may respond differently and become irritable, e.g. with sodium valproate or phenobarbitone. Whether antiepilepsy drugs interfere with later mental and physical development remains uncertain, and it is unwise to assume they do not. The sensible course is to control the epilepsy with monotherapy in minimal doses and with special attention to precipitating factors, and to attempt drug withdrawal when it is deemed safe (see above).
When a child has febrile convulsions the decision to embark on continuous prophylaxis is serious for the child, and depends on an assessment of risk factors, e.g. age, nature and duration of the fits. Most children who have febrile convulsions do not develop epilepsy. Prolonged drug therapy, e.g. with phenytoin or phenobarbitone, has been shown to interfere with cognitive4 development, the effect persisting for months after the drug is withdrawn. Parents may be supplied with a specially formulated solution of diazepam for rectal administration (absorption from a suppository is too slow) for easy and early administration, and advised on managing fever, e.g. use paracetamol at the first hint of fever, and tepid sponging.
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