Prophylactic diazepam or phenobarbitone in febrile convulsions: a prospective, controlled study

SUMMARY After their first episode of febrile convulsions, 195 previously healthy children, aged 6-30 months, were given either diazepam or phenobarbitone for a year. Each child was assigned at random to one of the two medications: children admitted on even days were given a suppository containing 5 mg diazepam every 8 hours when the rectal temperature was _38 5°C. Children admitted on odd days were given treatment with phenobarbitone, 3.5 ±1 mg/kg per day. 156 children completed treatment and outpatient control for a year, 83 in the diazepam and 73 in the phenobarbitone group. The rate of recurrence was independent of the prophylactic and 15-16% of the children in both groups had new febrile convulsions within a year. The recurrence rate after 6 months was also similar, 11 % in the diazepam group and 9 % in the phenobarbitone group. New convulsions were of similar duration and severity in both groups. In both groups 6 % of all febrile episodes led to new convulsions. Long-term treatment with phenobarbitone thus offered no advantage over intermittent diazepam. The use of prophylactics for treating febrile con-vulsions is controversial. Some doctors think that long-term treatment with phenobarbitone is in-dicated after one episode (Faer0 et al., 1972; Lennox-Buchthal, 1973), others do not (Ouellette, 1974; Heckmatt et al., 1976). Some believe that long-term treatment with phenobarbitone prevents recurrences (Faer0 et al., 1972; Wolf et al., 1977), others consider it of limited or no prophylactic value (Heckmatt et al., 1976). However, nearly all agree that side effects and noncompliance ar