A meta-analytic review of the preventive treatment of recurrences of febrile seizures.
OBJECTIVE
To assess the efficacy of various medications in the prevention of recurrent febrile seizures.


METHODS
A meta-analysis of all published randomized, placebo-controlled trials of the preventive treatment of febrile seizures published in English; 45 articles were found, but only 9 trials were randomized and placebo-controlled--4 using phenobarbital; 3, diazepam; 1, pyridoxine; and 1, phenytoin. In one of the phenobarbital trials, valproate was also compared with placebo.


RESULTS
The risk of recurrences was significantly lower in children receiving continuous phenobarbital therapy than placebo (odds ratio 0.54, 95% confidence intervals 0.33 to 0.90, p = 0.017). The odds ratio for recurrences in the valproate group was 0.09, 95% CI 0.01 to 0.78, p = 0.011. No difference in the risk was found for recurrences between children receiving intermittent diazepam and placebo (odds ratio 0.81, 95% CI 0.54 to 1.22, p = 0.31). The risk for recurrences in children receiving pyridoxine or phenytoin did not differ from the risk among children receiving placebo. Four children would have to be treated with valproate (95% CI 2 to 11) or eight children would have to be treated with phenobarbital (95% CI 5 to 27), continuously, to prevent one febrile seizure.


CONCLUSIONS
Because both agents found to be effective in prevention of recurrent febrile seizures have known adverse effects, prophylaxis of febrile seizures cannot be recommended.
Rantala
H
H
Department of Pediatrics, University of Oulu, Finland.
Tarkka
R
R
Uhari
M
M
D000927:Anticonvulsants / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D002648:Child; D003975:Diazepam / Q000627:therapeutic use; D004334:Drug Administration Schedule; D005334:Fever / Q000150:complications*; D006801:Humans; D016017:Odds Ratio; D010634:Phenobarbital / Q000627:therapeutic use; D010672:Phenytoin / Q000627:therapeutic use; D011736:Pyridoxine / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D018570:Risk Assessment; D003294:Seizures, Febrile / Q000517:prevention & control*; D014635:Valproic Acid / Q000627:therapeutic use
D000927:Anticonvulsants; D014635:Valproic Acid; D010672:Phenytoin; D011736:Pyridoxine; D003975:Diazepam; D010634:Phenobarbital