Dose of Frisium (Clobazam) in Simple Febrile Seizures
Frisium (clobazam) should NOT be prescribed for simple febrile seizures, as the American Academy of Pediatrics explicitly recommends against both continuous and intermittent anticonvulsant prophylaxis in these children due to potential toxicities clearly outweighing the minimal risks. 1, 2
Why No Prophylaxis is Recommended
The harm-benefit analysis unequivocally favors no treatment for simple febrile seizures. 2 The rationale is straightforward:
Simple febrile seizures cause no long-term harm: No decline in IQ, academic performance, neurocognitive function, behavioral abnormalities, or structural brain damage occurs from recurrent simple febrile seizures. 1, 2
Risk of epilepsy is extremely low: The risk of developing epilepsy by age 7 is approximately 1%, identical to the general population. Even high-risk children (multiple seizures, age <12 months at first seizure, family history of epilepsy) have only 2.4% risk of epilepsy by age 25 years. 2
Prophylaxis does not prevent epilepsy: No medication has been shown to prevent future afebrile seizures (epilepsy), as epilepsy development is likely due to genetic predisposition rather than the febrile seizures themselves. 1, 2
Why Clobazam Specifically Should Not Be Used
While research studies have compared clobazam to diazepam for intermittent prophylaxis 3, 4, these studies do not override the clear guideline recommendation against any prophylactic therapy. The American Academy of Pediatrics guideline is based on aggregate evidence quality B from randomized controlled trials and explicitly states that neither continuous nor intermittent anticonvulsant therapy should be used for children with one or more simple febrile seizures. 2, 5
What About Recurrence Risk?
- Children younger than 12 months at first seizure have approximately 50% probability of recurrent febrile seizures. 2
- Children older than 12 months at first seizure have approximately 30% probability of a second febrile seizure. 2
- However, recurrent simple febrile seizures cause no harm and do not warrant prophylactic treatment. 2
Appropriate Management Instead
The correct approach is parent education and reassurance, not medication: 1, 2, 5
- Educate caregivers about the benign nature of simple febrile seizures and excellent prognosis. 2, 5
- Provide practical guidance on home management of seizures (positioning on side, protecting head, removing harmful objects). 2
- Explain when to seek emergency care: first-time seizure, seizure lasting >5 minutes, multiple seizures without return to baseline, or seizure with traumatic injury or breathing difficulties. 2, 5
- Antipyretics (acetaminophen, ibuprofen) may be used for comfort but do not prevent febrile seizures or reduce recurrence risk. 2, 5
Critical Pitfall to Avoid
Do not prescribe clobazam, diazepam, phenobarbital, valproic acid, or any other anticonvulsant for simple febrile seizure prophylaxis. 1, 2, 5 The guideline recommendation is unequivocal and based on high-quality evidence demonstrating that the risks of these medications (including sedation, drowsiness, ataxia, behavioral changes, and rare serious adverse effects) outweigh any benefit in this benign condition. 1, 2