Treatment

Uncomplicated seizures usually resolve after a few minutes spontaneously. However, abortive therapy should be administered if seizures ≥ 5 min or complex.

• Abortive therapy

  • Treatment of choice: IV lorazepam DOSAGE

  • Alternative: IV diazepam DOSAGE, buccal/intranasal midazolam (when IV access is not possible) DOSAGE

  • If necessary, repeat medication after 5 min

  • Additional measures are needed with status epilepticus

• Reassure caregivers and provide information

• After a febrile seizure, initiate antipyretic therapy (NSAIDs and acetaminophen) at an early stage (temperatures from 38°C (100.4°F)) as they restore the central thermoregulatory setpoint back to normal by reducing the synthesis of prostaglandin E2.

Febrile seizures primarily occur during the rise in temperature; therefore, prophylactic measures are often too late because a seizure cannot be anticipated! Long-term continuous or intermittent prophylaxis with anticonvulsant drugs (e.g., phenobarbital) or diazepam is not recommended.

• The risk of recurrent, simple febrile seizures is 30%.

• Risk of developing epilepsy:

  • ∼ 1–2% in children who have had a simple febrile seizure

  • 5–10% in children with complex febrile seizures or a family history of epilepsy

• Risk factors for recurrence:

  • Initial complex febrile seizure

  • Family history of febrile seizures

  • Initial febrile seizure with temperature < 40°C

  • Age of onset < 18 months [5]

  • Structural brain lesions, cerebral palsy