| ObjectiveFebrile seizures(FS)is a common nervous system disease in childhood.Preventive treatment of FS recurrence has always been the direction of clinical research.At present,it is believed that long-term or intermittent use of carbamazepine,phenobarbital and other antiepileptic drugs has no obvious effect on the prevention of recurrent FS.Recent studies suggest that short-term oral administration of levetiracetam(LEV)can play a certain role in preventing the recurrence of FS.Therefore,this study comprehensively screened the risk factors of recurrent FS;By comparing the clinical efficacy of short-term oral levetiracetam and diazepam(DZP)in the prevention of recurrent FS,we explored the effectiveness and safety of oral LEV in the treatment of recurrent FS,and provided reliable evidence-based medical evidence for the clinical prevention of FS recurrence.MethodsThis study collected 131 children who had recurrent febrile convulsions and were diagnosed as recurrent febrile convulsions for more than 5 times within a year and were treated in the Department of Neurology of Shenyang Children’s Hospital from November 2019 to February 2022 as the study subjects.23 cases were lost,and 108 cases were finally included.When the children were enrolled,they received comprehensive clinical data collection such as gender,age,time of fever before onset,FS family history,whether there was premature infant,delivery mode,etc.,and recorded the time of convulsion during FS onset,temperature at onset,number of convulsions within 24 hours of the first onset,type of convulsion,time between fever and convulsion,EEG results,and using levetiracetam or diazepam during treatment.All children were followed up for 48 weeks.The patients were divided into recurrent group and non-recurrent group according to whether FS recurred during the follow-up period.The risk factors of FS recurrence were screened out through binary logistic regression analysis.The 108 children in the study were treated with routine symptomatic treatment and intermittent short-term prophylaxis.And the number of cases was 37 refusing the intervention of diazepam and levetiracetam.The patients agreed to intermittent short-term prophylaxis were randomly divided into diazepam group and levetiracetam group.The number of cases in diazepam group was 42,during the treatment period and 48 weeks follow-up visits,diazepam group was given diazepam orally for 2 days.Levetiracetam group was given levetiracetam orally for 2 days.The number of cases was 29.After treatment and 4 follow-up visits,the number of fever,the number of days of fever,the number of recurrent seizures,the number of recurrent seizures,the recurrence rate,FS control and recurrence rate,and the incidence of adverse reactions were observed and compared.Results1.By comparing the clinical indicators of the recurrent group and the non-recurrent group,it was found that 26 patients younger than 3 years old(76.47%)in the recurrent group were higher than 42 patients younger than 3 years old(56.76%)in the non-recurrent group;27 children(79.41%)with FS family history in the recurrent group were higher than those in the non-recurrent group 30(40.54%);28(82.35%)of the children in the recurrent group had a body temperature≥ 38.5℃ at the time of attack,which was higher than 39(52.70%)of the children in the non-recurrent group;The use of levetiracetam in 4 patients(11.76%)in the recurrent group was lower than that in 25 patients(33.33%)in the non-recurrent group;Seven cases(20.59%)of diazepam in the recurrent group were lower than 35 cases(47.30%)of diazepam in the non-recurrent group.The difference between the two groups was statistically significant(P<0.05).Age,family history of FS,body temperature at onset,whether to use levetiracetam,and whether to use diazepam were included in the logistic regression analysis.The results showed that whether to have a family history of FS(B=1.068,OR=3.124,P=0.049),whether to use levetiracetam(B=-2.288,OR=0.101,P=0.001),and whether to use diazepam(B=-2.334,OR=0.097,P<0.001)were independently related to FS recurrence.2.Diazepam group:20 males and 17 females,aged from 6 months to 6 years,with an average age of(3.86 ± 0.79)years.The number of previous episodes was 5-10,with an average of(7.26 ± 1.03),141 of simple type,106 of complex type,19 of genetic history,23 of viral infection at the time of enrollment;In levetiracetam group,there were 17 males and 12 females,ranging in age from 6 months to 6 years,with an average age of(3.74 ± 0.78)years.The number of previous episodes was 5-10,with an average of(7.31±1.10),122 of simple type,96 of complex type,16 of genetic history,18 of viral infection at the time of enrollment.There was no statistically significant difference in general data between the two groups(P>0.05).3.Observe the frequency of fever,the number of days of fever,the number of recurrent convulsions,the number of recurrent convulsions,the recurrence rate of FS and the recurrence rate of FS in diazepam group were(16.31 ± 2.41),(6.05 ± 0.51),(2.89 ± 0.40),7 cases,17.72%and 18.92%respectively;The number of fever,days of fever,number of recurrent convulsions,number of recurrent convulsions,recurrence rate of FS and recurrence rate of FS in levetiracetam group were observed to be(15.99± 2.38),(6.00 ± 0.50),(2.71 ± 0.36),4 cases,16.95%and 13.79%respectively.The number of recurrent convulsions,the number of recurrent convulsions,the recurrence rate of FS,the recurrence rate of FS and the total recurrence rate of FS in levetiracetam group were slightly lower than those in diazepam group,but the difference was not statistically significant(P>0.05).The control and recurrence rates of diazepam group were 81.08%and 18.92%respectively;The control and recurrence rates of levetiracetam group were 86.21%and 13.79%respectively,and there was no statistically significant difference between the two groups(P>0.05).4.Observe 2 cases of dizziness,3 cases of lethargy,1 case of respiratory depression and 2 cases of lacking in strength in diazepam group,and only 1 case of lethargy in levetiracetam group.The total incidence of adverse reactions in levetiracetam group is lower than that in diazepam group,and the difference is statistically significant(P<0.05).Conclusions1.The family history of FS was independently related to FS recurrence,diazepam or levetiracetam short-term oral administration can prevent the recurrence of febrile convulsions.2.Levetiracetam short-term oral administration can prevent the recurrence of febrile convulsions,and its effect is equivalent to that of diazepam short-term oral administration.3.The use of levetiracetam orally to prevent FS recurrence is relatively safe,and its adverse reaction rate is lower than that of diazepam. |
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