PREVENTION OF RECURRENCES OF FEBRILE SEIZURES. † 2262

Abstract

Continuous phenobarbital and intermittent diazepam have been widely used in the prevention of febrile seizures, but their efficacy is still controversial. We performed a meta-analysis of all published randomized, placebo-controlled trials to asses the efficacy of different drugs in prevention of febrile seizures. Forty-five articles were found, but only 9 were randomized and placebo-controlled: 4 on phenobarbital, 3 on diazepam, 1 on pyridoxine, and 1 on phenytoin. In one of the phenobarbital trials also valproate was compared with placebo. The risk for recurrences was significantly lower in children receiving continuous phenobarbital than placebo (odds ratio 0.54, 95% confidence intervals (CI) 0.33 - 0.90, P=0.017). The odds ratio for recurrences in the valproate group was 0.09, 95% CI 0.01 - 0.78, P=0.011. There was no difference in the risk for recurrences in children receiving intermittent diazepam or placebo (odds ratio 0.81, 95% CI 0.54 - 1.22, P=0.31). The risk for recurrences in children receiving pyridoxine or phenytoin did not differ from children receiving placebo. The number of patients needed to treat one patient successfully with continuous phenobarbital was 8 (95% CI 5-27), with intermittent diazepam 26, and with valproate 4 (95% CI 2-11). Considering the side effects of valproate and phenobarbital and the lack of efficacy of diazepam, none of these drugs can be recommended for prophylaxis of febrile seizures. Totally new approaches should be tested in randomized placebo controlled trials before making ubiquitous recommendations for the medical treatment in the prevention of recurrences of febrile seizures.