Knudsen F U
Børneafdeling L, Amtssygehuset i Glostrup.
Ugeskr Laeger. 2001 Feb 19;163(8):1098-102.
Epidemiological data indicate that the long-term prognosis in the vast majority of children with febrile seizures is good. Three main problems are important for the treatment: febrile seizures are extremely upsetting for the parents, the recurrence rate is 30-40% and the febrile status occurs unpredictably and is potentially damaging to the CNS. There is universal agreement that daily prophylaxis with valproate, primidone, or phenobarbital should only be used in highly selected cases, if at all. The effectiveness of phenytoin and carbamazepine has not been documented. Antipyretic treatment does not reduce the recurrence rate. Intermittent diazepam prophylaxis at times of fever may or may not reduce the recurrence rate significantly, but there is no data to suggest that it improves the long-term outcome, as compared with short-term seizure control, in terms of IQ, cognition, academic progress, motor control, and subsequent epilepsy. Acute anticonvulsive treatment with rectal diazepam in solution or other benzodiazepines is effective in aborting recurrent seizures with almost the effectiveness of i.v. treatment and is safe, simple, and easy to use for the parents. The long-term prognosis is probably uninfluenced by the type of treatment given in early childhood. It has not been established that acute anticonvulsive treatment with benzodiazepine is better than placebo.
流行病学数据表明，绝大多数热性惊厥儿童的长期预后良好。治疗方面有三个主要问题较为重要：热性惊厥会让家长极为担心，复发率为30%-40%，而且发热状态不可预测，可能会对中枢神经系统造成损害。大家普遍认为，丙戊酸盐、扑米酮或苯巴比妥的每日预防性用药即使要使用，也只应在经过严格挑选的病例中使用。尚无苯妥英钠和卡马西平有效性的相关记录。退热治疗并不能降低复发率。发热时使用地西泮进行间歇性预防，可能会显著降低复发率，也可能不会，但没有数据表明与短期癫痫发作控制相比，它在智商、认知、学业进展、运动控制和后续癫痫方面能改善长期预后。直肠给予地西泮溶液或其他苯二氮䓬类药物进行急性抗惊厥治疗，在终止复发癫痫发作方面几乎与静脉注射治疗效果相当，而且对家长来说安全、简单且易于使用。幼儿期所采用的治疗类型可能不会影响长期预后。尚未证实苯二氮䓬类药物进行急性抗惊厥治疗比安慰剂更有效。
