Profilaxia intermitente com diazepam via oral na convulsão febril: estudo de 82 casos

Costa, Maristela; Silva, Ednea A.; Silva, Anna E. S. Mendes da; Guerreiro, Marilisa M.

doi:10.1590/S0004-282X1996000200003

Resumos

Apresentamos os resultados do uso de diazepam intermitente na profilaxia da convulsão febril (CF). Acompanhamos 82 pacientes com idade entre 3 meses e 5 anos por período médio de 15,8 meses. Dezoito crianças (21,95% da casuística) apresentaram efeitos colaterais transitórios que não limitaram o uso da medicação. Houve recorrência em 26% dos casos. Concluímos que o diazepam, via oral, é eficaz para prevenir recorrência de CF. Ele apresenta fácil manuseio e boa tolerabilidade. Sugerimos o seu uso em crianças que apresentem algum fator de risco preditivo para recorrência.

convulsão febril; diazepam

We present our results of intermittent prophylaxis with oral diazepam in febrile seizures. We treated 82 patients aged between 3 months and 5 years. They have had simple or complex febrile seizures. Recurrence occurred in 22 patients (26%), none had a long-lasting febrile convulsion. Transient side effects occurred in 21.95% of the cases. We conclude that diazepam is a safe and effective drug for prophylaxis of febrile seizures when used as soon as any sign of illness appears. We suggest, however, that the administration of the drug should be indicated if the child presents at least one consistent predictor of risk of recurrent febrile seizures.

febrile seizures; diazepam

Profilaxia intermitente com diazepam via oral na convulsão febril: estudo de 82 casos

Intermittent prophylaxis in febrile seizures with oral diazepam: study of 82 cases

Maristela Costa^I; Ednea A. Silva^II; Anna E. S. Mendes da Silva^II; Marilisa M. Guerreiro^III

^IResidente de Neurologia Infantil

^IIPós-Graduanda em Neurociências

^IIIProfessor Assistente Doutor

RESUMO

Apresentamos os resultados do uso de diazepam intermitente na profilaxia da convulsão febril (CF). Acompanhamos 82 pacientes com idade entre 3 meses e 5 anos por período médio de 15,8 meses. Dezoito crianças (21,95% da casuística) apresentaram efeitos colaterais transitórios que não limitaram o uso da medicação. Houve recorrência em 26% dos casos. Concluímos que o diazepam, via oral, é eficaz para prevenir recorrência de CF. Ele apresenta fácil manuseio e boa tolerabilidade. Sugerimos o seu uso em crianças que apresentem algum fator de risco preditivo para recorrência.

Palavras-chave:convulsão febril, diazepam.

ABSTRACT

We present our results of intermittent prophylaxis with oral diazepam in febrile seizures. We treated 82 patients aged between 3 months and 5 years. They have had simple or complex febrile seizures. Recurrence occurred in 22 patients (26%), none had a long-lasting febrile convulsion. Transient side effects occurred in 21.95% of the cases. We conclude that diazepam is a safe and effective drug for prophylaxis of febrile seizures when used as soon as any sign of illness appears. We suggest, however, that the administration of the drug should be indicated if the child presents at least one consistent predictor of risk of recurrent febrile seizures.

Key words: febrile seizures, diazepam.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Aceite: 16-janeiro-1996.

Estudo realizado na Disciplina de Neurologia Infantil do Departamento de Neurologia da Faculdade de Ciências Médicas (FCM) da Universidade Estadual de Campinas (UNICAMP)

Dra. Marilisa M. Guerreiro - Departamento de Neurologia/FCM/UNICAMP - Caixa Postal 6111 - 13083-970 Campinas SP - Brasil.

