COMMENT. The authors advocate the prevention of recurrence of all febrile seizures and recommend oral diazepam, taken at the first sign of illness, as the optimal prophylactic medication. The benefit demonstrated in this zealously monitored study may not be duplicated in practice when compliance is often less than satisfactory. In a previous controlled trial, Autret and colleagues in France found the results of intermittent oral diazepam therapy disappointing, a lack of efficacy explained by poor compliance [2]. An approved rectal preparation of diazepam for the home treatment of the acute febrile seizure in high risk patients may offer one alternative to the universal prophylactic intermittent regimen proposed. A survey of pediatric neurologists found only 22% in favor of diazepam (mean dose, 0.46 mg/kg/day at times of fever) in 1990 [3]. A more general acceptance of diazepam by pediatricians and parents may be expected following the Boston report, and the results of this wider experience will determine the practical value and safety of this form of treatment.

A clearer understanding of the mechanism of susceptibility to febrile seizures may lead to more specific therapies. Experiments at Ehime Univ School of Medicine, Japan, demonstrate a hyperthermia-induced increase in cortical extracellular glutamate correlating with a decrease in seizure threshold temperature in rats. [4]