Acetaminophen reduces recurrence of febrile seizures in children within same fever episode

1. Rectal acetaminophen reduces rates of second febrile seizure (FS) in children during the course of the same febrile illness when given rectally soon after initial seizure.

2. Acetaminophen use in the setting of FSs was not associated with increased serious adverse events or neurologic sequelae.

 Evidence Rating Level: 1 (Excellent)

 Study Rundown: Febrile illnesses are the most common cause of seizures in the pediatric population. Many children experience multiple seizures during the course of one febrile illness, yet data on the prevention of recurrent convulsions is lacking. While acetaminophen is often used to decrease discomfort related to fevers, the relationship between antipyretics and the recurrence of FSs has not been studied. This randomized controlled trial evaluated the utility of acetaminophen to reduce recurrence of FSs within a single fever episode, and described the safety of acetaminophen use in this context. Findings indicated that children who received rectal acetaminophen after a febrile seizure were significantly less likely to experience a second seizure during the same illness course compared with children who did not receive acetaminophen. Furthermore, no study participants experienced serious adverse reactions (e.g. hypotension, anaphylaxis, etc.) associated with acetaminophen use. This study is limited by potential discrepancies in accuracy and sufficiency of body temperature monitoring, as the route of temperature measurement was unclear. Results from this study suggest acetaminophen could be effective in minimizing recurrence of a second convulsion in children presenting with FSs, without increasing rates of adverse events.

Click to read the study, published today in Pediatrics

Relevant reading: Efficacy of diazepam suppository at preventing febrile seizure recurrence during a single febrile illness

In-depth [randomized controlled trial]: This study analyzed recurrence of FSs in children between the ages of 6 and 60 months presenting to a Japanese pediatric emergency department with seizures in the setting of a fever ≥38.0°. Participants were randomized to receive either no antipyretics or 10mg/kg rectal acetaminophen (N=209 and N=229, respectively). Patients received acetaminophen every 6 hours for up to 24 hours if they continued to be febrile. Children who had neurologic comorbidities, who had already had 2+ convulsions during the current fever course, who had a seizure lasting >15 minutes or who received diazepam or antihistamines were excluded. Patients in the medication arm received rectal acetaminophen every 6 hours for 24 hours, starting as soon as possible after the first seizure. Results showed that 68 participants (16%) experienced a recurrent seizure. Children, regardless of age, who received acetaminophen were significantly less likely to experience a recurrent seizure (9.1% and 23.5%, respectively, P<.001). This difference was most pronounced in children aged 22 to 60 months (4.1% and 22.6% respectively, P<.001).  29% of patients who had FSs and 56% of patients who did not have them used rectal acetaminophen (P<.001). Other factors shown to be significantly associated with seizure recurrence were younger age and shorter initial seizure duration (P<.05 for both). None of the study participants experienced serious complications, including hypotension, hypothermia, anaphylaxis, or neurologic sequelae.

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