be statistically significant with an Odds ratio of 14.47 and p value of 0.01 in determining that intermittent clobazam therapy is effective in preventing the recurrence of febrile seizure.

• #41 Febrile Seizure: What It Is, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/febrile-seizure

  If your child has a first-time febrile seizure, they may recover from it fairly quickly. But you should contact your child’s healthcare provider or visit the emergency room to verify that this seizure is, in fact, a febrile seizure and not caused by something more serious. […] A provider may offer treatment recommendations or supportive care for the cause of the fever. This may include taking age-safe acetaminophen (Tylenol), ibuprofen (Motrin) or other medications as directed. […] Complex febrile seizures (a seizure that lasts longer than five minutes or if your child has more than one seizure in 24 hours) are more likely to need treatment. Your child’s provider may recommend the following medications: Intranasal (given through the nose) midazolam. Intravenous (injection into a vein) benzodiazepines. Rectal (given through the rectum) diazepam.

• #42 Febrile Seizures Treatment & Management: Prehospital Care, Emergency Department Care, Further Care

  https://emedicine.medscape.com/article/801500-treatment

  Most patients should be observed in the ED until awake and alert. […] Conditions requiring admission of the patient include the following: More than 1 seizure within 24 hours, unstable clinical status, lethargy beyond the postictal period, uncertain home situation, unclear follow-up care. […] Randomized, controlled trial of ibuprofen syrup administered during febrile illnesses to prevent febrile seizure recurrences. […] Antipyretic agents for preventing recurrences of febrile seizures: randomized controlled trial. […] A controlled trial of diazepam administered during febrile illnesses to prevent recurrence of febrile seizures.

• #43 Febrile Seizures Treatment & Management: Prehospital Care, Emergency Department Care, Further Care

  https://emedicine.medscape.com/article/801500-treatment

  Most patients should be observed in the ED until awake and alert. […] Conditions requiring admission of the patient include the following: More than 1 seizure within 24 hours, unstable clinical status, lethargy beyond the postictal period, uncertain home situation, unclear follow-up care. […] Randomized, controlled trial of ibuprofen syrup administered during febrile illnesses to prevent febrile seizure recurrences. […] Antipyretic agents for preventing recurrences of febrile seizures: randomized controlled trial. […] A controlled trial of diazepam administered during febrile illnesses to prevent recurrence of febrile seizures.

• #44 Best practices for the management of febrile seizures in children | Italian Journal of Pediatrics | Full Text

  https://ijponline.biomedcentral.com/articles/10.1186/s13052-024-01666-1

  Management of FS is summarized in Fig. 1. The acute management of FSE follows the established protocol for managing status epilepticus of any cause and is not the focus of this review. […] Hospitalization is often carried out for observation after the occurrence of a first FS. One of the primary reasons for observation is the potential for infections affecting the CNS and the concern about further seizures in the immediate aftermath. […] Factors that indicate a child’s admission for hospitalization include being drowsy before the seizure, having a Glasgow Coma Scale (GCS) score less than 15 more than an hour after the seizure, exhibiting signs of meningeal involvement, being under 18 months of age, having received antibiotic treatment before the FS, and having incomplete immune status.

• #45 Febrile Seizure: What It Is, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/febrile-seizure

  If your child has a history of this condition, their healthcare provider can guide you on seizure first aid and what to do to treat these at home. In general, you should do the following: Stay calm. Seeing your child having a seizure can be very frightening, but it’s important for you to keep as calm as possible. Track the time. Note how long your child’s seizure lasts. If the seizure lasts more than five minutes, you should immediately call 911 (or your local emergency services number). […] Febrile seizures happen unpredictably and aren’t usually preventable. Even if you treat your child’s fever, they’re still at risk of having one. […] All first-time febrile seizures need medical attention. You should contact a healthcare provider or emergency services if your child has a seizure for the first time. […] If your child has a history of seizures, your child’s pediatrician can offer the best guidance on what you can and should do to treat these. They can also tell you about any signs that you need to look out for.

