The Role of Sodium Valproate Prophylaxis in Preventing Recurrent Complex Febrile Seizures in Children: A Retrospective Study at Tripoli University Hospital, Libya

Abstract

Complex febrile seizures represent a critical clinical scenario in pediatric neurology due to their association with prolonged ictal events, focal features, and heightened parental anxiety. While intermittent or continuous antiseizure prophylaxis is occasionally deployed, the clinical efficacy of prophylactic Depakin (sodium valproate) in preventing recurrent complex febrile seizures remains intensely debated. To evaluate and compare the recurrence rate of febrile seizures in children receiving prophylactic sodium valproate (Depakin) versus those managed without continuous prophylaxis. This retrospective observational comparative study was conducted at the Pediatric Neurology Outpatient Department of Tripoli University Hospital in Libya from February 2023 to March 2026. A total of 115 children aged 9-50 months (68 females [59.1%] and 47 males [40.9%]) with recurrent complex febrile seizures were analysed. Patients were categorised into Group A (n=70) receiving Depakin prophylaxis (15-20 mg/kg/day after normal baseline liver function tests, complete blood count, serum amylase, and coagulation profile) and Group B (n=45) receiving no prophylaxis. Follow-up spanned two years. Group A demonstrated a recurrence rate of 20.0% (14 out of 70 children; 56 with no recurrence), whereas Group B showed a recurrence rate of 24.4% (11 out of 45 children; 34 with no recurrence). The difference in recurrence proportions between the two cohorts was not statistically significant (p = 0.57, chi-square test; relative risk = 0.82). Prophylactic sodium valproate did not yield a statistically significant reduction in complex febrile seizure recurrence compared to unexposed controls. These findings corroborate international consensus advising against universal continuous prophylaxis, emphasising individualised risk-benefit assessments and rigorous safety monitoring.