Pediatric Health, Medicine and Therapeutics (Mar 2021)
Febrile Seizures: Evidence for Evolution of an Operational Strategy from an Armed Forces Referral Hospital
Abstract
Sunil Jain,1 Abhijith Santhosh2 1Department of Paediatrics, Command Hospital (Northern Command), Jammu & Kashmir, India; 2Medical Officer, Emergency Department, Command Hospital (Northern Command), Jammu & Kashmir, IndiaCorrespondence: Sunil JainProfessor & Head, Department of Paediatrics, Command Hospital (Northern Command), c/o 56 APO, 901131, IndiaTel +91 9086068677Email [email protected]: Current recommendations for ‘Febrile seizures’ management include emergency first aid and treatment along with intermittent prophylaxis. Evidence of practices, efficacy, side-effects, and complications should lead to refined and rational management strategies.Patients and Methods: Study of cases referred and treated at a tertiary level hospital, providing referral services to a large state in India. Evidence sought for the research questions identified, these were (i) immediate treatment: First aid components and practices; response to drug treatment (ii) intermittent prophylaxis: effectiveness, compliance, and side-effects (iii) complications arising due to treatment side-effects: quantifying the number of cases of CNS infections missed as a result of alterations in consciousness levels due to benzodiazepines.Results: A total of 85 febrile seizure cases were studied. Full correct “First Aid” was provided by only 13 parents. Total 35 cases (41.18%) had seizures lasting more than 05 minutes. Emergency treatment for these included rectal diazepam in 14 cases with 57.14% success in terminating seizure, and intranasal midazolam in 21 cases with 71.43% success. The cases with persisting seizures were managed as status epilepticus treatment algorithm. Intermittent prophylaxis prevented recurrence of seizures in 90%, however side-effects were reported in 36.36%. There was no case of CNS infection missed.Conclusion: Safe and effective management strategy should include “Health education” for correct first aid and ‘Protocols’ for timely and correct emergency treatment by parents/pre-hospital teams/emergency duty doctors. Intermittent prophylaxis is effective but refinements needed to minimize side-effects. Vigilant clinical monitoring obviates the fear that treatment may mask CNS infection.Keywords: first aid, emergency treatment, prophylaxis, benzodiazepines, meningitis, monitoring
