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Justification: Febrile seizures are quite common in children but there are controversies in many aspects of their diagnosis and management. Methods: An expert group consisting of pediatric neurologists and pediatricians was constituted. The modified Delphi method was used to develop consensus on the issues of definitions and investigations. The writing group members reviewed the literature and identified the contentious issues under these subheadings. The questions were framed, pruned, and discussed among the writing group members. The final questions were circulated to all experts during the first round of Delphi consensus. The results of the first round were considered to have arrived at a consensus if more than 75% experts agreed. Contentious issues that reached a 50- 75% agreement was discussed further in online meetings and subsequently voting was done over an online platform to arrive at a consensus. Three rounds of Delphi were conducted to arrive at final statements. Results: The expert group arrived at a consensus on 52 statements. These statements pertain to definitions of febrile seizures, role of blood investigations, urine investigations, neuroimaging, electroencephalography (EEG), cerebrospinal fluid analysis and screening for micronutrient deficiency. In addition, role of rescue medications, intermittent anti-seizure medication and continuous prophylaxis, antipyretic medication and micronutrient supplementation have been covered. Conclusion: This consensus statement addresses various contentious issues pertaining to the diagnosis and management of febrile seizures. Adoption of these statements in office practice will improve and standardize the care of children with this disorder.
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Background: To compare efficacy of intermittent prophylaxis during subsequent febrile episodes with antipyretics alone or antipyretics with anticonvulsant (clobazam) vis a vis no prophylactic interventions except need-based antipyretic measures in preventing recurrence of febrile seizures.Methods: This prospective randomized controlled interventional study was carried out in neurologically normal children. Study conducted over 14 months (March 2014 - May 2015), tertiary care hospital Mumbai. Inclusion criteria was, children aged from 6 month to 5 years with history of simple febrile seizure, lasting for less than 15 minutes, with Frequency less than one episode in 24 hours. Children with history of afebrile or complex febrile seizure, CNS comorbidity, family history of epilepsy, abnormal electroencephalogram, Unwillingness or non-feasibility of follow up were excluded from study. The patients were randomly grouped in A (No Prophylaxis n= 60), B (Antipyretic prophylaxis n=57) and C (Antipyretics + clobazam prophylaxis n=55). All cases were followed up telephonically every 15 days from date of first seizure as well as personal follow up at 1,3,6 months either in the hospital or at home. End point of study was taken as six months of follow-up from enrolment or lost-to-follow up. Efficacy of intervention was compared using chi-square test, Pearson chi-square test with/without Yates continuity correction and/or Fisher exact test, with p value of <0.05 as test of significance.Results: Sixty cases in group A developed febrile episodes and 6 of them developed recurrence of febrile seizures, with a recurrence rate of 10% among total cases and 9.67% among all febrile episodes. Recurrence rate was significantly higher (10%) in cases who did not receive any prophylactic intervention (Group A) as compared to pooled recurrence rate in group B and C together 1.78% (p=0.022).Conclusion: Regular antipyretic prophylaxis, alone or along with clobazam does not reduce the risk of recurrence in simple febrile seizures as compared to those who receive antipyretic intervention.
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Background: Febrile seizure (FS) is the most common type of childhood seizure disorder with a prevalence of 2-5% in children less than 5 years. Although the prognosis of febrile seizure is usually good, however, the possibility of recurrence keeps many parents and families in a state of anxiety and concerned, for years after the first seizure. Thus, intermittent prophylactic treatment might be advised in children with high risk of recurrence.Methods: The study was a prospective randomized, double blind, placebo-controlled trial conducted at Department of Pediatrics, Umaid Hospital, Dr S N Medical College, Jodhpur on neurologically normal children aged from 6 months to 5 years with a history of simple febrile seizures and normal electroencephalogram without any evidence of acute central nervous system infection. Subjects were randomly prescribed oral clobazam according to weight of child and placebo when they developed a febrile disease during the first 48 h of the onset of fever.' Temperature reduction measures with paracetamol and tepid sponging were also advised. Patients were followed up for the frequency and time of febrile seizure recurrence, febrile episodes and side effects of drugs for 12 months.Results: Ten (3.8%) of 257 episodes in clobazam group and 38 (14.07%) episodes in placebo group had seizure recurrence (p value <0.001). The two groups were not significantly different in terms of side effects. (p >0.05).Conclusions: Intermittent oral clobazam therapy is a very effective measure in preventing recurrence of febrile seizures.
