Revisión sistemática: Ácido valproico vs otras drogas anticonvulsivantes o no tratamiento, para profilaxis de recurrencia de convulsiones febriles / Systematic review: Valproic acid vs. other anticonvulsants drugs or non-treatment, for prophylaxis of febrile convulsions recurrence

Introducción: Las convulsiones febriles son el trastorno convulsivo más común en niños menores de 5 años. Después de una primera convulsión febril, alrededor del 33% de los niños experimentan una o más recurrencias, y alrededor del 9% tienen 3 o más. Debido a que los riesgos asociados con las convulsiones febriles simples son poco frecuentes, excepto la recurrencia, y porque el número de niños que tienen convulsiones febriles en los primeros años de vida es muy alto, una terapia propuesta tendría que ser extremadamente baja en riesgos, efectos adversos, de bajo costo y altamente efectiva. Objetivo primario: Identificar y analizar la bibliografía relevante y disponible a la actualidad para evaluar si existe evidencia científica que indique que el uso de ácido valproico es superior a otros anticonvulsivantes para prevenir recurrencias de episodios de convulsiones febriles en niños entre 6 y 60 meses. Objetivo secundario: evaluar la seguridad de la administración de las distintas medicaciones evaluadas, así como también los efectos adversos presentados. Materiales y métodos: Se realizó una revisión sistemática utilizando bases de datos de Medline, LILACS, Cochrane y Google académico. Se analizaron mediante las guías de J.A.M.A. los ECAs y metaanálisis que evalúen la eficacia del uso del ácido valproico vs otros anticonvulsivantes o el no tratamiento hasta diciembre 2012 en idiomas inglés español. Se incluyeron pacientes de 0 a 60 meses con un primer episodio de convulsión febril simple. Resultados: De 40 artículos encontrados, 20 se descartaron por no responder a la pregunta, 6 por ser estudios de baja calidad metodológica, 7 fueron descartados por inaccesibilidad al texto original completo, 1 se descartó por no ser la población humana. Por lo que solo quedaron 4 ECAs y 3 metaanálisis que compararon la eficacia del uso de ácido valproico vs. otros anticonvulsivantes o no tratamiento. Los resultados arrojaron iscrepancias; en algunos estudios el ácido valproico disminuyó el índice de recurrencia de convulsiones febriles comparado con el no tratamiento, no se encontró mayor eficacia frente a otras drogas anticonvulsivantes, como diazepam o fenobarbital, mientras que en otros no se encontró beneficio alguno. Conclusión: Si bien en algunos estudios el ácido valproico disminuyó el índice de recurrencias, se observó en otros que las recurrencias fueron mayores. Al comparar la eficacia contra la de otras drogas anticonvulsivantes las diferencias no fueron estadísticamente significativas. Por lo tanto, no existe evidencia suficiente que permita recomendar o no recomendar el uso de ácido valproico para la prevención de las recurrencias de convulsiones febriles en niños con factores de riesgo para el desarrollo posterior de epilepsia

Introduction: Febrile seizures are the most common type of seizures in children younger than 5 years. After the first febrile seizure, around 33% of children have one or more recurrences, and around 9% have three or more. Ask the risks associated with febrile seizures are not common, except recurrences, and because the number of children that have febrile seizures in the first years of life is high, a treatment protocol should have extremely low risks, have very few adverse effects, and should be low cost and highly effective. Main aim: To identify and analyze the relevant currently available literature to evaluate if there is scientific evidence that shows that the use of valproic acid is superior to other antiepileptic drugs to prevent recurrence of febrile seizures in children between 6 and 60 months of age. Secondary aim: To assess the safety of different medications used as well as the adverse effects observed. Material and methods: A systematic review of the literature using the data bases of LILACS, Cochrane, and Google scholar. The analysis was conducted using guidelines of the J.A.M.A., RCTs, and meta-analyses evaluating the efficacy of valproic acid vs other antiepileptic drugs or no treatment up to December 2012 in English and Spanish. Patients 0 to 60 months with a first simple febrile seizure were included. Results: Of 40 articles identified, 20 were excluded as they did not answer the question, 6 because of inadequate methodology, 7 because the complete original text could not be accessed, and 1 because of a non-human study population. Therefore, only 4 RCTs and 3 meta-analysis that compared the efficacy of valproic acid vs other antiepileptic drugs or no treatment were included. The results showed discrepancies: In some studies valproic acid diminished recurrences of febrile seizures compared to no treatment, no improved efficacy compared to other antiepileptic drugs, such as diazepam or phenobarbital was found, while in other studies no benefit whatsoever was found. Conclusion: Although in some studies valproic acid decreased the recurrence rate, others found that recurrences increased. When comparing efficacy with other antiepileptic drugs, the differences were not statistically significant. Therefore, there is not enough evidence that justifies recommending or not recommending valproic acid to prevent recurrence of febrile seizures in children with risk factors to subsequently develop epilepsy.

