Effect of acetaminophen and of low intermittent doses of diazepam on prevention of recurrences of febrile seizures,☆☆,,★★

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Abstract

See commentary, “Prevention of recurrent febrile seizures”

Acetaminophen and low doses of diazepam were evaluated for the prevention of recurrences of febrile seizures in a placebo-controlled, double-blind trial. Children after their first febrile seizure were assigned to receive either one dose of rectally administered diazepam, and then, after 6 hours, oral doses of 0.2 mg/kg three times a day for the first 2 days if the fever stayed greater than 38.5° C, or a placebo similarly during forthcoming febrile episodes. In addition, each febrile episode was randomly assigned to be treated with acetaminophen or the placebo. Thus four groups were examined for 2 years: patients receiving two kinds of placebo, patients receiving diazepam and a placebo, patients receiving acetaminophen and a placebo, and patients receiving both diazepam and acetaminophen. Of a total of 180 patients (102 boys), 161 were followed for the 2-year period and 157 were seen at the last outpatient examination: 80 in the diazepam group and 77 in the placebo group. The final analysis of the efficacy of the drugs was made on the basis of the data from 153 patients who had had at least one febrile episode during follow-up. There were 641 fever events during this period, and 38 children (21.1%) had 55 recurrences of febrile seizures. Acetaminophen had no effect on the recurrence rate. Seizures recurred at least once in 21 patients (28.4%) receiving diazepam and 17 (21.5%) receiving a placebo (p = 0.4138, log-rank test). The combination of antipyretic agents with anticonvulsant medication did not reduce the recurrence of febrile seizures. Our results show that low doses of acetaminophen or diazepam or both are ineffective for preventing febrile seizures. (J PEDIATR 1995;126:991-5)

Section snippets

METHODS

The parents of all children seeking medical help from the University of Oulu Department of Pediatrics for their first febrile seizures between November 1986 and September 1990 were offered the possibility of participating in a 2-year follow-up study. The parents of all but three patients expressed willingness to participate; in addition to these unwilling parents, only those patients known to be unable to attend the follow-up visit at the end of the 2-year period were excluded. All children

RESULTS

Altogether 153 children of the total of 180 (85.0%) had at least one febrile event during the follow-up, and the total number of such events during that period was 641. Of the 180 children, 38 (21.1%) had a total of 55 recurrences of febrile seizures; 27 had one such recurrence, and one child had as many as five (Table I). Thirty-two of the children (17.8%) had seizures during the first year of the follow-up, and 15 (9.8%) of the 153 children had a seizure during their first febrile event. The

DISCUSSION

Both acetaminophen as an antipyretic agent and the prophylactic use of diazepam appeared to be ineffective in preventing recurrences of febrile seizures. Even though such seizures are associated with the degree of fever, surprisingly few surveys have analyzed the importance of the temperature for their occurrence. Even high doses of antipyretics have been shown to be ineffective for preventing a new rise in temperature among children hospitalized for febrile convulsions8; during the first day

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From the Department of Pediatrics, University of Oulu, Oulu, Finland

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Supported by the Alma and K.A. Snellman Foundation, Finland.

Reprint requests: M. Uari, MD, PhD, MSc, Associate Professor of Pediatrics, Department of Pediatrics, University of Oulu, FIN-90220 Oulu, Finland.

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