Materiały źródłowe

• #1 Prophylactic drug management for febrile seizures in children

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6464693/

  Febrile seizures occurring in a child older than one month during an episode of fever affect 2% to 4% of children in Great Britain and the United States and recur in 30%. Rapid-acting antiepileptics and antipyretics given during subsequent fever episodes have been used to avoid the adverse effects of continuous antiepileptic drugs. […] To evaluate primarily the effectiveness and safety of antiepileptic and antipyretic drugs used prophylactically to treat children with febrile seizures; but also to evaluate any other drug intervention where there was a sound biological rationale for its use. […] We found no significant benefit for intermittent phenobarbitone, phenytoin, valproate, pyridoxine, ibuprofen or zinc sulfate versus placebo or no treatment; nor for diclofenac versus placebo followed by ibuprofen, acetaminophen or placebo; nor for continuous phenobarbitone versus diazepam, intermittent rectal diazepam versus intermittent valproate, or oral diazepam versus clobazam.

• #1 Febrile Seizures Medication: Antipyretics, Anticonvulsant agents

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

  Prophylactic use of antipyretics and sedatives/anticonvulsants for possible recurrence of febrile seizure has not shown to be effective. […] Regular or sporadic administration of antipyretics during febrile illness is generally safe, but no study has shown them to be effective in reducing recurrence of febrile seizures. Acetaminophen and ibuprofen are no better than placebo for preventing recurrences of febrile seizures. […] Citing a preponderance of harm over benefit, the 2008 Clinical Practice Guideline for the Long-Term Management of the Child with Simple Febrile Seizures recommends neither continuous nor intermittent use of anticonvulsants for children with one or more simple febrile seizures. […] The AAP guideline released in 2008 does not recommend prophylactic use of diazepam as the risk outweighs the benefits.

• #1 Prophylactic drug management for febrile seizures in children

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8207248/

  Febrile seizures occurring in a child older than one month during an episode of fever affect 24% of children in Great Britain and the United States and recur in 30%. […] To evaluate primarily the effectiveness and safety of antiepileptic and antipyretic drugs used prophylactically to treat children with febrile seizures; and also to evaluate any other drug intervention where there is a sound biological rationale for its use. […] We found no significant benefit for intermittent phenobarbital, phenytoin, valproate, pyridoxine, ibuprofen, or zinc sulfate versus placebo or no treatment; nor for diclofenac versus placebo followed by ibuprofen, paracetamol, or placebo; nor for continuous phenobarbital versus diazepam, intermittent rectal diazepam versus intermittent valproate, or oral diazepam versus clobazam.

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

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

  A benign form of seizure that occurs in association with viral gastroenteritis, and in the absence of dehydration or electrolyte disturbance, has a prognosis similar to that of FS. […] It is important for the family to understand that there is no increased risk of intellectual delay or school difficulties and that febrile seizures less than 30 minutes in duration do not result in brain damage. […] Similarly, the family should appreciate the low risk of developing epilepsy and the lack of benefit in using antiepileptic drug treatment to lower that risk. […] Cooling the child and using antipyretics does not reduce the frequency of recurrent FS. […] Several medications have been found to reduce the risk of a recurrent febrile seizure. […] However, there may be situations where drug treatment has a role.

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

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

  Multiple pharmacologic interventions have been studied to prevent recurrence of febrile seizures. However, potential benefits must be weighed against potential risks. A Cochrane review showed that intermittent diazepam significantly reduced recurrent febrile seizures for up to 48 months compared with placebo or no treatment. Continuous phenobarbital reduced recurrent febrile seizures compared with placebo at 6, 12, and 24 months but not at 18 or 72 months. […] Although an intermittent benzodiazepine or a continuous antiepileptic has clinically and statistically significant benefits, adverse effects occur in up to 30% of patients. Given the benign nature of febrile seizures, routine use of these medications is not recommended to reduce recurrence of febrile seizures. […] Ibuprofen and acetaminophen are postulated to decrease the risk of febrile seizure by attenuating the effect of the fever as a trigger for the seizure. A Cochrane review found no benefit of antipyretics for decreasing the risk of febrile seizures. However, 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 (9.1% vs. 23.5%; P.001; number needed to treat = 7).

