Intellectual progress in relation to anticonvulsant therapy and to recurrence of fits
One hundred and fifteen of 121 children consecutively admitted to hospital, each with his first febrile convulsion, were subsequently assessed on the Griffiths's mental development scales during a period of 24 months The effect of anticonvulsant medication on intellectual development was studied in 50 of the 73 children without recurrence of convulsions who had either continuous phenobarbitone, continuous sodium valproate, or no drugs during the 24-month period. The effect of further fits was studied in 42 of the 115 children who had recurrences. Children with further febrile convulsions showed a decrease in Griffiths's development quotient between the initial and 24-month assessment, whereas children with no subsequent fits showed a trend in the reverse direction. The increase in Griffiths's development quotient in children with no subsequent fits was found irrespective of whether the children were on anticonvulsant medication, but there was a non-significant tendency for this increase to be greatest in the group without drugs. The present study suggests that further fits after an initial febrile convulsion are likely to be more detrimental in terms of overall intellectual development than continuous medication with either phenobarbitone or sodium valproate. If the decision to treat is based on the risk of further fits, the present study supports continuous anticonvulsant medication if this risk is significantly increased, until the child is past the vulnerable period. In children at low risk of further febrile fits, intellectual development may be better if drugs are avoided.
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