The Value of Phenobarbital in the Child Who Has Had a Single Febrile Seizure: A Controlled Prospective Study

Abstract

A group of 355 children who were seen after a 1st febrile convulsion at the Kaiser Foundation Hospitals in Southern California [USA] from 1970-1975 were randomly assigned to 3 treatment groups: daily phenobarbital, intermittent phenobarbital given at the onset of fever, and no phenobarbital. Forty two percent had a relative with a febrile seizure and 16% a relative with an afebrile convulsion. Thirteen percent had seizures which were either lateralized or longer than 10 min. Parents were unaware of the fever prior to the seizure in about 30% of the cases. In 81% the preseizure duration of fever was less than 24 h. The mean follow-up was 28 mo., with a range of 6-70 mo. There was no significant difference in the recurrence rate between children receiving intermittent as compared with no phenobarbital. The recurrence rate in children receiving daily phenobarbital was significantly decreased compared to either of the other 2 groups. Severe recurrent febrile seizures occurred in no children on daily phenobarbital and in 4.4% of the children receiving either intermittent or no phenobarbital. Parental resistance, compliance and reversible hyperactivity were the main problems encountered with the continuous phenobarbital regimen.