Convulsión febril / Febrile seizure

Febrile seizures are the most common seizure disorder in the pediatric population and represent a frequent cause of consultation in emergency departments, confirming its importance. We present an updated and practical review regarding this pathology, along with an operative definition that supports the application of a flowchart that integrates concepts and procedures that can be easily applied at any location nationwide. This review is designed to provide an analytic framework regarding pediatric febrile seizures, as well as present a guideline based on our experience in the emergency department by summarizing the main benzodiazepines in actual use that have been proved to be both safe and effective in treating this disorder, such as lorazepam and midazolam...

Atualização no diagnóstico e tratamento das crises epilépticas febris / Update on diagnosis and treatment of febrile seizures

As crises epilépticas febris são uma entidade benigna da infância e a maioria das crianças que a apresenta terá apenas um episódio na vida. Apesar disso, as crises geram grande apreensão nos familiares e há grande discussão na literatura sobre quando estes pacientes devem ser tratados e qual a melhor opção terapêutica. Esta revisão traz uma síntese dos dados e recomendações atuais para diagnóstico e tratamento dos pacientes que apresentem crises febris.

Febrile seizures are a benign condition of childhood and most children will have only one episode in their lifetime. Nevertheless, a crisis generates major concern in the family and there is much discussion in literature about when to treat as well as which is the best therapeutic approach. This review summarizes data and current recommendations for diagnosis and treatment of patients with febrile seizures.

Febrile seizures: four steps algorithmic clinical approach

Febrile seizures [FS] are the most common form of convulsive phenomena in human being and affect 2% to 14% of children. It is the most common type of seizures that every pediatrician is dealing with. It is the most benign type of all seizures occurring in childhood. There are many debates on how to approach to febrile seizures in pediatric neurology and there are many possible malpractices in this field. Some of the most common frequent queries are: * How could we differentiate FS from seizures and fever associated with serious infections involving the central nervous system? * When should we refer the affected child for further investigations such as lumbar puncture, EEC, neuroimaging, and routine biochemical studies? * How should we treat FS in its acute phase? * How could we assess the risk for further recurrences as well as other risks threatening the child's health in future? * How could we select the patients for treatment or prophylaxis? * Which medication[s] should be selected for treatment or prophylaxis? Trying to answer the above-mentioned questions, this review article will present a four steps algorithmic clinical approach model to a child with febrile seizures based on the current medical literature

Intermittent clonazepam in the prevention of recurrent febrile seizures

To evaluate the efficacy and common side effects of intermittent clonazepam in febrile seizures. This study was an experimental trial designed to determine the efficacy of intermittent clonazepam in febrile seizures Thirty patients with an age range of 6 months to 5 years [60% male, 40% female] were studied. Children with a history of psychomotor delay, abnormal neurological examination, a history of antiepileptic drug consumption, and afebrile seizures were excluded from the study. Patients received a single dose of prophylactic Clonazepam [0.05 mg/kg/ day] on the first day of febrile illness and twice daily during the course of fever. An antipyretic medication [Acetaniinophen] was advised if fever exceeded 38[degree symbol]C Patients were followed up for one year after the study inclusion date. Three patients were excluded from study since they didnot follow the tritment and three patients experienced afebrile seizures. Twenty four patients had 162 febrile episodes during the course of the study and all patients were seizure-free after 1 year, Clonazepam was 100% effective but lethargy and ataxia were common side effects in patients. Fortunately, their parents continued treatment because they had prior awareness of the possible side effects of clonazepam. Clonazepam is efficacious as an intermittent therapy for febrile seizures if parents are informed of its side effects

