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Copyright © 2008 Massachussetts Medical Society. All rights reserved.

AAP DOES NOT RECOMMEND PREVENTIVE TREATMENT FOR SIMPLE FEBRILE SEIZURES

A new AAP clinical practice guideline states that the potential toxicities of preventive treatments outweigh the benefits.

Febrile seizures affect 2% to 5% of children between ages 6 and 60 months. Simple febrile seizures are generalized, brief, and isolated and occur in neurologically normal children. Simple febrile seizures are not associated with learning or behavioral problems, are associated with, at most, a very small increased risk for later development of epilepsy (an association often attributed to underlying genetic predisposition), but do have a high rate of recurrence. An AAP subcommittee on febrile seizures has updated the 1999 clinical practice guideline for long-term management of children with simple febrile seizures. The subcommittee focused on studies published during the past decade that evaluated the safety and effectiveness of treatments aimed at preventing recurrent simple febrile seizures.

Anticonvulsants

Citing a preponderance of harm over benefit, the guideline recommends neither continuous nor intermittent use of anticonvulsants for children with one or more simple febrile seizures. Although phenobarbital, primidone, and valproic acid prevent recurrence of febrile seizure compared with placebo, side effects (including irritability, lethargy, and sleep and behavioral disturbances) are common with phenobarbital and primidone, and serious adverse hepatic, hematologic, and gastrointestinal effects have been reported with valproic acid. Carbamazepine and phenytoin are not effective in preventing febrile seizure recurrence. Administration of oral diazepam during febrile illness effectively decreases recurrence of …

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