CPG First Simple Febrile Seizure
CPG First Simple Febrile Seizure
b. Treatment for the Prevention of Epilepsy 3. Considerations for the draft recommendation for the Philippine setting
No study has demonstrated that treatment can prevent the development of Because there is no difference in the risk of seizure recurrence in children
epilepsy. Likewise, there is no evidence that will show that children with simple receiving intermittent diazepam and placebo, the draft recommendation does not
febrile seizures are at risk for cognitive decline. recommend the use of intermittent anticonvulsants to prevent seizure
recurrences.
3. Recommendation of Others
The AAP Practice Parameters does not recommend the use of continuous
anticonvulsant therapy for children with one or more simple febrile seizures based C. PROGNOSTIC EVALUATION
on the risks and benefits of effective therapies. The AAP recognizes that recurrent
episodes of febrile seizures can create anxiety in some parents, thus appropriate 1. ELECTROENCEPHALOGRAM (EEG)
education and emotional support should be provided. A. DRAFT RECOMMENDATION STATEMENT:
Electroencephalogram should not be routinely requested in children with a
4. Considerations for the draft recommendation for the Philippine setting first simple febrile seizure.
The draft recommendation does not recommend the prophylactic use of Grade of Recommendation: C
continuous anticonvulsant for the prevention of seizure recurrence because of Level of Evidence: 4
the side effects of these drugs and the benign nature of simple febrile seizures.
B. SUMMARY OF EVIDENCE:
I. Accuracy of the test
ANTIEPILEPTIC DRUG USE - intermittent anticonvulsant (Phenobarbital An abnormal EEG after the first unprovoked or afebrile seizure predicts
or diazepam) recurrence for another epileptic attack. Patients with afebrile seizures, which show
A. DRAFT RECOMMENDATION STATEMENT: epileptiform activity on EEG, have a 54% recurrence rate. However in patients
The use of intermittent anticonvulsant (whether Phenobarbital or diazepam) with new onset febrile seizures, doing an EEG does not reliably predict who
is not recommended for the prevention of recurrent febrile seizures. among them would have another febrile seizure or who would develop epilepsy in
Grade of Recommendation: C the future. Most of the studies done where paroxysmal EEG changes were
Level of Evidence: 2 recorded included not only children with simple febrile seizures, but also those
with complex febrile seizures and a preexisting neurological disability. A study by
B. SUMMARY OF EVIDENCE
Maytal showed EEG abnormalities of 8.6% or less in post-ictal patients with
1. Availability of effective treatment complex febrile seizures. Heijbel et.al. limited their study to simple febrile seizures
Knudsen was among the first who investigated the role of diazepam for and two subjects who subsequently developed epilepsy had normal EEGs.27
seizure prevention.23 However although some of his earlier studies that favored
treatment were randomized some were not blinded and there were considerable
patients lost to follow-up. More recent three randomized controlled clinical trials
8
2. Recommendation of Others VI. SUMMARY OF RECOMMENDATIONS
The AAP Practice Parameter recommends that "EEG not be performed in the
evaluation of a neurologically healthy child with a first simple febrile seizure." 1. Lumbar puncture should be performed in all children below 18 months for a first
simple febrile seizure. For those children >/= 18 months of age, lumbar
3. Considerations for the draft recommendation for the Philippine setting puncture should be performed in the presence of clinical signs of meningitis
Because there is no evidence that EEG can predict future incidence of (e.g., presence of meningeal signs, sensorial changes).
epilepsy, it does not recommend its use for prognosticating children with simple
febrile seizures. Likeivise the presence of paroxysmal abnormalities in the EEG 2. Neuroimaging studies should not be routinely performed in children for a first
does not change the recommendation that these children with febrile seizures simple febrile seizure.
should not be treated anticonvulsants.
3. Antipyretic drugs are used to lower fever and should not be relied upon to
prevent the recurrence of febrile seizures.
10 11
APPENDIX REFERENCES
12 13