• #1 Prophylactic antipyretics for prevention of febrile seizures following vaccination | The College of Family Physicians of Canada

  https://www.cfp.ca/content/63/2/128

  Vaccinations associated with increased risk of febrile seizure include the following: the measles-mumps-rubella vaccine; the measles-mumps-rubella-varicella vaccine; the combined diphtheria, tetanus, acellular pertussis, polio, and Haemophilus influenzae type b vaccine; the whole-cell pertussis vaccine; the 7-valent pneumococcal conjugate vaccine; and concomitant administration of the trivalent inactivated influenza vaccine with either the 7-valent pneumococcal conjugate vaccine or the diphtheria, tetanus, and acellular pertussis vaccine. […] Despite being a higher-risk group, children receiving these vaccinations should not receive prophylactic antipyretics, as no statistically significant reduction in the rate of febrile seizures has been documented, and prophylactic antipyretic use potentially decreases the immune response to certain vaccines.

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

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

  Daily oral phenobarbital reduces the frequency of recurrences, but has a high incidence of behavioral and cognitive side effects. […] Daily oral valproic acid is also effective in reducing the frequency of recurrent FS, but the high incidence of fatal liver failure in infants and young children suggests that the risks of this drug outweigh the benefits in this situation. […] Benzodiazepines may reduce the frequency of recurrent febrile seizures. […] All parents should be informed that there is no evidence that treatment with antiepileptic drugs influences the risk of developing epilepsy.

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

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

  Continuous phenobarbital resulted in significantly fewer recurrences at 6, 12, and 24 months, but not at 18 and 60 to 72 months. […] There is currently insufficient evidence to support the use of continuous or intermittent treatment with zinc, antiepileptic or antipyretic drugs for children with febrile seizures. […] We found reduced recurrence rates for intermittent diazepam and continuous phenobarbital, with adverse effects in up to 30% of children. […] Given the benign nature of recurrent febrile seizures, and the high prevalence of adverse effects of these drugs, parents and families should be supported with adequate contact details of medical services and information on recurrence, first aid management, and, most importantly, the benign nature of the phenomenon. […] To evaluate primarily the effectiveness and safety of antiepileptic and antipyretic drugs used prophylactically to treat children with febrile seizures; and also to evaluate any other drug intervention where there is a sound biological rationale for its use.

• #1 Treatment of Febrile Seizures | Pediatric Neurology Briefs

  https://pediatricneurologybriefs.com/articles/10.15844/pedneurbriefs-4-1-1

  The risk of febrile seizure recurrence was studied in 186 consecutive children aged between 6 and 72 months admitted to the Booth Hall and Royal Manchester Childrens Hospitals, Pendlebury, Manchester, England. […] Prophylactic treatment with sodium valproate or phenobarbital did not significantly lessen the risk of febrile seizure recurrence. The authors do not recommend the use of sodium valproate or phenobarbital prophylaxis for children with febrile convulsions even in those considered high risk categories. […] Until new approaches to the management of febrile seizures can be defined by well controlled studies, the following recommendations are suggested: 1) Emphasis on parental counseling and education in the management of fever and convulsions. 2) Intermittent prophylactic therapy with oral diazepam, 0.5 mg/kg/daily in divided doses, at times of subsequent fever, as an alternative to long-term phenobarbital. 3) An approved rectal preparation of diazepam for the treatment of the acute febrile seizure in the home for use by selected parents in high risk patients. 4) Phenobarbital, when indicated in selected patients, should be limited to 6-12 months seizure free periods and monitored by blood levels (15 mcg/ml) at six weeks to three month intervals and by behavioral and psychological evaluations before and during therapy.

• #1 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

  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. Carbamazepine and phenytoin are not effective in preventing recurrent FS. Levetiracetam can be an effective ASM in preventing the recurrence of complex FS. However, 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.

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

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

  We found no significant benefit for intermittent phenobarbital, phenytoin, valproate, pyridoxine, ibuprofen, or zinc sulfate versus placebo or no treatment. […] There was a significant reduction of recurrent febrile seizures with intermittent diazepam versus placebo or no treatment at six months. […] Phenobarbital versus placebo or no treatment reduced seizures at six months. […] Intermittent clobazam compared to placebo at six months resulted in a RR of 0.36, an effect found against an extremely high recurrence rate in the controls, a result that needs replication. […] When compared to placebo, intermittent oral levetiracetam significantly reduced recurrent seizures at 12 months. […] The recording of adverse effects was variable. […] The methodological quality of most of the included studies was low or very low.

