CC Jan 2016 Febrile Seizure Treatment

echoecho's version from 2016-03-27 22:37


Question Answer
Several prospective studies have shown that daily administration of what 2 drug options is effective to prevent febrile seizures (number needed to treat [NNT], 5)?1) phenobarbital 2) valproic acid
What is the dose regarding above phenobarbital for children < 2 years of age? for children > 2 years of age?1) 5-8 mg/kg/day 2) 3-5 mg/kg/day
What is the dose for Valproic acid (Depakote) to prevent febrile seizures?10-15 mg/kg/day in divided doses
List the 7 adverse effects of phenobarbital?1) transient sleep disturbances 2) daytime drowsiness 3) fussiness 4) attention deficit 5) hyperactivity 6) decreased memory 7) impaired cognitive function
List the 4 adverse effects of valproic acid?1) renal toxicity 2) thrombocytopenia 3) pancreatitis 4) fatal hepatotoxicity
*** The AAP Steering Committee concluded that potential adverse effects of antiepleptic medications outweigh the _____ of febrile seizure reduction?benefit
What 2 other anticonvulsant medications are not effective in the prevention of recurrent febrile seizures?1) carbamazepine (Tegretol) 2) phenytoin (Dilantin)
Do the number and type of febrile seizures influence the long-term outcome for subsequent epilepsy or for neurologic, motor, intellectual, cognitive and scholastic ability?no
What is the reason that the present consensus that ongoing anticonvulsant prophylaxis is NOT necessary for children with either simple or complex febrile seizures?because there are significant adverse events associated with preventative therapy
Is there an indication for the use of intermittent anticonvulsant therapy?no
An exception to the statements above might be the use of what medication? Given at what dose at the onset of fever to prevent recurrence of febrile seizures?1) diazepam (Valium) 2) rectally or orally intermittently (0.3 - 0.5 mg/kg, maximum 10 mg)
What are the 2 potential drawbacks of intermittent diazepam therapy?1) some seizures occur BEFORE a fever is apparent 2) not all febrile episodes will have associated seizure activity
List the 8 adverse effects of diazepam therapy/1) lethargy 2) drowsiness 3) ataxia 4) dizziness 5) slurred speech 6) bradycardia 7) hypotension 8) respiratory depression
The adverse effects of diazepam may also mask evolving signs of what?meningitis
*** What is the conclusion of use of intermittent diazepam?the adverse events associated with this intermittent diazepam use therapy outweigh the benefits
For situations in which parental anxiety is high (particularly in patients at risk for prolonged or multiple febrile seizures), consideration of intermittent therapy with diazepam might be reasonable. When should it be given?at the onset of febrile illness
What 2 medications are effective antipyretic agents in children with fever?1) acetaminophen 2) ibuprofen
Controlled studies have failed to show a _____ effect of antipyretic medications given during a febrile illness on the recurrence of febrile seizures?preventive
Although antipyretic medications might not prevent further febrile seizures, what do they reduce?discomfort
What is the overall prognosis for children with febrile seizures?excellent
Do most of these children have any sequelae?no
What is the major risk of febrile seizures?recurrence of the febrile seizure
The risk of epilepsy is ____% in the general population. ____% after simple febrile seizures and ___ to ____% after a complex febrile seizure?1%; 2%; 6-8%
List the 5 risk factors for the evelopment of epilepsy after a febrile seizure?1) antecedent neurologic abnormality 2) developmental abnormality 3) postiive family hx of epilepsy 4) a complex febrile seizure 5 onset of febrile seizures before 1 year of age
Of note, the number of febrile seizures usually does not alter the risk of having epilepsy after a febrile seizure, so drug _______ is even less useful?prophylaxis
Is there any evidence that simple or complex febrile seizures cause any structural damage to the brain?no
Are affected children at risk for later development of a neurologic deficit or any effect on their intelligence and cognitive function?no
Is there any significant differences between children with a hx of febrile seizures and children in the general popualation?no
Do children with febrile seizures have an increased risk of mortality?no
Is there an association between febrile seizures and sudden infant death syndrome?no
*** SUMMARY = Generally, is the use of antiepileptic medications indicated for febrile seizure treatment?no
*** SUMMARY = What medication, given how at the onset of fever, prevents recurrences of febrile seizure?Diazepam (Valiium) administered INTERMITTENTLY either rectally or orally in sufficient doses (0.3 - 0.5 mg/kg, maximum 10 mg)