Febrile Seizures: Clinical Practice Guideline for the Long-term Management of the Child With Simple Febrile Seizures Steering Committee on Quality Improvement and Management, Subcommittee on Febrile Seizures

Febrile seizures are the most common seizure disorder in childhood, affecting 2% to 5% of children between the ages of 6 and 60 months. Simple febrile seizures are defined as brief ( 15-minute) generalized seizures that occur once during a 24-hour period in a febrile child who does not have an intracranial infection, metabolic disturbance, or history of afebrile seizures. This guideline (a revision of the 1999 American Academy of Pediatrics practice parameter [now termed clinical practice guideline] “The Long-term Treatment of the Child With Simple Febrile Seizures”) addresses the risks and benefits of both continuous and intermittent anticonvulsant therapy as well as the use of antipyretics in children with simple febrile seizures. It is designed to assist pediatricians by providing an analytic framework for decisions regarding possible therapeutic interventions in this patient population. It is not intended to replace clinical judgment or to establish a protocol for all patients with this disorder. Rarely will these guidelines be the only approach to this problem. Pediatrics 2008;121:1281–1286 The expected outcomes of this practice guideline include: 1. optimizing practitioner understanding of the scientific basis for using or avoiding various proposed treatments for children with simple febrile seizures; 2. improving the health of children with simple febrile seizures by avoiding therapies with high potential for adverse effects and no demonstrated ability to improve children’s long-term outcomes; 3. reducing costs by avoiding therapies that will not demonstrably improve children’s long-term outcomes; and 4. helping the practitioner educate caregivers about the low risks associated with simple febrile seizures. The committee determined that with the exception of a high rate of recurrence, no long-term effects of simple febrile seizures have been identified. The risk of developing epilepsy in these patients is extremely low, although slightly higher than that in the general population. No data, however, suggest that prophylactic treatment of children with simple febrile seizures would reduce the risk, because epilepsy likely is the result of genetic predisposition rather than structural damage to the brain caused by recurrent simple febrile seizures. Although antipyretics have been shown to be ineffective in preventing recurrent febrile seizures, there is evidence that continuous anticonvulsant therapy with phenobarbital, primidone, or valproic acid and intermittent therapy with diazepam are effective in reducing febrile-seizure recurrence. The potential toxicities associated with these agents, however, outweigh the relatively minor risks associated with simple febrile seizures. As such, the committee concluded that, on the basis of the risks and benefits of the effective therapies, neither continuous nor intermittent anticonvulsant therapy is recommended for children with 1 or more simple febrile seizures. INTRODUCTION Febrile seizures are seizures that occur in febrile children between the ages of 6 and 60 months who do not have an intracranial infection, metabolic disturbance, or history of afebrile seizures. Febrile seizures are subdivided into 2 categories: simple and complex. Simple febrile seizures last for less than 15 minutes, are generalized (without a focal component), and occur once in a 24-hour period, whereas complex febrile seizures are prolonged ( 15 minutes), are focal, or occur more than once in 24 hours.1 Despite the frequency of febrile seizures (2%–5%), there is no unanimity of opinion about management options. This clinical practice guideline addresses potential therapeutic interventions in neurologically normal children with simple febrile seizures. It is not intended for patients with complex febrile seizures and does not pertain to children with previous neurologic insults, known central nervous system abnorwww.pediatrics.org/cgi/doi/10.1542/ peds.2008-0939 doi:10.1542/peds.2008-0939 All clinical reports from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time. The guidance in this report does not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.