Convulsions triggered by fever (febrile seizures) are the most common
type of seizure, with a prevalence of 3 to 4 percent. Febrile seizures
frequently recur with a recurrence rate of 33 percent overall and 50
percent when the first febrile seizure occurs before one year of age.
Prevention of febrile seizures is highly desirable since seizures are
upsetting to both parents and children, and since medical costs can
be considerable. Any child with a convulsion is at risk for brain injury
due to falls caused by seizures or due to hypoxia if there is accompanying
respiratory compromise. Most studies, though not all, have found a relation
between the number of febrile seizures, particularly those that are
complex, and the risk of later afebrile seizures. Hence, prevention
of febrile seizures might also lessen that risk.
For two decades, daily phenobarbital has been the drug of choice for
the prevention of febrile seizures, and in most studies it has been
effective. More recently, however, its role in prophylaxis has been
questioned. Concern has centered on the frequency of behavioral side
effects, consistently poor compliance with the drug regimen, and evidence
of some accompanying decline in IQ. Finally, assessments of the efficacy
of daily phenobarbital, based on the intention to treat, have shown
no advantage over placebo.
The study summarized suggested that oral diazepam, given only when fever
is present, is safe and reduces the risk of recurrent febrile seizures.1