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Effectiveness of daily phenobarbital in the prevention of febrile seizure recurrences in "simple" febrile convulsions and "epilepsy triggered by fever".

Of 290 children with an initial febrile convulsion, 216 met Livingston's criteria for a "simple" febrile convulsion and 74 for "epilepsy triggered by fever." Daily phenobarbital produced a significant decrease in febrile seizure recurrences in both groups, as compared to children who received phenobarbital at the onset of fever and those who received no phenobarbital prophylaxis. Although statistically significant in both groups, the effectiveness of daily phenobarbital was more pronounced in the "epilepsy with fever" children.

Child

Predictors of epilepsy in children who have experienced febrile seizures.

We examined the frequency of development of afebrile seizures in 1706 children who had experienced at least one febrile seizure and were followed to the age of seven years. Epilepsy developed by seven years of age in 20 per 1000 (2 per cent), and another 10 per 1000 had at least one afebrile seizure that did not meet our definition of epilepsy. In children whose neurologic or developmental status was suspect or abnormal before any seizure and whose first seizure was complex (longer than 15 minutes, multiple or focal) epilepsy developed at a rate 18 times higher than in children with no febrile seizures (92 vs. 5 per 1000; P less than 0.001). In the largest group with febrile seizures, those previously normal with noncomplex first febrile seizures, epilepsy developed in 11 per 1000; this rate, although moderate, was greater than that for children with no febrile seizures (P = 0.027). Prior neurologic and developmental status and characteristics of the first febrile seizure are important predictors of epilepsy after febrile seizures.

Age Factors

The initial management of simple febrile seizures.

One hundred consecutive cases of simple febrile seizures in childhood were studied. Seventeen of these children had had more than one seizure during the febrile episode, but none of the patients had a further seizure after treatment with simple antipyretic measures. Thus it appears unnecessary to give anticonvulsants to prevent early recurrence of simple febrile seizures.

Anti-Inflammatory Agents, Non-Steroidal

Febrile seizures and later intellectual performance.

The relationship of febrile seizures to later intellectual and academic performance was examined in a sibling-control study. Amont 431 sibling pairs tested at the age of 7 years, the mean full scale IQ on the Vechsler Intelligence Scales for Children was not different for children who had febrile seizures as compared with siblings who were seizure-free. Neither recurrent seizures nor those lasting 30 minutes or longer were associated with IQ deficit. Poor academic achievement, defined as Wide Range Achievement Test performance more than one grade level below school placement in children with IQs of 90 or above, was equally frequent in index cases and control patients. Febrile seizures were not associated with a decrement in IQ or early academic performance, as judged by comparison of affected children with their siblings.

Achievement

Febrile seizures.

Thirty to 40 percent of children who have a febrile seizure between the ages of six months and six years are at risk for further and more serious febrile seizures and possibly for afebrile seizures. The risk is heightened if the child is less than one year of age and if the seizure lasts more than 20 minutes or is focal rather than generalized. A history of epilepsy in a first-degree relative also increases the risk. The use of long-term phenobarbital therapy is advocated when the seizure is "atypical".

Anticonvulsants

Behavior disturbance, phenobarbital, and febrile seizures.

Of 109 children treated daily with phenobarbital following the first fibrile convulsion, 42% developed a behavior disorder, usually hyperactivity. Daily phenobarbital therapy was prematurely discontinued in 54% of the children with behavior abnormality (20% of those treated). The behavior disturbance usually appeared within several months, was no correlated with high blood barbiturate levels, disappeared in 73%, and improved in all children when barbiturate therapy was discontinued. No characteristics of the child, the initial febrile seizure, or recurrence of febrile seizures were significantly correlated with the occurrence of the behavior disorder except for behavioral abnormality preceding the initial febrile convulsion. Eighteen percent of the children who received no phenobarbital developed behavior disorder, most often hyperactivity. The behavior disturbance spontaneously disappeared in 52%. Among these children not given phenobarbital, the group with normal behavior had a greater frequency of family history of seizures, especially febrile convulsions, and a lower frequency of preseizure behavior disturbance; abnormalities of pregnancy, labor, delivery, and neonatal period; delayed milestones; long seizures; abnormal results of neurological examination; abnormal EEG; and recurrent febrile seizures.

Barbiturates

The value of phenobarbital in the child who has had a single febrile seizure: a controlled prospective study.

A group of 355 children who were seen after a first febrile convulsion at the Kaiser Foundation Foundation Hospitals in Southern California from 1970 to 1975 were randomly assigned to three treatment groups-daily phenobarbital, "intermittent" phenobarbital given at the onset of fever, and no phenobarbital. We found that 42% had a relative with a febrile seizure and 16% a relative with an afebrile convulsion. 13% had seizures which were either lateralized or longer than ten minutes. Parents were unaware of the fever prior to the seizure in about 30% of the cases. In 81% the preseizure duration of fever was less than 24 hours. The mean follow-up was 28 months, with a range of 6 to 70 months. There was no significant difference in the recurrence rate between children receiving "intermitent" as compared with no phenobarbital. The recurrence rate in children receiving daily phenobarbital was significantly decreased compared to either of the other two groups. Severe recurrent febrile seizures occurred in no children on daily phenobarbital and in 4.4% of the children receiving either intermittent or no phenobarbital. Parental resistance, compliance, and reversible hyperactivity were the main problems encountered with the continuous phenobarbital regimen.

Child, Preschool

Febrile seizures.

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Adolescent

Febrile seizures.

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Child, Preschool