Abstracts

Rationale: A febrile seizure (FS) is an event characteristic of infancy and early childhood, when it happens quite frequently: from 2 to 5% of children at this age range will have one epileptic seizure associated with fever. Despite of a great deal of reports on this subject, there still are many issues related to the best therapy, the goal for lower rates of side effects and the decision on beginning therapy for FS. Intermittent prophylactic treatment with benzodiazepines for FS has been the most widely proposed therapy. The goal of the present study was to evaluate the efficacy of intermittent Clobazam and Clonazepam for children with FS who showed at least one predictive factor of recurrence, analyzing the eventual side effects of the medications and the association between predictive factors of recurrence and the repetition of FS. Methods: We prospectively evaluated children seen at the University Hospital of Ribeirão Preto School of Medicine, University of São Paulo, and submitted to prophylactic treatment for FS, from April 2002 to October 2004, ramdomly selecting 96 patients, according to the prescribed medication, either Clobazam 0.5 mg/kg/day or Clonazepam 0.1 mg/Kg/day. Twenty seven children were excluded along the follow-up, due to lack of adherence, no need of prophylactic use of the medication or evolution into non-febrile seizures. Results: We included 69 children: two of them ended up using both medications which were interchanged due to side effects. Then, 71 children were computed, 29 (40.8%) under prophylaxis with Clobazam, and 42 (59.2%) treated with Clonazepam. The efficacy of prophylactic treatment was demonstrated comparing the rate of febrile events associated with seizure recurrence among children receiving medication (2.9%) and children without prophylactic medication (59.2%) (p<0.01), with a similar recurrence rate during the use of Clobazam (2.5%) and of Clonazepam (3.4%)(p<0.676, x2). Side effects were identified in 52.1% of the children, mostly transient and considered limiting in only 1.4% of them, with a predominance of vomiting, in Clobazam group (p=0.033, x2), and ataxia, in the Clonazepam group (p=0.033, x2). Our children showed marked tendency to FS repetition based upon the high number of predictive factors of recurrence (91.5% of the kids with more than one factor), as well as on the number of FS before treatment (66.2% with 2 or more FS). However, after the institution of the prophylactic medication, only 8.4% of the children, among those who really used it, had recurrence of FS, suggesting a reduction of the expression of those risk factors by the effect of prophylactic medication. Conclusions: Intermittent prophylaxis for FS with Clobazam or Clonazepam showed effective, by significantly reducing the number of febrile events associated with recurrence of FS, when drugs were adequately used. The side effects were mostly transients as well as non-limiting. In general, the introduction of prophylactic treatment should be considered for children with FS in the presence of predictive factors for recurrence. Supported by FAEPA