• #1 Prophylactic drug management for febrile seizures in children

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8207248/

  There was a significant reduction of recurrent febrile seizures with intermittent diazepam versus placebo or no treatment at six months (risk ratio (RR) 0.64, 95% confidence interval (CI) 0.48 to 0.85; 6 studies, 1151 participants; moderate-certainty evidence), 12 months (RR 0.69, 95% CI 0.56 to 0.84; 8 studies, 1416 participants; moderate-certainty evidence), 18 months (RR 0.37, 95% CI 0.23 to 0.60; 1 study, 289 participants; low-certainty evidence), 24 months (RR 0.73, 95% CI 0.56 to 0.95; 4 studies, 739 participants; high-certainty evidence), 36 months (RR 0.58, 95% CI 0.40 to 0.85; 1 study, 139 participants; low-certainty evidence), 48 months (RR 0.36, 95% CI 0.15 to 0.89; 1 study, 110 participants; moderate-certainty evidence), with no benefit at 60 to 72 months (RR 0.08, 95% CI 0.00 to 1.31; 1 study, 60 participants; very low-certainty evidence).

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

  https://www.aafp.org/pubs/afp/issues/2012/0115/p149.html

  Febrile seizures are common in the first five years of life, and many factors that increase seizure risk have been identified. […] Continuous or intermittent antiepileptic or antipyretic medication is not recommended for the prevention of recurrent febrile seizures. […] Use of long-term continuous or intermittent antiepileptic medication after a first simple febrile seizure is not recommended because of potential adverse effects. […] Use of antipyretic agents at the onset of fever is not effective at reducing simple febrile seizure recurrence. […] Intermittent use of antipyretics or anticonvulsants at the onset of fever is not recommended. No studies have shown a reduction in recurrent simple febrile seizures when antipyretics are given at the onset of fever. […] Although intermittent use of oral diazepam at the onset of fever is effective at reducing recurrence of simple febrile seizures, the AAP does not recommend it because of potential adverse effects and because many recurrent febrile seizures occur before recognition of fever.

• #1 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. […] Prevention of the febrile seizure is highly desirable since seizure is upsetting to both parents and children. Clobazam, a 1,5-benzodiazepine, is completely absorbed 1 to 4 hours after oral administration, has a mean half-life of 18hours, and has less sedative and behavioral effects than diazepam. […] We observed that out of 36 children who took intermittent clobazam therapy as advised, only 3 had a recurrence during the one year follow up study. Out of the 44 children who had not taken prophylaxis even though advised, 25 developed a recurrence of febrile seizure. 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.

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

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

  Most febrile seizures occur in the first few hours of a fever, during the initial rise in body temperature. […] 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.

• #1 Febrile seizures in children: a condensed update | HKMJ

  https://www.hkmj.org/abstracts/v25n6/499.htm

  We would like to provide a condensed update on febrile seizures in children. […] Antipyretics are not recommended for febrile seizure prophylaxis. […] Long-term or intermittent anticonvulsants are useful to reduce recurrence but in general not recommended because of their side-effects. […] Rescue medication, eg, rectal diazepam should be considered for prolonged febrile seizure, febrile status epilepticus, or patients with limited medical access. […] Intermittent oral benzodiazepines could be considered for recurrent febrile seizures which are likely predictable, ie, seizures occurred after detection of fever. […] Caregivers should be taught to manage acute seizures.

• #1 Febrile Seizures – Children’s Health Issues – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/children-s-health-issues/neurologic-disorders-in-children/febrile-seizures

  Febrile status epilepticus […] More than 4 febrile seizures per year. […] If children who have had a long febrile seizure have a subsequent seizure that lasts more than 5 minutes, doctors may give a prescription for diazepam gel to be put into the rectum. Children can be treated with this medication at home.

• #1 The Prophylaxis of Febrile Convulsions in Childhood: Secular Trends in the Last Decade (2007-2008 versus 2017-2018) – The Journal of Pediatric Research

  https://jpedres.org/articles/the-prophylaxis-of-febrile-convulsions-in-childhood-secular-trends-in-the-last-decade-2007-2008-versus-2017-2018/doi/jpr.galenos.2022.87847

  Aim: To analyze trends in the prophylaxis of febrile convulsions (FC) in childhood by comparing two cohorts from the previous two decades (2007-2008 versus 2017-2018). […] Conclusion: Prophylaxis rates were determined to be lower in the last decade in children with FC. There was no impact of recurrence risk factors for the initiation of prophylaxis in children with simple or complex FC. […] We defined two secular trends for the prophylaxis of FC in children in the last decade: (1) a reduced rate of FC prophylaxis (22.1%) in the period of 2017-2018 compared with a rate of 63.8% in 2007-2008. […] In recent years, prophylaxis of FC in children is not preferred because of the adverse effects of the drugs and the benign nature of the seizures. […] The most rational use of prophylactic treatment in children with FC is to prevent prolonged seizures.

