Limited evidence for benefits of prophylactic drug treatment for febrile seizures

Intermittent diazepam and continuous phenobarbitone reduced recurrence rates for children with febrile seizures (NNT* 5–14), but with adverse effects in up to 30%. There was no significant benefit for intermittent phenobarbitone, phenytoin, valproate, pyridoxine, ibuprofen or zinc sulphate versus placebo or no treatment; nor for diclofenac versus placebo followed by ibuprofen, acetaminophen or placebo; nor for continuous phenobarbitone versus diazepam, intermittent rectal diazepam versus intermittent valproate, or oral diazepam versus clobazam. Given the benign nature of recurrent febrile seizures, and the high prevalence of adverse effects of these drugs, parents and families should be supported with adequate contact details of medical services and information on recurrence, first aid management and, most importantly, the benign nature of the phenomenon.

*NNT = number needed to treat to benefit 1 individual.