• #46 Patient education: Febrile seizures (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/febrile-seizures-beyond-the-basics

  Fever treatment – After the seizure has stopped, treatment for the fever is started, usually by giving oral or rectal acetaminophen or ibuprofen and sometimes by sponging with room temperature (not cold) water. […] Home treatment – Parents who witness their child’s febrile seizure should take a number of steps to prevent the child from harming him or herself. […] Parents of a child who is at risk of having a recurrent febrile seizure can be taught to give treatment at home for seizures that last longer than five minutes. Treatment usually involves giving one dose of diazepam gel (brand name: Diastat) into the rectum. […] Preventive treatment – In most cases, treatment to prevent future seizures is not recommended; the risks and potential side effects of daily antiseizure medications outweigh their benefit. […] Treatment for fever (temperature greater than 100.4°F or 38°C) is acceptable but not always required; parents should speak with their health professional for help in deciding when to treat a child’s fever.

• #47 Febrile seizures: treatment and prognosis – PubMed

  https://pubmed.ncbi.nlm.nih.gov/10643916/

  Recent epidemiologic data indicate that the vast majority of children with febrile seizures have a normal longterm 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.

• #48 Febrile Seizures – Child Neurology Foundation

  https://www.childneurologyfoundation.org/disorder/febrile-seizures/

  Febrile seizures are the most common type of seizures in healthy children. They result from a high or rapid rise in fever. […] Treatments exist for both preventing febrile seizures and for the seizures themselves. […] It can be extremely traumatic for caregivers to witness an otherwise healthy child have a seizure. It may seem like an eternity in the moment. However, the vast majority of these are brief. Children almost always recover completely even when febrile seizures last a long time or are recurrent. Death due to febrile convulsions is almost nonexistent. […] For seizures lasting longer than 5 minutes, a physician may prescribe a special medication that can end the seizure. The treatment is typically one that the caregiver can administer into the child’s rectum. […] About one in three children who experienced a febrile seizure may have additional febrile seizures.

• #49 Febrile seizures: treatment and prognosis – PubMed

  https://pubmed.ncbi.nlm.nih.gov/10643916/

  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.

• #50 Febrile Seizures: Risks, Evaluation, and Prognosis | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0401/p445.html

  Hospital admission is usually not required for children with febrile seizures, although factors to consider when making the decision include younger age, need for further observation because of abnormal examination findings, or unreliable follow-up. […] A Cochrane review showed that intermittent diazepam significantly reduced recurrent febrile seizures for up to 48 months compared with placebo or no treatment. […] Given the benign nature of febrile seizures, routine use of these medications is not recommended to reduce recurrence of febrile seizures. […] A recent Japanese unblinded randomized trial of 423 children with febrile seizure found that rectal acetaminophen given every six hours for 24 hours significantly reduced the likelihood of short-term recurrence compared with no antipyretics.

• #51 Febrile seizures

  https://www.rch.org.au/kidsinfo/fact_sheets/febrile_convulsions/

  A febrile seizure is a fit or convulsion caused by a sudden change in your child’s body temperature, and is usually associated with a fever (see our fact sheet Fever in children). […] Treating a childs fever with paracetamol or ibuprofen will not prevent a febrile seizure. […] If the seizure lasts more than five minutes call an ambulance. […] If the seizure lasts less than five minutes and your child was very unwell before the seizure, take them to the GP or hospital emergency department as soon as possible. […] No. Febrile seizure are fits or seizures that occur only with a fever. […] No. No matter how dramatic and frightening febrile seizures may look, they do not cause brain damage. […] No. Even though these medicines may help to reduce a fever, if your child is going to have a febrile seizure, then it will happen. There is nothing you can do to prevent it.