Comparison between diazepam and phenobarbital in prevention of febrile seizure: clinical trial

Febrile convulsions [FC] are the most common convulsive events in childhood, occurring in 2-5% of children. About one third of these children will have a recurrence during a subsequent febrile infection. This sudden neurologic problem is extremely frightening and emotionally traumatic for parents so some physicians try to prevent recurrence of FC by prescribing different drugs. This is a randomized clinical trial in 85 healthy children, aged 6 months to 5 years, who were not treated before. These children received randomly either oral diazepam [0.33 mg/kg/TDS for two days during febrile illness] or continuous oral Phenobarbital [3-5mg/kg /24 h]. Ultimately 64 patients completed the study and were followed up for an average of 13 months [12-18 months]. The rate of recurrence of febrile seizure was 18.2% in diazepam group and 32.3% in Phenobarbital group; the difference is not statistically significant [p=0.16]. There was no significant difference between intermittent oral diazepam and continuous oral Phenobarbital for FC prevention

Intermittent diazepam and continuous phenobarbital to treat recurrence of febrile seizures: a systematic review with meta-analysis

Convulsions triggered by fever are the most common type of seizures in childhood, and 20 percent to 30 percent of them have recurrence. The prophylactic treatment is still controversial, so we performed a systematic review to find out the effectiveness of continuous phenobarbital and intermittent diazepam compared to placebo for febrile seizure recurrence. METHOD: Only randomized, double-blind, placebo-controlled trials were analyzed. The recurrence of febrile seizure was assessed for each drug. RESULTS: Ten eligible clinical trials were included. Febrile seizure recurrence was smaller in children treated with diazepam or phenobarbital than in placebo group. Prophylaxis with either phenobarbital or diazepam reduces recurrences of febrile seizures. The studies were clinical, methodological, and statistically heterogeneous. CONCLUSION: The effectiveness of phenobarbital and diazepam could not be demonstrated because clinical trials were heterogeneous, and the recommendation for treatment recurrence should rely upon the experience of the assistant physician yet

Management of febrile seizures.

Febrile seizures are seizures associated with fever of extracranial origin. The preventive and long-term management aspects of febrile seizures are briefly discussed in this article.

The family attitudes towards febrile convulsions.

Giving adequate information about febrile convulsion and its prognosis would be helpful in alleviating parental stress, and would contribute to decrease in the morbidity of febrile convulsion. In this study, the knowledge level of parents on taking body temperature, and decreasing high fever, their attitudes during febrile convulsion and the impact of febrile convulsion on parents are evaluated. One hundred seventy-four parents of 132 children with FC were enrolled in the study. Twenty-seven per cent of parents had no thermometer at home, 32.8% of them did not know how to take a temperature, 72.2% of them did not know the minimum range of increased body temperature, and 69.5% of them did not know how to decrease the increased body temperature. Thirty-six percent of parents recognised the convulsions when their children suffered from them, the others assumed the convulsion were fainting spells (6.9%), near death state (38.5%) and suffocation (18.4%). Thirty-six per cent of parents brought their children to the hospital without doing anything themselves. Most parents (91.4%) had a fear of a recurrence of febrile convulsion in their children. Seventy-four per cent of parents complained of insomnia, 24.3% parents had dyspeptic symptoms even 14 parents had weight loss due to dyspepsia.

Role of phenobarbitone in preventing recurrence of febrile convulsions.

A randomized double blind placebo controlled trial was carried out to study the effect of phenobarbitone (PB) in preventing recurrences of simple and atypical febrile convulsions among children in the age group 6 months to 6 years. Children with simple febrile convulsions were randomly allocated to receive either phenobarbitone or placebo. Children with atypical convulsions were treated with phenobarbitone, as a third group. Thirty children were admitted in each group. All the children were followed up for a period of twelve months. Recurrence of convulsions and side effects of PB were recorded. Recurrence occurred in only 7% (95% confidence interval: 1-22) of children on Phenobarbitone, suffering from either simple or atypical febrile convulsions, compared to 53% (95% confidence interval: 34-72) of children on placebo, suffering from simple febrile convulsions. With Phenobarbitone, 5% of children had intolerable side effects. These results suggest that long term prophylaxis with phenobarbitone, even in simple febrile convulsions will be useful.