Children with febrile seizures, have to be treated with anticonvulsivants when they have fever?

Authors´ conclusion: in the first randomized controlled trial, the intermittent rectal diazepam (RD) prophylaxis reduces 45% the recurrence rates of febrile seizures in high risk patients (p = 0.005), 20% reduction in the intermediate-risk (p = 0.341) and only 13% in the low-risk children (p = 0.412). The side effects in the RD group were mild and transient and no long-term side effects during the 3-year follow-up were observed. The clinical practice guideline reviewed the literature with the aim of addressing possible therapeutic interventions in the management of children with simple febrile seizures and concluded that although there is evidence that both continuous antiepileptic therapy and intermittent therapy with oral diazepam (OD) are effective in reducing the risk of recurrence, the potential toxicities associated with antiepileptic drugs outweigh the relatively minor risk associated with simple febrile seizures. In situations of parental anxiety associated with febrile seizures, intermittent OD at the onset of febrile illness may be effective in preventing recurrence.

Reviewers´commentary: continuous antiepileptic therapy or intermittent therapy with diazepam, is not recommended because the risks outweigh the benefits. In situations with severe parental anxiety associated with febrile seizures, intermittent OD or RD could be used at the onset of a febrile illness. The first choice is RD at a dose of 0.33 mg/kg with a total of three doses within the first 24 h from the onset of fever.