Neuropediatrics 2005; 36 - P67
DOI: 10.1055/s-2005-868052

Effectiveness of intermittent diazepam in febrile convulsions: A long term prospective controlled study

E Pavlidou 1, M Tzitiridou 2, E Kontopoulos 1, C Panteliadis 1
  • 1Ippokratio Hospital, Aristotle University, Paediatric Neurology, Thessaloniki, Greece
  • 2Ippokratio Hospital und University Munich, Paediatric Neurology, Thessaloniki, Greece und Munich, Germany

Objectives: To assess the efficacy of intermittent rectal diazepam prophylaxis in the prevention of recurrent febrile seizures (FS).

Material and Methods: In a prospective randomized controlled trial 139 children (77 females, 62 males), who experienced a first FS, were allocated to intermittent rectal diazepam prophylaxis (n=68) or to no prophylaxis (n=71) and followed for 3 years. The inclusion criteria were: no personal history of afebrile seizures, normal neurodevelopment, no previous anticonvulsant therapy and age between 6 months and 3 years. There were no significant differences between the two groups in respect of sex, type, age at onset and duration of convulsions. Both groups were stratified to low, intermediate and high risk according to five major risk factors (RF) for recurrent FS: age at onset ≤ 15 months, family history of epilepsy, FS in first degree relatives, a first complex FS and increased febrile episodes. Diazepam (0.33mg/kg BW) was administered three times the first day and twice the second day of a febrile illness. All children had an electroencephalographic (EEG) recording within a few days after apyrexia.

Results: The number of recurrences during the follow up period was 38 in the diazepam group and 103 in the control group. The 36-month recurrence rates to the no prophylaxis group were 82.6% in the high-risk patients (three or more RF), 55% in the intermediate (two RF) and 46.43% in the low-risk ones (one or none RF). In the prophylaxis group the recurrence rates were reduced in all risk groups: 38.1%, 35% and 33.33% respectively. High numbers of recurrences were found because the vast majority of all children (56%) randomly were aged 15 months or less at their first FS. Recorded side effects were minor and transient.

Conclusions: Diazepam given rectally at times of fever substantially reduces the recurrence rate mainly in high-risk children provided that sufficient doses are given timeously and compliance problems are limited.