Optimum management of febrile seizures in childhood

According to comprehensive cohort studies the long term prognosis for children with febrile seizures is far better than previously assumed. There is very little risk of neurological deficit, epilepsy, mental retardation, or altered behaviour as sequelae to febrile seizures. As a natural consequence of the good long term prognosis, the routine use of continuous phenobarbitone or valproic acid prophylaxis is not indicated in simple febrile seizures and only rarely in complex febrile seizures. A rational alternative is intermittent prophylaxis by rectally administered diazepam in solution in the event of fever or acute treatment during continuing convulsions. This prophylaxis may be used selectively for children at high risk of new febrile seizures, or routinely for all children after the first attack of febrile seizure. The treatment is almost devoid of major side effects. If prophylaxis is to be avoided altogether, parents should be supplied with a diazepam solution for rectal use to deal with new seizures.