My 12-month old recently had a complex febrile seizure, although there is some question as to exactly what type of seizure he actually had. It lasted about 30 minutes, and they're not sure if it was a focal seizure. He was intubated and spent two days in the PICU because he wasn't waking up correctly. His CT, EEG, and LP were all negative. The MRI results aren't in yet. My question is about phenobarbital -- are there any side affects for usage up to a year? Also, since this seizure was pretty bad, do I have to be afraid every time he gets a cold?
There are many medicines available for trying to prevent seizures. Phenobarbital has been used for quite some time for this purpose. The main side effects seen are hyperactivity, irritability, decreased attention span, severe temper tantrums, and allergic reactions.
The biggest concern with phenobarbital is that in some kids, it affects their intelligence. Phenobarbital has not been all that effective in preventing simple febrile seizures, but in complex seizures it may be worth it.
Another option that is sometimes done is to give a tiny bit of diazepam (Valium) just during illnesses with fevers.
The negative EEG and CT are very encouraging. Some people watch and wait without anticonvulsants after the first seizure if the neurological exam was normal after the episode was over and the EEG and CT were both normal. You will want to work with a pediatric neurologist to make these decisions. Ask them to compare options in your son's case -- medicines, no medicines, or medicines only during fevers (a recent approach, by no means universally agreed upon). If medicines are recommended, ask them to compare and explain to you the different side effects of a couple of different options.
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