Anti-pyretic agents are ineffective in the prevention of febrile seizures

Article Outline

• Question
• Design
• Setting
• Participants
• Intervention
• Outcomes
• Main Results
• Conclusions
• Commentary
• Reference
• Copyright

Strengell T, Uhari M, Tarkka R, Uusimaa J, Alen R, Lautala P, et al. Antipyretic agents for preventing recurrences of febrile seizures: randomized controlled trial. Arch Pediatr Adolesc Med 2009;163:799-804.

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Question 

In children with a history of febrile seizures, will antipyretic agents given at their highest recommended doses prevent recurrent febrile seizures?

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Design 

Randomized, placebo-controlled, double-blind trial.

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Setting 

Five pediatric hospitals in Finland.

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Participants 

231 children who experienced their first febrile seizure between January 1, 1997, and December 31, 2003.

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Intervention 

All febrile episodes during a 2-year follow-up period were treated first with either rectal diclofenac or placebo. After 8 hours, treatment was continued with oral ibuprofen, acetaminophen, or placebo.

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Outcomes 

Recurrence of febrile seizures.

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Main Results 

The children experienced 851 febrile episodes, and 89 of these included a febrile seizure. Febrile seizure recurrences occurred in 54 of the 231 children (23.4%). There were no significant differences between the groups: the recurrence rate was 23.4% (46 of 197) in those receiving antipyretic agents and 23.5% (8 of 34) in those receiving placebo (difference, 0.2; 95% confidence interval, −12.8 to 17.6; P = .99). Fever was significantly higher during the episodes with seizure than in those without seizure (39.7°C vs 38.9°C; difference, 0.7°C; 95% confidence interval, −0.9°C to −0.6°C; P < .001), and this phenomenon was independent of the medication given.

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Conclusions 

Antipyretic agents are ineffective for the prevention of recurrences of febrile seizures and for the lowering of body temperature in patients with a febrile episode that leads to a recurrent febrile seizure.

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Commentary 

This is an interesting study that evaluated the efficacy of antipyretics in preventing febrile seizure recurrence in a large cohort of children from Finland. The authors used a randomized, placebo-controlled, double-blind trial in which oral acetaminophen, oral ibuprofen, and rectal diclofenac were administered for fevers of 38°C or higher. Although prior studies have demonstrated that both acetaminophen and ibuprofen are ineffective in preventing febrile seizure recurrence, this study used maximum dosages of the agents and began treatment with rectal diclofenac (or placebo) to achieve rapid onset of action. In addition, 3 antipyretics with different mechanisms of action were compared. The authors found that all of the antipyretics were ineffective in preventing febrile seizure recurrence. Moreover, none of the agents reduced fever during those episodes in which febrile seizures occurred. The American Academy of Pediatrics Practice Guideline published in 2008 summarized the available literature on the use of antipyretics in preventing febrile seizure recurrence and came to the same conclusion as the authors: Although antipyretics may improve the comfort of the child, they will not prevent febrile seizures.¹ Importantly, families must be counseled that administration of an antipyretic will not prevent febrile seizure recurrence. Too often, families express feelings of guilt that had they administered the medication earlier, their child would have been spared from having another seizure.

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Reference 

1. AAP Steering Committee on Quality Improvement and Management, Subcommittee on Febrile Seizures. Febrile seizures: clinical practice guideline for the long-term management of the child with simple febrile seizures. Pediatrics. 2008;121:1281–6
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