Clobazam Should NOT Be Prescribed for Simple Febrile Seizure Prophylaxis
The American Academy of Pediatrics explicitly recommends against any continuous or intermittent anticonvulsant prophylaxis—including clobazam—for children with simple febrile seizures, because the potential toxicities outweigh the minimal benefits. 1
Why No Prophylaxis Is Recommended
Simple Febrile Seizures Are Benign
- Simple febrile seizures cause no long-term adverse outcomes: no decline in IQ, academic performance, neurocognitive function, behavioral abnormalities, or structural brain damage. 1, 2
- The risk of developing epilepsy is approximately 1% by age 7 years—identical to the general population—and anticonvulsant prophylaxis does not prevent future epilepsy development. 1, 3
- Even children with multiple simple febrile seizures, first seizure before 12 months, and family history of epilepsy have only a 2.4% risk of developing epilepsy by age 25 years. 1
Harms Clearly Outweigh Benefits
- All anticonvulsants carry unacceptable risks when used for simple febrile seizure prophylaxis, including sedation, drowsiness, ataxia, behavioral changes, and rare serious adverse events. 1
- The harm-benefit analysis unequivocally favors no treatment for simple febrile seizures. 1, 2
If Clobazam Were to Be Used (Against Guidelines)
Although not recommended, research studies have used the following weight-based dosing when clobazam was administered intermittently during febrile episodes:
- Up to 5 kg: 5 mg/day orally 4
- 5 to 10 kg: 10 mg/day orally 4
- 11 to 15 kg: 15 mg/day orally 4
- Over 15 kg: 20 mg/day orally 4
These doses were given during the febrile episode (first 48 hours of fever onset) and resulted in adverse effects in 35.7% of children, including vomiting, somnolence, and hyperactivity. 4
Correct Management Approach
The recommended management is parent education and reassurance rather than medication. 1
Key Points for Parent Counseling
- Simple febrile seizures have an excellent prognosis with no long-term consequences. 1, 2
- Recurrence risk is approximately 30% overall (50% if first seizure occurs before 12 months of age, 30% if after 12 months). 1, 2
- Antipyretics (acetaminophen, ibuprofen) do not prevent febrile seizures or reduce recurrence risk, though they may improve comfort. 1, 2
- Educate families on seizure first aid: position on side, protect head, clear environment, never restrain or place objects in mouth. 1, 2
Critical Pitfall to Avoid
Do not prescribe clobazam, diazepam, phenobarbital, valproic acid, or any other anticonvulsant for prophylaxis of simple febrile seizures. 1 This recommendation is based on high-quality evidence (randomized controlled trials) and represents the clear consensus of the American Academy of Pediatrics. 1, 3