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Febrile seizure is the most common seizures seen in infancy and pre-school era. They are mostly benign in nature. There are two categories of febrile seizures, simple and complex. Both the International League against Epilepsy and the American academy of paediatrics have published definitions on the classification of febrile seizures. Simple febrile seizures are mostly benign, but a prolonged (complex) febrile seizure can have long term consequences. Most children who have a febrile seizure have normal health and development after the event, but recent evidence suggests a small subset of children presenting with seizures and fever may have recurrent seizure or develop epilepsy. Diagnosis is solely clinical. But other causes of fever and seizure must be ruled out. Electroencephalogram, lumbar puncture and neuroimaging, all are to be used for specific indications but not routinely. Treatment consists of acute management and prophylaxis for further attack. This review will give an overview of the definition of febrile seizures, epidemiology, evaluation, treatment, outcomes and recent research.
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Background & objectives: The use of clobazam in epilepsy has increased since its introduction in 1975. However, it has not been audited for its overall usefulness in Indian set up. The present study was aimed to evaluate usage pattern, retention rate, effectiveness and tolerability of clobazam during routine practice in an outpatient epilepsy clinic of a tertiary care hospital in New Delhi, India. Methods: This study was performed on the patients prescribed antiepileptic medication who had clobazam as last added drug in their treatment regimen during October 2010 - March 2012. These patients were followed up for two OPD visits. The primary points evaluated were retention rate, percentage of seizure-free patients and reasons for discontinuing clobazam. Results: oOf the 417 consecutive patients, 132 (31.7%) were on clobazam treatment for more than four years (median 6 yr, range 4-15 yr). No seizure for previous 12 months was considered as seizure free and was observed in 151 (36.2%) patients. There was no improvement in seizure control in 32 (7.7%) patients. A decrease in seizure severity without any change in seizure frequency was observed in 76 (18.2%) patients. Clobazam was discontinued by 15 (3.6%) patients due to complaints like drowsiness (13), fatigue/tiredness (8), headache (6), poor memory (6), irritable behaviour (5), abdominal pain (3) and dizziness (3). Interpretation & conclusions: oOur results provide valuable information about the clinical use of clobazam as add-on antiepileptic drug therapy in the management of patients with epilepsy.
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Seizures are more common in children than in any other age group, except the elderly. In fact, there are several kinds of seizures that affect only children. Sometimes children outgrow their seizures but many need to be treated for their seizures for their entire life. The main objectives of this study are to study the physician prescribing pattern in pediatric seizures and to educate the patient care taker about the disease and the use of drugs in order to control seizures and improve the quality of life. A non invasive prospective observational study was done with 86 pediatric patients from 01.11.2010 to 30.04.2011. Females were found to be more prone to seizures; prevalence of seizure was more in children aged 1-5 years old. Febrile seizures (46.5%) are the most commonly observed type of seizure in children followed by tonic – clonic seizures (21%) and complex partial seizures (14%). The other types of seizures observed are simple partial seizures (7%), status epilepticus (2.3%) and others (9.3%). We observed that Clobazam is the most commonly prescribed drug for prophylaxis of febrile seizures. Phenytoin, Clobazam and Sodium valproate were commonly used drug in children. We infer that monotherapy for seizure is effective choice of treatment.
