Lack of efficacy of phenytoin in children presenting with febrile status epilepticus

Abstract

Background: Fever is the most common precipitant of status epilepticus in children. Animal models suggest that only γ-aminobutyric acidic drugs are effective in the treatment of febrile seizures, but there is limited clinical evidence to support this.

Objective: The aim of this study was to determine the efficacy of phenytoin, a sodium channel blocker, in the treatment of febrile status epilepticus in children.

Methods: This study is a retrospective chart review of 56 children (62 episodes) who presented to our emergency department with febrile status epilepticus and received phenytoin. The clinical parameters were evaluated by reviewing the charts. The efficacy of phenytoin was classified into 3 categories: positive, negative, and nonevaluable response.

Results: The primary outcome was to evaluate the efficacy rate of phenytoin; there were 9 (14.5%) of 62 episodes with a positive response, 25 (40.3%) with a negative response, and 28 (45.2%) with a nonevaluable response because phenytoin was given simultaneously with a γ-aminobutyric acidic (GABAergic) drug (P < .001). The secondary outcome was to measure the mean seizure duration for each treatment category, which were 52.8, 109.9, and 52.6 minutes, respectively (P < .01).

Conclusion: Phenytoin is rarely effective in controlling febrile status epilepticus. Children exposed to phenytoin have more prolonged febrile seizures, increasing the risk of brain injury.