Primary prevention
Complete prevention through avoidance of fever is impossible given that young children are exposed to numerous common infectious illnesses in childhood. Optimum hygiene in childcare facilities reduces risk of exposure to febrile illness.
Secondary prevention
The occurrence of a febrile seizure may depend, among other factors, on a child's individual seizure threshold temperature.[61] Recurrence may be less likely if the body temperature does not rise above this threshold. Exposure to infectious fevers can be reduced by the observation of optimal hygienic measures (e.g., frequent hand-washing) at home and at child care centres. Immunisations should be current and complete. Vaccinating children at the recommended age may prevent some febrile seizures by protecting children against measles, mumps, rubella, chickenpox, influenza, pneumococcal infections, and other diseases that can cause fever and febrile seizures.[122] Influenza vaccines are indicated, particularly in populations subject to epidemics. The measles, mumps, and rubella (MMR) and MMR-varicella combination vaccines are both associated with an increased risk of seizures.[29][31]
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Children at risk of developing a febrile seizure should rather receive MMR and varicella vaccines separately, to reduce risk of recurrence owing to the higher risk of seizures associated with the MMR-varicella combination vaccines.[31] Pharmacological treatment may be indicated in a small group to minimise recurrence in patients with a history of prior febrile seizures, especially when prolonged, and in status epilepticus. This subgroup is likely to have an underlying genetic epilepsy (i.e., SCN1A mutations). Antiepileptics (phenobarbital and valproic acid) have shown efficacy in preventing febrile seizures, but side effects may outweigh benefits.[98] Antipyretics are useful in treatment of discomfort relating to fever, but are not effective in prevention.[80] One study from Japan indicated that prophylactic paracetamol may reduce febrile seizure recurrence following an initial episode. However methodological considerations mean this study is unlikely to be applicable to other health care systems.[123]
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