1. Addy DP. Prophylaxis and febrile convulsions. Arch Dis Child 1981;56:81-83.
2. Berg AT, Shinnar S, Hauser WA, Leventhal JM. Predictors of recurrent febrile seizures: a metaanalytic review. J Pediatrics 1990;116:329-337.
3. Berg AT, Shinnar S, Hauser WA, Alemany M, Shapiro ED, Salomon ME, Crain EF. A prospective study of recurrent febrile seizures. N Engl J Med 1992;327:1122-1127.
4. Camfield P, Camfield C. Diazepam to prevent febrile seizures. N Engl J Med 1993;329:2034.
5. Cendes F, Andermann F, Dubeau F, Gloor P, Evans A, Jones-Gotman M, Olivier A, Andermann E, Robitaille Y, Lopes-Cendes I, Peters T, Melanson D. Early childhood prolonged febrile convulsions, atrophy and sclerosis of mesial structures, and temporal lobe epilepsy: an MRI volumetric study. Neurology 1993;43:1083-1087.
6. Dianese G. Prophylaxis of febrile convulsions: searching for the best. Arch Dis Child 1986;61:621-622.
7. Farwell JR, Lee YJ, Hirtz DG, Sulzbacher SI, Ellenberg JH, Nelson KB. Phenobarbital for febrile seizures: effect on intelligence and on seizure recurrence. N Engl J Med 1990;322:364-369.
8. Freeman JM. Febrile seizures: a consensus of their significance, evolution, and treatment. Pediatrics 1980;66:1009-1012.
9. Freeman JM. The best medicine for febrile seizures. N Engl J Med 1992;327:1161-1162.
10. Guerreiro MM, Costa M, Bellomo MA, Sabino SH, Scotoni AE. Profilaxia intermitente na convulsão febril com diazepam vi a oral. Arq Neuropsi qui atr 1992;50:163-167.
11. Hauser WA. The natural history of febrile seizures. In Nelson KB, Ellenberg JH (eds). Febrile seizures. New York: Raven Press, 1981:5-17.
12. Herranz JL, Armijo JA, Arteago K. Effectiveness and toxicity of phenobarbital, primidone and sodium valproate in prevention of febrile convulsions controlled of plasma levels. Epilepsia 1984;25:89-95.
13. Knudsen FU. Effective short-term diazepam prophylaxis in febrile convulsions. JPediatr 1985;106:487-490.
14. Knudsen FU. Recurrent risk after first febrile seizure and effect of short-term diazepam prophylaxis. Arch Dis Child 1985;60:1045-1049.
15. Knudsen FU. Intermittent diazepam prophylaxis in frebile convulsions. Acta Neurol Scand 1991;83 (Suppl 135):1-24.
16. Knudsen FU, Vestermark S. Prophylatic diazepam or phenobarbital in febrile convulsions: a prospective controlled study. Arch Dis Child 1978;53:660-663.
17. Kuks JBM, Fish DR, Stevens JM, Shorvon SD. Hippocampal sclerosis in epilepsy and childhood febrile seizures. Lancet 1993;342:1391-1394.
18. Maytal J, Shinnar S. Febrile status epilepticus. Pediatrics 1990;86:611-616.
19. MoshéSL. Seizures in developing brain. Neurology 1993;43(Suppl 5):S3-S7.
20. Millichap JG. The definition of febrile seizures. In: Nelson KL, Ellenberg JH (eds). Febrile seizures. New York: Raven Press, 1981;l-3.
21. Nelson KB. Can treatment of febrile seizures prevent subsequent epilepsy? In Nelson KB, Ellenberg JH (eds). Febrile seizures. New York: Raven Press, 1981:143-145.
22. Nelson KB, Ellenberg JH. Predictors of epilepsy in children who have experienced febrile seizures. N Engl J Med 1976;295:1029-1033.
23. Nelson KB, Ellenberg JH. Prognosis in children with febrile seizures. Pediatrics 1978;61:720-727.
24. Nelson KB, Ellenberg JH. The role of recurrences in determining outcome in children with febrile seizures. In: Nelson KB, Ellenberg JH (eds). Febrile seizures: New York: Raven Press, 1981 ;19-25.
25. Nelson KB, Ellenberg JH. Prenatal and perinatal antecedent of febrile seizures. Ann Neurol 1990;27:127-131.
26. Newton RW. Randomized controlled trials of phenobarbitone and valproate in febrile convulsions. Arch Dis Child 1988, 63:1189-1191.
27. Offringa M. Seizures associated with fever: current management controversies. Sem Ped Neurol 1994;11:90-101.
28. Offringa M, Bossuyt P, Lubsen J, Ellenberg J, Nelson K, Knudsen F, Annegers J, El-Radhi A, Habbema J, Derksen-Lubsen G, Hauser W, Kurland L, Banajeh S, Larsen S. Risk factors for seizure recurrence in children with febrile seizures: a pooled analysis of individual patient data from five studies. J Pediatr 1994;124:574-584.
29. Offringa M Derksen-Lubsen G, Bossuyt P, Lubsen J. Seizure recurrence after a firts febrile seizure: a multivariate approach. Dev Med Child Neurol 1992;34:15-24.
30 . Pilgaard S, Hansen J, Perregaard P. Prophylaxis against febrile convulsions with phenobarbital. Acta Pediatr Scand 1986;70:67-71.
31. Rantala H, Uhari M. Risk factors for recurrences of febrile convulsions. Acta Neurol Scand 1994;90:207-210.
32. Rosman NP, Colton T, Labazzo J, Gilbert PL, Gardella NB, Kaye EM, van Bennekom C, Winter MR. A controlled trial of diazepam administered during febrile illnesses to prevent recurrence of febrile seizures. N Engl J Med 1993;329:79-84.
33 . Thorn I. Prevention of recurrent febrile seizures: intermittent prophylaxis with diazepam compared with continuous treatment with phenobarbital. In Nelson KB, Ellenberg JH (eds). Febrile seizures. New York: Raven Press, 1981:119-126.
34. Verity CM, Golding G. Risk of epilepsy after febrile convulsions: a national cohort study. Br Med J 1991;303:373-376.
35. Wallace SJ. Prevention of recurrent febrile seizures using continuous prophylaxis: sodium valproate compared with phenobarbital. In Nelson KB, Ellenberg JH (eds). Febrile seizures. New York: Raven Press, 1981:135-142.

