Management of febrile seizures. a. Acute Attack: (i) Position patient semiprone (ii) Place oral airway (iii) O2 through mask (iv) Control seizures : Rectal or IV Diazepam 0.5 mg/kg, repeated after 15 minutes if necessary (v) Control of fever – antipyretics – paracetamol 10 mg/kg per dose every 4-6 hourly. Tepid sponging with tap water (vi) Treat the cause of fever.
Note: No role for intramuscular diazepam in control of seizures as it may cause erratic absorption of the drug and late respiratory depression
b. Treatment of recurrences (i) Intermittent prophylaxis: Medications are given only when child is sick with fever. Oral diazepam 0.3 mg/kg every 8 hours (1 mg/kg/day) during the febrile episode (2 to 3 days) is effective in controlling recurrences. Alternatively rectal diazepam solutions 5-7.5 mg 12 hourly or Diazepam suppositories 5 mg 8th hrly whenever temperature is >38.5oC can be used. Clonazepam and Clobazam have also been found efficacious in preventing febrile seizure recurrences. The recommended dose of clobazam is 5 mg/d up to 5 kg, 10 mg/d from 5-10 kg, and 15 mg/day from 11-15 kg. (ii) Continuous prophylaxis : Phenobarbital and sodium valproate are effective in controlling febrile seizure recurrences, but the risks and potential side effects overweigh the benefits of therapy. Hence the present recommendation is that long term AED is generally not preferred except in patients at maximum risk (i.e.) below 1 year old who are likely to develop recurrent febrile seizures, having in mind the long term side effects.