• #1 The Prophylaxis of Febrile Convulsions in Childhood: Secular Trends in the Last Decade (2007-2008 versus 2017-2018) – The Journal of Pediatric Research

  https://jpedres.org/articles/the-prophylaxis-of-febrile-convulsions-in-childhood-secular-trends-in-the-last-decade-2007-2008-versus-2017-2018/doi/jpr.galenos.2022.87847

  In this study, we defined two secular trends regarding the prophylaxis of FC in children: (1) a significantly reduced rate of FC prophylaxis (22.1%) and (2) no significant impact of recurrence risk factors on the initiation of prophylaxis in complex FC in the recent period. […] In this study, we determined a significantly reduced rate (22.1%) of prophylaxis in children with FC in the last decade (2017-2018). […] Prophylaxis for FC has significantly decreased during the previous decade, with a current rate of 21%. Despite the guidelines recommendations, the rate of prophylaxis with ASM is still high in children with FC. Validated scoring models, including predominant risk factors, are needed to determine those children with FC who require prophylaxis.

• #1 Febrile Seizures and Vaccines | Vaccine Safety | CDC

  https://www.cdc.gov/vaccine-safety/about/febrile-seizures.html

  Vaccinating children at the recommended age may prevent some febrile seizures by protecting children against measles, mumps, rubella, chickenpox, influenza, pneumococcal infections and other diseases that can cause fever and febrile seizures. […] There is a small increased risk for febrile seizures after MMR and MMRV vaccines. […] There is a small increased risk for febrile seizures when inactivated influenza vaccine (flu shot) is given at the same doctor visit as either the PCV13 (pneumococcal) vaccine or the DTaP vaccine. […] The risk of febrile seizure with any combination of these vaccines is small (at most 30 febrile seizures in 100,000 children vaccinated) and CDC’s Advisory Committee on Immunization Practices (ACIP) continues to encourage the vaccination of children according to the vaccination schedule, which allows for the flu, pneumococcal and DTaP vaccinations to be given during the same doctor’s visit.

• #1 What Every Parent Needs To Know About Febrile Seizures – Dr. Green Mom

  https://drgreenmom.com/what-every-parent-needs-to-know-about-febrile-seizures/

  Melatonin is receiving some attention for its possible role in the prevention of febrile seizures in children. If you are interested in trying melatonin supplementation for your child, speak to your doctor first. The doses given in the trial are higher than standard melatonin doses and have some risk of side effects. This should be monitored by a physician. […] Certain nutrients are found to be lower in children with febrile seizures, including zinc, sodium, melatonin, magnesium, vitamin D, and vitamin B12. While the research is less conclusive, there may also be a connection between low levels of selenium and iron and the likelihood of febrile seizures in children. At present it is unknown whether or not correcting these nutrients levels would reduce the risk of febrile seizure.

• #1

  https://www.healthychildren.org/English/health-issues/conditions/fever/Pages/Febrile-Seizures.aspx

  Febrile seizures can happen with any condition that causes a fever, such as common colds, the flu, ear infection or roseola. […] Vaccines can cause your child to have a fever, but febrile seizures are generally rare after vaccination. Recommended vaccines can actually help prevent some febrile seizures, since getting sick with measles, mumps, rubella, chickenpox, influenza (the flu), pneumococcal infections and other diseases can cause fevers and febrile seizures. […] In general, doctors do not recommend treatment of a simple febrile seizure with preventive medicines. However, this should be discussed with your child’s doctor. In cases of prolonged or repeated seizures, the recommendation may be different.