Datas de Publicação

Publicação nesta coleção
17 Dez 2010
Data do Fascículo
Jun 1996

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Addy DP. Prophylaxis and febrile convulsions. Arch Dis Child 1981;56:81-83.

[2] 2. Berg AT, Shinnar S, Hauser WA, Leventhal JM. Predictors of recurrent febrile seizures: a metaanalytic review. J Pediatrics 1990;116:329-337.

[3] 3. Berg AT, Shinnar S, Hauser WA, Alemany M, Shapiro ED, Salomon ME, Crain EF. A prospective study of recurrent febrile seizures. N Engl J Med 1992;327:1122-1127.

[4] 4. Camfield P, Camfield C. Diazepam to prevent febrile seizures. N Engl J Med 1993;329:2034.

[5] 5. Cendes F, Andermann F, Dubeau F, Gloor P, Evans A, Jones-Gotman M, Olivier A, Andermann E, Robitaille Y, Lopes-Cendes I, Peters T, Melanson D. Early childhood prolonged febrile convulsions, atrophy and sclerosis of mesial structures, and temporal lobe epilepsy: an MRI volumetric study. Neurology 1993;43:1083-1087.

[6] 6. Dianese G. Prophylaxis of febrile convulsions: searching for the best. Arch Dis Child 1986;61:621-622.

[7] 7. Farwell JR, Lee YJ, Hirtz DG, Sulzbacher SI, Ellenberg JH, Nelson KB. Phenobarbital for febrile seizures: effect on intelligence and on seizure recurrence. N Engl J Med 1990;322:364-369.

[8] 8. Freeman JM. Febrile seizures: a consensus of their significance, evolution, and treatment. Pediatrics 1980;66:1009-1012.

[9] 9. Freeman JM. The best medicine for febrile seizures. N Engl J Med 1992;327:1161-1162.

[10] 10. Guerreiro MM, Costa M, Bellomo MA, Sabino SH, Scotoni AE. Profilaxia intermitente na convulsão febril com diazepam vi a oral. Arq Neuropsi qui atr 1992;50:163-167.

[11] 11. Hauser WA. The natural history of febrile seizures. In Nelson KB, Ellenberg JH (eds). Febrile seizures. New York: Raven Press, 1981:5-17.

[12] 12. Herranz JL, Armijo JA, Arteago K. Effectiveness and toxicity of phenobarbital, primidone and sodium valproate in prevention of febrile convulsions controlled of plasma levels. Epilepsia 1984;25:89-95.

[13] 13. Knudsen FU. Effective short-term diazepam prophylaxis in febrile convulsions. JPediatr 1985;106:487-490.

