Scheduled Acetaminophen and Febrile Seizure

November 26, 2018

Summary by Alex Chen

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Patients given scheduled acetaminophen (APAP) after a febrile seizure had a lower rate of seizure recurrence during the same febrile illness as compared to the no-APAP group (9.1% vs 23.5% respectively).

Why does this matter?
Febrile seizures are the most common type of seizure in childhood and often end up in the ED. While the prognosis is great, it can be very distressing for patients and their families. Besides good return precautions, reassurance, and follow-up, there is not much more we can offer these patients. Previous trials have not shown a difference in seizure recurrence with acetaminophen vs placebo. 

Tylenol is the new ‘tussin – good for what ails ya
This was a randomized controlled trial conducted at a single center in Japan. 438 patients who had a single febrile seizure were randomized to either APAP 10mg/kg PR q6h for 24h or no-APAP. 15 patients were ultimately excluded (10 for non-adherence, 5 lost to follow-up). They were well randomized, with similar baseline labs. 

When they looked at all patients, the recurrence rate was 9.1% in the APAP group vs 23.5% in the no-APAP group (P<0.001). This effect was larger in the 22-60m age group when stratified by age (4.1% APAP vs 22.6% no-APAP, P<0.001). Ultimately, they did not report any serious complications from the febrile seizures or the APAP (hypotension, anaphylaxis, hypothermia).

You should take this with caution, as this is the first RCT to show that APAP has an effect on febrile seizure recurrence rate. However, if you are giving APAP for symptom control then you might as well schedule it. It could potentially save people from a bounce-back visit and has little downside.

Source
Acetaminophen and Febrile Seizure Recurrences During the Same Fever Episode. Pediatrics. 2018 Oct 8. pii: e20181009. doi: 10.1542/peds.2018-1009. [Epub ahead of print]

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Reviewed by Clay Smith