ABSTRACT
Seizures are more common in children than in any other age group, except the elderly. In fact, there are several kinds of seizures that affect only children. Sometimes children outgrow their seizures but many need to be treated for their seizures for their entire life. The main objectives of this study are to study the physician prescribing pattern in pediatric seizures and to educate the patient care taker about the disease and the use of drugs in order to control seizures and improve the quality of life. A non invasive prospective observational study was done with 86 pediatric patients from 01.11.2010 to 30.04.2011. Females were found to be more prone to seizures; prevalence of seizure was more in children aged 1-5 years old. Febrile seizures (46.5%) are the most commonly observed type of seizure in children followed by tonic – clonic seizures (21%) and complex partial seizures (14%). The other types of seizures observed are simple partial seizures (7%), status epilepticus (2.3%) and others (9.3%). We observed that Clobazam is the most commonly prescribed drug for prophylaxis of febrile seizures. Phenytoin, Clobazam and Sodium valproate were commonly used drug in children. We infer that monotherapy for seizure is effective choice of treatment.
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Objective. To evaluate the efficacy of clobazam in childhood refractory epilepsy and to characterize the adverse drug reaction profile in the Indian population. Methods. A cohort of 88 children with ‘refractory’ epilepsy was started on clobazam as add-on therapy. Diagnosis was established and seizure type recorded. Therapeutic response was recorded as ‘complete’, ‘good’, and ‘no response’. Observed side effects were classified as ‘mild’, ‘moderate’ and ‘severe’. Results. Most children were on at least two antiepileptics. Seizures most identified were either partial (36.3%) or generalized tonic-clonic (15.9%). The dose ranged from 0.3-2 mg/kg/day (average 1+0.2 mg/kg/day). Clobazam was effective against all seizure types with complete seizure control seen in 60.2% patients. Tolerance was seen in 5 (5.6%) patients. Side effects were seen in 23 (26%) patients and were ‘mild’ in 20 (86.9%) of them. Clobazam was stopped in three patients who developed ataxia, which resolved on stopping the drug. Conclusion. Clobazam was observed to be an effective broad-spectrum antiepileptic with ‘mild’ side effects in Indian children.
Subject(s)
Anticonvulsants/therapeutic use , Benzodiazepines/therapeutic use , Child , Drug Resistance , Drug Therapy, Combination , Epilepsy/drug therapy , Female , Humans , Male , Prospective StudiesABSTRACT
PURPOSE: Clobazam is a 1,5-benzodiazepine which has a unique structure different from other benzodiazepines and shows different spectrum in treatment of epilepsy. We evaluated the efficacy of clobazam as an add-on therapy in childhood epilepsy. METHODS: We reviewed the medical records of 44 patients, who had been on medication with clobazam. The frequency of seizure attacks, occurrence of adverse effects and resistance of the drug were monitored. We defined the patients who showed seizure reduction over 90% as a success outcome group and the others as a non-success outcome group. We analysed the factors that predict favorable response. RESULTS: Thirteen patients(29.5%) were seizure free, nine patients(20.5%) had more than 90% improvement, fourteen patients(31.8%) had between 50-90% improvement, and eignt patients(18.2%) had less than 50% improvement in seizure control. Age at seizure onset was higher in success outcome group(P=0.035). MRI abnormalities, EEG abnormalities, seizure type, the number of drugs medicated before the use of clobazam, seizure frequencies, seizure duration before clobazam medication, and age at the start of clobazam had no statistical differences. Seven out of 44 patients(15.9%) showed resistance to clobazam. Adverse effects included increase sleep time(8.1%) and bronchial secretion (4.5%). CONCLUSION: Add-on therapy of clobazam is effective in the management of epileptic children especially in older epileptic children and adverse effects are trivial.
Subject(s)
Child , Humans , Benzodiazepines , Electroencephalography , Epilepsy , Magnetic Resonance Imaging , Medical Records , SeizuresABSTRACT
Hyperekplexia or startle disease is a hereditary neurological disorder characterized by an abnormally exaggerated startle response to tactile, auditory and visual stimuli, together with a global muscular hypertonia and hyperactive tendon reflexes. This disease is a rare, genetically determined disorder, with an autosomal dominant inheritance with variable expression, first described by Suhren, et al. We report two cases of familial hyperekplexia, who developed hypertonia and pathologic startle response to tactile stimulation in the immediate neonatal period. The infant showed a marked improvement of the startle response and muscular hypertonia with low-dose clobazam.