[14] 14. Knudsen FU. Recurrent risk after first febrile seizure and effect of short-term diazepam prophylaxis. Arch Dis Child 1985;60:1045-1049.

[15] 15. Knudsen FU. Intermittent diazepam prophylaxis in frebile convulsions. Acta Neurol Scand 1991;83 (Suppl 135):1-24.

[16] 16. Knudsen FU, Vestermark S. Prophylatic diazepam or phenobarbital in febrile convulsions: a prospective controlled study. Arch Dis Child 1978;53:660-663.

[17] 17. Kuks JBM, Fish DR, Stevens JM, Shorvon SD. Hippocampal sclerosis in epilepsy and childhood febrile seizures. Lancet 1993;342:1391-1394.

[18] 18. Maytal J, Shinnar S. Febrile status epilepticus. Pediatrics 1990;86:611-616.

[19] 19. MoshéSL. Seizures in developing brain. Neurology 1993;43(Suppl 5):S3-S7.

[20] 20. Millichap JG. The definition of febrile seizures. In: Nelson KL, Ellenberg JH (eds). Febrile seizures. New York: Raven Press, 1981;l-3.

[21] 21. Nelson KB. Can treatment of febrile seizures prevent subsequent epilepsy? In Nelson KB, Ellenberg JH (eds). Febrile seizures. New York: Raven Press, 1981:143-145.

[22] 22. Nelson KB, Ellenberg JH. Predictors of epilepsy in children who have experienced febrile seizures. N Engl J Med 1976;295:1029-1033.

[23] 23. Nelson KB, Ellenberg JH. Prognosis in children with febrile seizures. Pediatrics 1978;61:720-727.

[24] 24. Nelson KB, Ellenberg JH. The role of recurrences in determining outcome in children with febrile seizures. In: Nelson KB, Ellenberg JH (eds). Febrile seizures: New York: Raven Press, 1981 ;19-25.

[25] 25. Nelson KB, Ellenberg JH. Prenatal and perinatal antecedent of febrile seizures. Ann Neurol 1990;27:127-131.

[26] 26. Newton RW. Randomized controlled trials of phenobarbitone and valproate in febrile convulsions. Arch Dis Child 1988, 63:1189-1191.

[27] 27. Offringa M. Seizures associated with fever: current management controversies. Sem Ped Neurol 1994;11:90-101.

[28] 28. Offringa M, Bossuyt P, Lubsen J, Ellenberg J, Nelson K, Knudsen F, Annegers J, El-Radhi A, Habbema J, Derksen-Lubsen G, Hauser W, Kurland L, Banajeh S, Larsen S. Risk factors for seizure recurrence in children with febrile seizures: a pooled analysis of individual patient data from five studies. J Pediatr 1994;124:574-584.

[29] 29. Offringa M Derksen-Lubsen G, Bossuyt P, Lubsen J. Seizure recurrence after a firts febrile seizure: a multivariate approach. Dev Med Child Neurol 1992;34:15-24.

[30] 30 . Pilgaard S, Hansen J, Perregaard P. Prophylaxis against febrile convulsions with phenobarbital. Acta Pediatr Scand 1986;70:67-71.

[31] 31. Rantala H, Uhari M. Risk factors for recurrences of febrile convulsions. Acta Neurol Scand 1994;90:207-210.

[32] 32. Rosman NP, Colton T, Labazzo J, Gilbert PL, Gardella NB, Kaye EM, van Bennekom C, Winter MR. A controlled trial of diazepam administered during febrile illnesses to prevent recurrence of febrile seizures. N Engl J Med 1993;329:79-84.

[33] 33 . Thorn I. Prevention of recurrent febrile seizures: intermittent prophylaxis with diazepam compared with continuous treatment with phenobarbital. In Nelson KB, Ellenberg JH (eds). Febrile seizures. New York: Raven Press, 1981:119-126.

[34] 34. Verity CM, Golding G. Risk of epilepsy after febrile convulsions: a national cohort study. Br Med J 1991;303:373-376.

[35] 35. Wallace SJ. Prevention of recurrent febrile seizures using continuous prophylaxis: sodium valproate compared with phenobarbital. In Nelson KB, Ellenberg JH (eds). Febrile seizures. New York: Raven Press, 1981:135-142.