• #1 Febrile Seizures – Children’s Health Issues – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/children-s-health-issues/neurologic-disorders-in-children/febrile-seizures

  Most children do not need to take medications to prevent febrile seizures. […] If children have had a febrile seizure, parents should watch for and treat high fevers, which can trigger a seizure. However, a febrile seizure often occurs early in the course of the fever, as the child’s temperature increases, or before parents know that the child is ill and recognize the fever. […] Medications to prevent additional seizures (antiseizure medications) are usually not given to children who have had only a few simple febrile seizures. However, antiseizure medications may be given to children who have any of the following: […] Complex febrile seizures and neurologic problems (such as cerebral palsy or abnormal brain imaging results) […] A strong family history of epilepsy and recurring simple or complex febrile seizures

• #1 Prophylactic drug management for febrile seizures in children

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8207248/

  We found reduced recurrence rates for intermittent diazepam and continuous phenobarbital, with adverse effects in up to 30% of children. […] Given the benign nature of recurrent febrile seizures, and the high prevalence of adverse effects of these drugs, parents and families should be supported with adequate contact details of medical services and information on recurrence, first aid management, and, most importantly, the benign nature of the phenomenon.

• #1 Indian Pediatrics – Personal Practice

  https://www.indianpediatrics.net/july2001/july-733-740.htm

  Diazepam administered intermittently either rectally as suppositories, or solution or orally at the onset of fever has been shown to be effective in preventing recurrence of febrile seizures. Adverse effects of oral diazepam include lethargy, drowsiness and ataxia. […] This perhaps is the most important (and often neglected) aspect of management of febrile seizures. As seizures in their child can be very frightening for the parents they should be counselled properly with particular emphasis on: the benign nature of the febrile seizures; that febrile seizures do not lead to neurological problems or developmental delay; what they should do immediately if their child has another seizure; a doctor should be consulted if the seizure lasts for more than 15 min. or if the post ictal drowsiness persists for more than 30 min.

• #1 Prophylactic drug management for febrile seizures in children

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6464693/

  There was a significant reduction of recurrent febrile seizures with intermittent diazepam versus placebo or no treatment, with a risk ratio (RR) of 0.64 (95% confidence interval (CI) 0.48 to 0.85 at six months), RR of 0.69 (95% CI 0.56 to 0.84) at 12 months, RR 0.37 (95% CI 0.23 to 0.60) at 18 months, RR 0.73 (95% CI 0.56 to 0.95) at 24 months, RR 0.58 (95% CI 0.40 to 0.85) at 36 months, RR 0.36 (95% CI 0.15 to 0.89) at 48 months, with no benefit at 60 to 72 months. […] We found reduced recurrence rates for children with febrile seizures for intermittent diazepam and continuous phenobarbitone, with adverse effects in up to 30%. […] Neither continuous nor intermittent treatment with zinc, antiepileptic or antipyretic drugs can be recommended for children with febrile seizures. […] Parents and families should be supported with adequate contact details of medical services and information on recurrence, first aid management and, most importantly, the benign nature of the phenomenon.

• #1 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 (10 mg/kg/dose four times per day), ibuprofen (5 mg/kg/dose every 6 h), and rectal diclofenac (1.5 mg/kg/dose every 6 h) have failed to show any benefit in preventing FS. Consistently, a recent systematic review did not find a clear benefit of using antipyretics to prevent FS within the same fever episode and during distant fever episodes. Another meta-analysis failed to identify benefits for children with FS from intermittent prophylaxis. Specifically, they found no significant benefit for intermittent phenobarbital, phenytoin, valproate, pyridoxine, ibuprofen, or zinc sulfate compared to placebo or no treatment; nor for diclofenac compared to placebo followed by ibuprofen, paracetamol, or placebo; nor for continuous phenobarbital compared to diazepam, intermittent rectal diazepam compared to intermittent valproate, or oral diazepam compared to clobazam. However, reduced recurrence rates were seen for intermittent diazepam and continuous phenobarbital, with adverse effects in up to 30% of children.

• #2 Prophylactic drug management for febrile seizures in children

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8207248/

  We found reduced recurrence rates for intermittent diazepam and continuous phenobarbital, with adverse effects in up to 30% of children. […] Given the benign nature of recurrent febrile seizures, and the high prevalence of adverse effects of these drugs, parents and families should be supported with adequate contact details of medical services and information on recurrence, first aid management, and, most importantly, the benign nature of the phenomenon.

• #2 Febrile Seizures: Overview, Symptoms, Treatment and Prevention

  https://www.nationwidechildrens.org/conditions/febrile-seizures

  Many children get fevers when theyre sick. Medicines like acetaminophen (Childrens Tylenol) or ibuprofen (Childrens Motrin or Advil) can help with fevers. These fever-reducing medicines may not prevent a seizure. […] You don’t have to change your lifestyle or the way you care for your child after a febrile seizure. […] Typically, if your child has a febrile seizure, they don’t need to go to a neurologist.

