Febrile seizures part 6: Treat the children well

Finally, let’s look at treatment.

Which need to be treated with anti-epileptics?

Most don’t. Rectal diazepam can be used if they last greater than 5 minutes. You may want to consider prescribing it for children with recurrent febrile seizures. Parents should be instructed on how to use it at home. It is true that phenobarb, depakote or diazepam can prevent the risk of recurrence, but since a recurrent febrile seizure carries such low risk, the costs associated with these drugs (side effects) aren’t usually worth it. These therapies don’t reduce the risk of epilepsy anyway.

And finally, in the ED for status epilepticus give a benzodiazepine (like lorazepam), followed by another benzo – then load with fosphenytoin or keppra. Phenobarbital and other coma inducing drugs come next. Fortunately, most kids don’t get to that point if they just have febrile seizures.

Will giving acetaminophen or ibuprofen prevent another febrile seizure from happening?

Wouldn’t it be great if they did? Seriously, I’ve seen this as a common misconception, but let me reiterate so that yiu can inform parents correctly…

Giving acetaminophen and/or ibuprofen – even alternating them – does not prevent a child from having a subsequent febrile seizure

However, they should still treat the fever cause it makes their kid feel good and stuff.

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OK folks, that’s all. Hope you enjoyed learning a bit more about febrile seizures.

By | 2013-08-08T23:50:12+00:00 August 12th, 2013|Neurology|

About the Author:

Brad Sobolewski, MD, MEd is an Assistant Professor of Pediatric Emergency Medicine and an Assistant Director for the Pediatric Residency Training Program at Cincinnati Children’s Hospital Medical Center. He is on Twitter @PEMTweets and authors the Pediatric Emergency Medicine site PEMBlog. All views are strictly my own and not official medical advice.