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● Seizures persisting longer than 5 min are treated as status epilepticus. Rectal Diazepam (5 mg at <20 kg, 10 mg at >20 kg body weight) is a convenient first-line option for small children.
● In children up to 5 years most first-time seizures are accompanied by fever >38°C and require no further treatment in the absence of CNS infection, trauma, tumor, or malformation.
● Recurrent febrile seizures (30% of cases) can be prevented with diazepam given for up to 3 days at the onset of a subsequent febrile event. The otherwise reasonable antipyretic therapy has no preventative effect.
● Afebrile first-time seizures require further diagnostics. Treatment usually starts after the occurrence of at least two unprovoked epileptic seizures or a single episode of status epilepticus. Drug choice depends on the diagnosed epilepsy form.
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