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

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

  Multiple pharmacologic interventions have been studied to prevent recurrence of febrile seizures. However, potential benefits must be weighed against potential risks. A Cochrane review showed that intermittent diazepam significantly reduced recurrent febrile seizures for up to 48 months compared with placebo or no treatment. Continuous phenobarbital reduced recurrent febrile seizures compared with placebo at 6, 12, and 24 months but not at 18 or 72 months. […] Although an intermittent benzodiazepine or a continuous antiepileptic has clinically and statistically significant benefits, adverse effects occur in up to 30% of patients. Given the benign nature of febrile seizures, routine use of these medications is not recommended to reduce recurrence of febrile seizures. […] Ibuprofen and acetaminophen are postulated to decrease the risk of febrile seizure by attenuating the effect of the fever as a trigger for the seizure. A Cochrane review found no benefit of antipyretics for decreasing the risk of febrile seizures. However, 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 (9.1% vs. 23.5%; P.001; number needed to treat = 7).

• #2 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 (10 mg/kg/dose four times per day), ibuprofen (5 mg/kg/dose every 6 h), and rectal diclofenac (1.5 mg/kg/dose every 6 h) have failed to show any benefit in preventing FS. Consistently, a recent systematic review did not find a clear benefit of using antipyretics to prevent FS within the same fever episode and during distant fever episodes. Another meta-analysis failed to identify benefits for children with FS from intermittent prophylaxis. Specifically, they found no significant benefit for intermittent phenobarbital, phenytoin, valproate, pyridoxine, ibuprofen, or zinc sulfate compared to placebo or no treatment; nor for diclofenac compared to placebo followed by ibuprofen, paracetamol, or placebo; nor for continuous phenobarbital compared to diazepam, intermittent rectal diazepam compared to intermittent valproate, or oral diazepam compared to clobazam. However, reduced recurrence rates were seen for intermittent diazepam and continuous phenobarbital, with adverse effects in up to 30% of children.

• #2

  https://www1.racgp.org.au/newsgp/clinical/does-new-evidence-stack-up-for-paracetamol-prevent

  Is paracetamol useful in treating febrile seizures? […] However, a new paper in Pediatrics, Acetaminophen and febrile seizure recurrences during the same fever episode, has come to a different conclusion, finding rectally administered paracetamol is effective at preventing recurrence of febrile seizures. […] The primary outcome was seizure recurrence rate in the same acute illness (all events occurred in the first 24 hours). […] In the first 24 hours, 16% of all included children had a subsequent seizure during the same episode of illness. Broken down, that was 9.1% in the per rectum paracetamol group and 23.5% in the no intervention arm. This yielded a very impressive p-value of 0.001. […] A 14.4% absolute risk reduction gives a number needed to treat of about seven. […] Despite a significant result, I do not believe this data can change the probability for efficacy enough to make this a practice changer.

• #2 Prophylactic antipyretics for prevention of febrile seizures following vaccination | The College of Family Physicians of Canada

  https://www.cfp.ca/content/63/2/128

  While the increased risk of febrile seizure following vaccination is small, witnessing a febrile seizure can be a frightening experience for parents and caregivers. In hopes of preventing seizures, as well as caring for pain and fever, health care providers and parents routinely administer antipyretics around the time of vaccination. […] Therefore, the evidence suggests that acetaminophen is not effective at preventing febrile seizure recurrence. […] Therefore, it appears that prudent timing of MMR vaccination is the only known factor that decreases the rate of febrile seizure recurrence following vaccination. […] Current evidence does not suggest benefit to providing prophylactic antipyretics, especially in face of potential lack of immunogenicity.

• #2 Prophylactic drug management for febrile seizures in children

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6464693/

  Febrile seizures occurring in a child older than one month during an episode of fever affect 2% to 4% of children in Great Britain and the United States and recur in 30%. Rapid-acting antiepileptics and antipyretics given during subsequent fever episodes have been used to avoid the adverse effects of continuous antiepileptic drugs. […] To evaluate primarily the effectiveness and safety of antiepileptic and antipyretic drugs used prophylactically to treat children with febrile seizures; but also to evaluate any other drug intervention where there was a sound biological rationale for its use. […] We found no significant benefit for intermittent phenobarbitone, phenytoin, valproate, pyridoxine, ibuprofen or zinc sulfate versus placebo or no treatment; nor for diclofenac versus placebo followed by ibuprofen, acetaminophen or placebo; nor for continuous phenobarbitone versus diazepam, intermittent rectal diazepam versus intermittent valproate, or oral diazepam versus clobazam.

