title: Prolonged febrile seizures, clinical characteristics, and acute management.
abstract: OBJECTIVE
  Prolonged febrile seizures (PFS) lasting ≥15 min have been associated with increased risk for epilepsy in later life. Initial treatment, mostly prehospital, aims to prevent its evolution to febrile status epilepticus (FSE) and reduce adverse outcome. Paucity of information is available on the immediate treatment before reaching a hospital facility.
  
  
  METHODS
  We obtained data, prospectively, on all children who presented from January 2008 to March 2010 with PFS to the emergency rooms of four Israeli medical centers. Information related to seizure semiology, treatment, and medical history was collected into a predefined pro forma form and reviewed centrally.
  
  
  RESULTS
  Sixty children, median age 18.3 months (interquartile range [IQR] 12-28) were included with a median seizure duration of 35 min (IQR 26-60), 43 (71.7%) lasting ≥30 min. Seizures had focal onset in 34 infants (57%). Fifty-four families (90%) activated the ambulance service; median ambulance arrival time was 8 min (IQR 5-10), 33 (61%) were medically treated by the ambulance paramedic, of whom 15 (45%) responded to treatment. Twelve children with active seizures did not receive medications. Initial treatment with rectal diazepam was more common in those with seizure duration >30 min.
  
  
  CONCLUSIONS
  Most children with PFS are treated with antiepileptic drugs early by the ambulance service. However, even timely treatment does not prevent status epilepticus in the majority of cases. These data highlight the need for effective early treatment of this common pediatric emergency.
authors.affiliation: Child Neurology and Development Unit, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel. bassan@post.tau.ac.il
authors.forename: Haim
authors.initials: H
authors.lastname: Bassan
authors.forename: Marina
authors.initials: M
authors.lastname: Barzilay
authors.forename: Shlomo
authors.initials: S
authors.lastname: Shinnar
authors.forename: Zamir
authors.initials: Z
authors.lastname: Shorer
authors.forename: Israel
authors.initials: I
authors.lastname: Matoth
authors.forename: Varda
authors.initials: V
authors.lastname: Gross-Tsur
mesh_terms: D000927:Anticonvulsants / Q000627:therapeutic use; D002675:Child, Preschool; D003975:Diazepam / Q000627:therapeutic use; D004632:Emergency Medical Services; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D003294:Seizures, Febrile / Q000150:complications / Q000473:pathology / Q000628:therapy*; D013226:Status Epilepticus / Q000517:prevention & control; D013997:Time Factors
chemical_list: D000927:Anticonvulsants; D003975:Diazepam