Elsevier

The Journal of Pediatrics

Volume 131, Issue 6, December 1997, Pages 922-925
The Journal of Pediatrics

A meta-analytic review of the preventive treatment of recurrences of febrile seizures,☆☆,

https://doi.org/10.1016/S0022-3476(97)70045-3Get rights and content

Abstract

Objective: To assess the efficacy of various medications in the prevention of recurrent febrile seizures. Study design: A meta-analysis of all published randomized, placebo-controlled trials of the preventive treatment of febrile seizures published in English; 45 articles were found, but only 9 trials were randomized and placebo-controlled—4 using phenobarbital; 3, diazepam; 1, pyridoxine; and 1, phenytoin. In one of the phenobarbital trials, valproate was also compared with placebo. Results: The risk of recurrences was significantly lower in children receiving continuous phenobarbital therapy than placebo (odds ratio 0.54, 95% confidence intervals 0.33 to 0.90, p = 0.017). The odds ratio for recurrences in the valproate group was 0.09, 95% CI 0.01 to 0.78, p = 0.011. No difference in the risk was found for recurrences between children receiving intermittent diazepam and placebo (odds ratio 0.81, 95% CI 0.54 to 1.22, p = 0.31). The risk for recurrences in children receiving pyridoxine or phenytoin did not differ from the risk among children receiving placebo. Four children would have to be treated with valproate (95% CI 2 to 11) or eight children would have to be treated with phenobarbital (95% CI 5 to 27), continuously, to prevent one febrile seizure. Conclusions: Because both agents found to be effective in prevention of recurrent febrile seizures have known adverse effects, prophylaxis of febrile seizures cannot be recommended. (J Pediatr 1997;131:922-5)

Section snippets

Methods

A literature search of Medline was performed to find all randomized controlled studies on the prevention of febrile seizures published in English. This reference list and articles known to us before the computer search were reviewed to ascertain that all the articles were found. Forty-five studies were found; all authors read and analyzed these articles independently using a predesigned data collection sheet. Only the randomized, placebo-controlled studies were included in the final analysis.

Results

Thirty-six of the 45 articles (80%) were excluded for the following reasons: 26 studies were not adequately randomized or controlled, 8 were not efficacy trials, 1 was a review article, and 1 was a meta-analysis comparing the efficacy of phenobarbital and valproate. Nine articles met the inclusion criteria and are presented in the Table. There were four placebo-controlled studies on phenobarbital, three on diazepam, one on pyridoxine, and one on phenytoin. In one of the phenobarbital trials,

Discussion

Although different preventive therapies have been used for more than 20 years, few randomized, placebo-controlled trials on the prevention of recurrent febrile seizures exist. According to this meta-analysis, only continuously administered phenobarbital or valproate has been shown to be more effective than placebo in the prevention of febrile seizures. Phenobarbital has been widely used since the 1972 report of Faero et al.4, which showed that children receiving phenobarbital had fewer

References (28)

  • O Faero et al.

    Successful prophylaxis of febrile convulsions with phenobarbital

    Epilepsia

    (1972)
  • JG Millichap et al.

    Management of febrile seizures: survey of current practice and phenobarbital usage

    Pediatr Neurol

    (1991)
  • JR Farwell et al.

    Phenobarbital for febrile seizures: effects on intelligence and on seizure recurrence

    N Engl J Med

    (1990)
  • FU Knudsen et al.

    Prophylactic diazepam or phenobarbitone in febrile convulsions: a prospective, controlled study

    Arch Dis Child

    (1978)
  • From the Department of Pediatrics, University of Oulu, FIN-90220 Oulu, Finland

    ☆☆

    Reprint requests: Heikki Rantala, MD, Assistant Professor of Pediatrics, Department of Paediatrics, University of Oulu, FIN-90220 Oulu, Finland.

    9/22/81361

    View full text