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

  https://www.aafp.org/pubs/afp/issues/2012/0115/p149.html

  Febrile seizures are common in the first five years of life, and many factors that increase seizure risk have been identified. […] Continuous or intermittent antiepileptic or antipyretic medication is not recommended for the prevention of recurrent febrile seizures. […] Use of long-term continuous or intermittent antiepileptic medication after a first simple febrile seizure is not recommended because of potential adverse effects. […] Use of antipyretic agents at the onset of fever is not effective at reducing simple febrile seizure recurrence. […] Intermittent use of antipyretics or anticonvulsants at the onset of fever is not recommended. No studies have shown a reduction in recurrent simple febrile seizures when antipyretics are given at the onset of fever. […] Although intermittent use of oral diazepam at the onset of fever is effective at reducing recurrence of simple febrile seizures, the AAP does not recommend it because of potential adverse effects and because many recurrent febrile seizures occur before recognition of fever.

• #2

  https://www.healthychildren.org/English/health-issues/conditions/fever/Pages/Febrile-Seizures.aspx

  Febrile seizures can happen with any condition that causes a fever, such as common colds, the flu, ear infection or roseola. […] Vaccines can cause your child to have a fever, but febrile seizures are generally rare after vaccination. Recommended vaccines can actually help prevent some febrile seizures, since getting sick with measles, mumps, rubella, chickenpox, influenza (the flu), pneumococcal infections and other diseases can cause fevers and febrile seizures. […] In general, doctors do not recommend treatment of a simple febrile seizure with preventive medicines. However, this should be discussed with your child’s doctor. In cases of prolonged or repeated seizures, the recommendation may be different.

• #2 Febrile Seizures – Children’s Health Issues – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/children-s-health-issues/neurologic-disorders-in-children/febrile-seizures

  Febrile status epilepticus […] More than 4 febrile seizures per year. […] If children who have had a long febrile seizure have a subsequent seizure that lasts more than 5 minutes, doctors may give a prescription for diazepam gel to be put into the rectum. Children can be treated with this medication at home.

• #2 Prophylactic drug management for febrile seizures in children

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6464693/

  There was a significant reduction of recurrent febrile seizures with intermittent diazepam versus placebo or no treatment, with a risk ratio (RR) of 0.64 (95% confidence interval (CI) 0.48 to 0.85 at six months), RR of 0.69 (95% CI 0.56 to 0.84) at 12 months, RR 0.37 (95% CI 0.23 to 0.60) at 18 months, RR 0.73 (95% CI 0.56 to 0.95) at 24 months, RR 0.58 (95% CI 0.40 to 0.85) at 36 months, RR 0.36 (95% CI 0.15 to 0.89) at 48 months, with no benefit at 60 to 72 months. […] We found reduced recurrence rates for children with febrile seizures for intermittent diazepam and continuous phenobarbitone, with adverse effects in up to 30%. […] Neither continuous nor intermittent treatment with zinc, antiepileptic or antipyretic drugs can be recommended for children with febrile seizures. […] Parents and families should be supported with adequate contact details of medical services and information on recurrence, first aid management and, most importantly, the benign nature of the phenomenon.

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

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

  Continuous phenobarbital resulted in significantly fewer recurrences at 6, 12, and 24 months, but not at 18 and 60 to 72 months. […] There is currently insufficient evidence to support the use of continuous or intermittent treatment with zinc, antiepileptic or antipyretic drugs for children with febrile seizures. […] We found reduced recurrence rates for intermittent diazepam and continuous phenobarbital, with adverse effects in up to 30% of children. […] Given the benign nature of recurrent febrile seizures, and the high prevalence of adverse effects of these drugs, parents and families should be supported with adequate contact details of medical services and information on recurrence, first aid management, and, most importantly, the benign nature of the phenomenon. […] To evaluate primarily the effectiveness and safety of antiepileptic and antipyretic drugs used prophylactically to treat children with febrile seizures; and also to evaluate any other drug intervention where there is a sound biological rationale for its use.

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