Antipyretics Do Not Prevent Febrile Convulsions

Abstract

Neurology| October 01 2003 Antipyretics Do Not Prevent Febrile Convulsions AAP Grand Rounds (2003) 10 (4): 42–43. https://doi.org/10.1542/gr.10-4-42 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Antipyretics Do Not Prevent Febrile Convulsions. AAP Grand Rounds October 2003; 10 (4): 42–43. https://doi.org/10.1542/gr.10-4-42 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: antipyretic therapy, febrile seizures Source: El-Radhi AS, Barry W. Do antipyretics prevent febrile convulsions? Arch Dis Child. 2003;88:641–642. Whether antipyretic medications prevent febrile seizures (FS) in at-risk children was investigated by pediatricians at Queen Mary’s Hospital, Sidcup, Kent, United Kingdom, using a literature search technique. Four previously published controlled studies were reviewed. One randomized, placebo-controlled trial found paracetamol (acetaminophen), with or without diazepam, to be ineffective in the prevention of FS during subsequent fevers. A second randomized trial comparing the antipyretic effectiveness of paracetamol administered at regular intervals (group 1) versus only at the time of fever (group 2) in children presenting with a FS found that early recurrences of FS (within the first 24 hours) were similar in the 2 groups. A third randomized, double-blind, controlled study using ibuprofen in children at risk of FS found similar recurrence rates in antipyretic- and placebo-treated patients. In a fourth study, an open trial, the risk of FS recurrence was similar in at-risk patients offered either ibuprofen or paracetamol at times of fever. It was concluded that the results of these 4 studies and the findings in a recently published review of 12 randomized controlled trials of paracetamol1 show no convincing evidence that antipyretics prevent FS. The prescription of paracetamol in a child at risk of FS may be expected to provide symptomatic relief but should not be recommended for the prevention of FS. The height of the body temperature when a seizure occurs is a measure of the febrile seizure threshold and an important determinant of the induction of FS.2 Risk factors for recurrence of FS include a low febrile seizure threshold (low grade fever at onset of FS), complex FS, age less than 1 year, and family history of FS. Animal studies support the conclusions regarding the ineffectiveness of antipyretic agents in the prevention of FS. Acetaminophen fails to retard the rate of temperature rise induced by radiotherm diathermy in animals, and large toxic doses of aspirin lower the threshold convulsive temperature and exacerbate experimental FS.2 Antipyretics, in therapeutic doses, facilitate heat loss by increased peripheral blood flow and sweating3 and, thereby, relieve discomfort associated with fever but do not retard temperature rise and have no proven anticonvulsant effect. Heat production is not inhibited by salicylates, but heat dissipation is augmented. Numerous studies have shown comparable antipyretic efficacy for aspirin and acetaminophen (APAP) in febrile children.4 Maximum antipyresis for rectal suppositories of APAP occurs at 2.5 to 4 hours, and efficacy of both oral and rectal APAP is related to dose and plasma level. Addition of tepid water sponging increases maximum antipyresis of APAP, but does not shorten time of onset of antipyresis. Ineffectiveness of intermittent antipyretic treatment in the prevention of FS is sometimes linked to failure to determine plasma levels, poor compliance, and difficulty in recognizing the onset of the febrile illness. Ibuprofen was superior to APAP in antipyretic efficacy in a randomized, multiple dose, double-blind study comparing ibuprofen (5 mg/kg) and... You do not currently have access to this content.