A study of the efficacy of antipyretic drugs in the prevention of febrile seizure recurrence

Abstract

Objective To estimate the potential preventive effect of antipyretic drugs on the recurrence of febrile seizures (FS). Design An experimental and a descriptive patient series, both prospectively followed, were combined in this study. Setting/participants Children who visited the outpatient department of the Sophia Children’s Hospital because of a FS experienced between the age of 10 and 36 months. Intervention A treatment group of 109 children was offered treatment with ibuprofen or acetaminophen syrup during fever, a control group of 103 children was not offered antipyretic treatment. This was not a randomized trial. In an intention‐to‐treat analysis, the risk of any recurrence and the number of recurrences per fever were compared between both groups. In an additional on‐treatment analysis, we compared the number of recurrences per fever between the control group and the children in the treatment group who actually received the study medication during fever. Effect measures were odds ratio (OR) as estimated by the Mantel–Haenszel procedure and hazard ratios (HR) as estimated by Cox regression. Results According to the intention‐to‐treat analysis, the hazard ratio of any recurrence in the treatment group compared with the control group was 1.1 [95% confidence interval (CI), 0.7–1.8]. The recurrence risk per fever was 15% in the treatment group and 12% in the control group (OR, 1.2; 95% CI, 0.7–2.3). In the exploratory on‐treatment analysis, the recurrence risk in the treatment group was estimated 6.9% in the treatment group versus 12% in the control group (OR, 0.5; 95% CI, 0.2–1.3). Conclusions/implications for practice We conclude that antipyretic treatment may have little or no preventive effect on the recurrence of febrile seizures in common practice. Some reduction of the risk of a recurrence may be acquired under optimal circumstances, namely that fever is noticed at once and that antipyretic drugs can be administered on time.

Healthcare professionals approach paediatric fever in significantly different ways and fever phobia is not just limited to parents

“…However, nurses thought that fever should always be treated and even considered waking a sleeping child to give them antipyretics. This was probably related to the belief that antipyretics could prevent febrile seizures, which is an idea that still remains within the medical community , despite lack of support from the evidence .…”

Fever management: paediatric nurses’ knowledge, attitudes and influencing factors

“…However, the evidence suggests that controlling fever rarely, if ever, prevents initial or recurrent febrile convulsions (Uhari et al. 1995, Baumann 1999, van Esch et al. 2000, Rantala et al.…”

Nursing interventions in the prevention of febrile seizures

“…Ibuprofen showed a stronger fever reducing effect as compared to acetaminophen; however, both have been shown to be safe and effective antipyretic drugs in the treatment of fever in children; and are safely administered for comfort during periods of illness. Furthermore, this study (Esch et al, 2000) identified a lack of evidence that antipyretics reduced the incidence of febrile seizures.…”

“…A previous study (Esch et al , 2000), examined ibuprofen versus acetaminophen. The objective was to estimate the potential preventive effect of antipyretics on the recurrence of febrile seizures.…”

“…This study concluded that antipyretic treatment might have little or no preventative effects on the recurrence of febrile seizures. Some reduction of the risk may be acquired if the fever is noticed at onset and treated with antipyretic medication, however, this is only under optimal circumstances (Esch et al, 2000). Ibuprofen showed a stronger fever reducing effect as compared to acetaminophen; however, both have been shown to be safe and effective antipyretic drugs in the treatment of fever in children; and are safely administered for comfort during periods of illness.…”