Febrile Seizures: A Consensus of Their Significance, Evaluation, and Treatment

Abstract

The National Institutes of Health recently convened experts from this country and abroad to present current knowledge about febrile seizures and their consequences, and about the risks and benefits of therapy. This information was presented to a panel under the chairmanship of Dr Edwin Kendig, former president of the American Academy of Pediatrics. The panel consisted of both academicians and practitioners. The accompanying statement represents the consensus of that panel. The statement bears reading in its entirety, for it should influence the way that a pediatrician thinks about the child who has had a seizure with fever, how he evaluates and treats that child, and what he tells the parents. The panel found that there were only two significant risks associated with febrile seizures: a 30% to 40% risk of recurrent febrile seizures and a slightly increased risk of later epilepsy. They found no evidence of mental or neurologic impairment due to the febrile seizure. The panel concluded that daily phenobarbital in sufficient dosage to produce a blood level of 15 µg/ml could prevent recurrence of febrile seizures, but that there was no evidence that either the administration of phenobarbital or the prevention of recurrences prevented later epilepsy. Phenobarbital was noted to produce side effects or toxic reactions in up to 40% of children. These included behavioral changes, sleep disturbances, and possible interference with learning. Valproic acid was also effective in preventing recurrences, but in view of the rare, but reported fatal hepatitis, liver function tests should be closely monitored.