Mental health

Management of febrile seizures

Question 3:
3a) Can febrile seizures (simple or complex) be managed at first or second level care by non-specialist health care providers in low and middle income country settings? What is the role of diagnostic tests in the management of febrile seizures by non-specialists in low and middle income settings?
3b) For prophylaxis to prevent recurrence of simple or complex febrile seizures, which of the pharmacological interventions when compared with placebo/comparator produce benefit/harm in specified outcomes?
1. Continuous anticonvulsant therapy
2. Intermittent anticonvulsant therapy
3. Intermittent antipyretic treatment

Management of epilepsy

3a)

  • Population: children with febrile seizures
  • Interventions: diagnostic tests such as lumbar puncture, blood tests (for malaria parasite, counts, culture), EEG and neuroimaging
  • Comparison: not applicable
  • Outcomes: appropriate diagnosis and improved management

3b)

  • Population: children with febrile seizures
  • Interventions:
    • intermittent antipyretic treatment (paracetamol, ibuprofen, physical methods)
    • intermittent anticonvulsant treatment (intermittent diazepam)
    • continuous anticonvulsant treatment (phenobarbitone, valproate)
  • Comparison: no treatment
  • Outcomes:
    • prevention of recurrence of febrile seizure
    • epilepsy
    • adverse effects of drugs.

Recommendation(s)

Children with simple febrile seizures can be diagnosed and managed by non-specialist health care providers in low and middle income countries. In simple febrile seizures, local standards for diagnosis and management of fever should be followed and children should be observed for 24 hours. Integrated Management of Childhood Illnesses (IMCI) guidelines should be used for management of fever.
Strength of recommendation: STRONG

Prophylactic treatment with intermittent antipyretics, intermittent anticonvulsant (diazepam or clobazam), or continuous anticonvulsant (phenobarbital or valproic acid) should not be considered for simple febrile seizures.
Strength of recommendation: STANDARD

For children with complex febrile seizures (CFS), observation within inpatient setting is recommended as these may result from an acute disorder of the central nervous system or could be simply a prolonged febrile seizure. Therefore they should be referred to second level care. Investigations such as blood tests, lumbar puncture to determine the presence of underlying etiology is recommended in case of CFS depending on the local context and other clinical symptoms.
Strength of recommendation: STRONG

Prophylactic intermittent diazepam may be considered in the treatment of recurrent or prolonged complex febrile seizures (CFS).
Strength of recommendation: STANDARD

Evidence profile

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