Update on the management of simple febrile seizures: emphasis on minimal intervention

We summarize recent clinical reviews and updated American Academy of Pediatrics (AAP) clinical guidelines for the management of children with simple febrile seizures. There has been a dramatic reduction in the incidence of bacterial meningitis and of occult bacteremia since the advent of Haemophilus influenzae type b and Streptococcus pneumoniae immunization. This has made routine laboratory evaluation for these bacterial infections unnecessary in a fully immunized, well appearing child who presents with a simple febrile seizure. At the same time there is increasing evidence that the neurotropic human herpes viruses 6 and 7 (HHV-6, HHV-7) comprise a significant proportion of viral infections associated with febrile seizures, and may be the primary cause of the seizure in many instances. Recent evidence-based guidelines emphasize the lack of a need for routine laboratory and neurodiagnostic evaluation, and for prophylactic antipyretics and anticonvulsants, in the majority of children with simple febrile seizures. If a child who is fully immunized according to the recommended schedule presents with a simple febrile seizure, minimal intervention should be the norm. Routine blood tests and routine lumbar punctures are usually unnecessary, and the risks of neurodiagnostic procedures (imaging or EEG), prophylactic antipyretics and anticonvulsants far outweigh their potential benefits.