- Lectures / Webinars
- Long term management : is there a right choice – no prophylaxis vs intermittent prophylaxis vs continuous prophylaxis with antiseizure medication
Long term management : is there a right choice – no prophylaxis vs intermittent prophylaxis vs continuous prophylaxis with antiseizure medication
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ICNC2024
The Tangled Web of Complex Febrile Seizures: A Common But Complex Conundrum
Long term management : is there a right choice – no prophylaxis vs intermittent prophylaxis vs continuous prophylaxis with antiseizure medication
Jo Wilmshurst
Whilst most Febrile seizures (FS) are self-limited and resolve with age, they can be recurrent, resulting in caregiver distress and frequent demand for intervention. Simple febrile seizures (SFS) do not warrant prophylactic ASM, but when the events are recurrent, the management becomes more contentious. There is no consistency in the recommendations of existing guidelines. A number of them support use of prophylactic short term ASM at the start of a febrile illness (diazepam, topiramate, levetiracetam), but these often acknowledge adverse effects. A Cochrane review also concluded that reduced recurrence rates for children with FS was evident with use of intermittent diazepam and continuous phenobarbital, but associated with adverse effects in up to 30%. Based on the self-limited nature of recurrent FS, and the high prevalence of adverse effects of these drugs, caregivers should be fully informed of the self-limited nature of the condition and supported with adequate emergency care plans, the most widely supported recommendation is that SFS do not require intervention with ASMs. The other intervention supported by some guidelines is access to rescue therapy for FS which are no longer simple FS. The role for regular ASM is generally not supported by guidelines; the Japanese guidelines are one of the few that are more open to regular phenobarbital for recurrent FS (more than 3) and in the setting of marked parental anxiety.
Other Lectures in this symposium:
Prognostication and counseling families of children with Complex Febrile seziures
Diagnostic testing (EEG, MRI, CSF studies) in Complex Febrile Seizures: when and why, and are they overdone?
Definitions and terminology of complex febrile seizures - is a subclassification required