prevention

Last reviewed 01/2018

There is a 30 to 50% risk of recurrence after one febrile convulsion. It is necessary to explain to the parents that febrile convulsions are generally a benign condition.

Intermittent use of antipyretics and antiepileptic drugs for the prevention of recurrent seizures is not recommended.

  • a cochrane review carried out in 2012 reported no benefit in the use of intermittent ibuprofen, diclofenac, or paracetamol versus placebo in preventing further febrile seizures
  • due to the adverse effects of the drugs and the benign prognosis of the condition, intermittent or continuous prophylaxis  with antiepileptic medication is not recommended
    • both the Royal College of paediatrics and child health and American academy of paediatrics do not recommend prophylaxis oral antiepileptics for either simple or complex febrile seizures (1)

If in future the parents are worried that the child may develop a febrile convulsion because the child has a high temperature and there is a recognised 'pattern' to the development of febrile convulsions, then the child must be given an antipyretic such as paracetamol so to try to reduce their high temperature. Sponging down of the child to reduce the temperature may also be attempted although the efficacy of physical cooling methods has been questioned (see notes).

Rectal diazepam may be given by parents to terminate seizures, or to reduce the risk of recurrence. Regular prophylaxis with sodium valproate or phenobarbitone may be used to reduce the risk recurrence, but only in extreme cases.

Notes:

  • use of antipyretics in prevention of febrile convulsions
    • a systematic review however found no evidence that antipyretics reduce the risk of subsequent febrile convulsions in at risk children. The review advised the prescription of paracetamol following febrile seizures may provide comfort and symptomatic relief, but should not be recommended to prevent further febrile convulsions (2)
  • physical cooling methods
    • external cooling lowers the temperature of febrile patients by overwhelming effector mechanisms that have been evoked by an elevated thermoregulatory set-point, rather than by lowering that set-point as happens with antipyretic therapy. It has been suggested that "...unless concomitant antipyretic agents have lowered the set-point or shivering is inhibited by other pharmacologic means, external cooling is vigorously opposed in the febrile patient by thermoregulatory mechanisms endeavoring to maintain the elevated body temperature..(3)", ie leading to a heating of the core-temperature rather than reduction.
    • if external cooling is used to treat fever, care must be taken to prevent shivering, because of its associated increased oxygen consumption (3)
    • few available clinical studies of the efficacy of physical methods of antipyresis differ in their conclusions
      • interpretation of the results of these studies is difficult, because pharmacologic agents are almost invariably administered concomitantly with external cooling
      • one study (4) found acetaminophen and sponging to be equally effective in lowering fever in children admitted to a pediatric hospital because of fever - however, when combined, the two modalities produced more rapid cooling than did either alone
      • a further study found that tepid-water sponging in combination with acetaminophen was no more effective than acetaminophen alone in lowering the temperature of febrile children (5)
    • NICE state that "...· Antipyretic agents do not prevent febrile convulsions and should not be used specifically for this purpose." (6)

Reference:

Related pages:

phenobarbitone

diazepam