• #52 What to Do if Your Baby Has a Febrile Seizure: Tips for Parents – BuzzRx Select permission for Location

  https://www.buzzrx.com/blog/febrile-seizure

  Treatment for Recurrent Febrile Seizures […] In rare cases, some children with repeated seizures may need to take prescription antiseizure medications on a daily basis to treat seizures and prevent recurrent febrile seizures. […] Medical Interventions and Follow-Up Care […] Having simple febrile seizures does not cause any long-term harm and does not increase the risk of epilepsy. Children who experience complex febrile seizures are at a 2.5% to 5% higher risk of developing epilepsy later in life. However, they don’t typically have any health complications or require long-term medical care.

• #53 Treatment and prognosis of febrile seizures – UpToDate

  https://www.uptodate.com/contents/treatment-and-prognosis-of-febrile-seizures

  Treatment and prognosis of febrile seizures […] While simple febrile seizures have typically spontaneously resolved by the time the child is evaluated and do not need to be treated, prolonged seizures may require abortive treatment with benzodiazepines in the ambulance or in the emergency department. […] Prophylactic antiseizure medications can decrease the risk of recurrent febrile seizures, but given the benign nature of most seizures, the risks of side effects generally outweigh the benefits. […] This topic will review the treatment and prognosis of febrile seizures, including febrile status epilepticus.

• #54 Febrile Seizure – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK448123/

  No specific treatment for simple or complex febrile seizures is indicated other than supportive care and evaluation for possible underlying conditions causing the fever. Antipyretics have not been shown to prevent a recurrence of febrile seizures. In those who have recurrent febrile seizures, prevention is challenging. A few studies have examined the treatment with benzodiazepines as a bridging measure for a few days during subsequent febrile events; however, the adverse effects outweighed the potential benefits. Therefore, benzodiazepines are not a recommended preventative measure. […] In patients with febrile status epilepticus or seizures lasting longer than 5 minutes, intravenous benzodiazepines (eg, lorazepam), rectal diazepam, or intranasal midazolam can be used. […] Follow-up as an outpatient with their pediatrician and neurologist, as indicated.

• #55 Best practices for the management of febrile seizures in children | Italian Journal of Pediatrics | Full Text

  https://ijponline.biomedcentral.com/articles/10.1186/s13052-024-01666-1

  Febrile seizures (FS) are commonly perceived by healthcare professionals as a self-limited condition with a generally benign nature. Nonetheless, they frequently lead to pediatric consultations, and their management can vary depending on the clinical context. For parents and caregivers, witnessing a seizure can be a distressing experience, significantly impacting their quality of life. […] In this review, we offer an in-depth exploration of FS management, therapeutic interventions, and prognostic factors, with the aim of providing support for physicians and enhancing communication with families. […] The majority of FS are self-limiting and tend to resolve before children arrive at the hospital. However, it has been demonstrated that prolonged FS are unlikely to spontaneously terminate. Consequently, seizures lasting longer than five minutes are improbable to cease on their own, and the administration of a benzodiazepine (BDZ) is recommended to terminate the seizure.

• #56 Febrile Seizure: What It Is, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/febrile-seizure

  If your child has a history of this condition, their healthcare provider can guide you on seizure first aid and what to do to treat these at home. In general, you should do the following: Stay calm. Seeing your child having a seizure can be very frightening, but it’s important for you to keep as calm as possible. Track the time. Note how long your child’s seizure lasts. If the seizure lasts more than five minutes, you should immediately call 911 (or your local emergency services number). […] Febrile seizures happen unpredictably and aren’t usually preventable. Even if you treat your child’s fever, they’re still at risk of having one. […] All first-time febrile seizures need medical attention. You should contact a healthcare provider or emergency services if your child has a seizure for the first time. […] If your child has a history of seizures, your child’s pediatrician can offer the best guidance on what you can and should do to treat these. They can also tell you about any signs that you need to look out for.

• #57 Febrile seizures | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/brain-nerves-and-spinal-cord/febrile-seizures/

  However, there may be exceptional circumstances where medication to prevent recurrent febrile seizures is recommended. For example, children may need medication if they have a low threshold for having seizures during illness, particularly if the seizures are prolonged. […] In this case, your child may be prescribed medications such as diazepam or lorazepam to take at the start of a fever.

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