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.