Remember me
Objectives
To evaluate the need for lumbar puncture (LP) in children aged 6 to 60 months experiencing their first febrile seizure, regardless of seizure type, and to determine if LP is particularly beneficial for those under 12 months old.
Materials & Methods
In this retrospective study, data from 253 children who presented with first febrile seizure were analyzed. All patients in this study underwent LP and were divided into two groups based on their cerebrospinal fluid (CSF) results: non-pleocytosis and pleocytosis. Patients were evaluated for age, sex, familial history of seizure, and type and duration of seizures. They were also evaluated based on laboratory results, including blood tests, CSF analysis, and electroencephalography.
Results
Sixty-seven (25.9%) of the 253 patients were under 12 months of age, and only two of the 67 patients (2.8%) had pleocytosis. Patients younger than 12 months did not have a higher rate of complex febrile seizure or pleocytosis than those over 13 months of age. None of the patients had bacterial meningitis. Regarding viral meningitis, seven patients (5.3%; age mean SD, 12.3±1.8 months) were diagnosed with enteroviral meningitis, though only one of them had pleocytosis. When compared to the non-pleocytosis group, the pleocytosis group showed no differences in clinical characteristics (age, sex, familial history of seizure, type, and duration of seizure), laboratory results, or the use of antiepileptic drugs.
Conclusion
The present study suggests that LP should be carefully considered in children with first febrile seizure, including children under 12 months of age
1. Shaked O, Pena BM, Linares MY, Baker RL. Simple febrile seizures: are the AAP guidelines regarding lumbar puncture being followed? Pediatr Emerg Care. 2009;25(1):8-11.
2. Steering Committee on Quality Improvement and Management Subcommittee on Febrile seizures. Febrile seizures: clinical practice guideline for the long-term management of the child with simple febrile seizures. Pediatrics. 2008;121(6):1281-6.
3. Subcommittee on Febrile Seizrues, American Academy of Pediatrics. Neurodiagnostic evaluation of the child with a simple febrile seizure. Pediatrics. 2011;127(2):389-94.
4. Lee JH, Cho HK, Kim KH, et al. Etiology of invasive bacterial infections in immunocompetent children in Korea (1996-2005): a retrospective multicenter study. J Korean Med Sci. 2011;26(2):174-83.
5. Rhie K, Choi EH, Cho EY, et al. Etiology of Invasive Bacterial Infections in Immunocompetent Children in Korea (2006-2010): a Retrospective Multicenter Study. J Korean Med Sci. 5 2018;33(6):e45.
6. Rosenberg NM, Meert K, Marino D, De Baker K. Seizures associated with meningitis. Pediatr Emerg Care. 1992;8(2):67-9.
7. Rosman NP, Peterson DB, Kaye EM, Colton T. Seizures in bacterial meningitis: prevalence, patterns, pathogenesis, and prognosis. Pediatr Neurol. 1985;1(5):278-85.
8. Guedj R, Chappuy H, Titomanlio L, et al. Risk of Bacterial Meningitis in Children 6 to 11 Months of Age With a First Simple Febrile Seizure: A Retrospective, Cross-sectional, Observational Study. Acad Emerg Med. 2015;22(11):1290-7.
9. Kimia AA, Capraro AJ, Hummel D, Johnston P, Harper MB. Utility of lumbar puncture for first simple febrile seizure among children 6 to 18 months of age. Pediatrics. 2009;123(1):6-12.
10. Seltz LB, Cohen E, Weinstein M. Risk of bacterial or herpes simplex virus meningitis/encephalitis in children with complex febrile seizures. Pediatr Emerg Care. 2009;25(8):494-7.
11. Correa-Lima AR, de Barros Miranda-Filho D, Valenca MM, Andrade-Valenca L. Risk Factors for Acute Symptomatic Seizure in Bacterial Meningitis in Children. J Child Neurol. 2015;30(9):1182-5
12. Green SM, Rothrock SG, Clem KJ, Zurcher RF, Mellick L. Can seizures be the sole manifestation of meningitis in febrile children? Pediatrics. 1993;92(4):527-34.
13. Sales JW, Bulloch B, Hostetler MA. Practice variability in the management of complex febrile seizures by pediatric emergency physicians and fellows. CJEM. 2011;13(3):145-9.
14. Kimia A, Ben-Joseph EP, Rudloe T, et al. Yield of lumbar puncture among children who present with their first complex febrile seizure. Pediatrics. 2010;126(1):62-9.
15. Fletcher EM, Sharieff G. Necessity of lumbar puncture in patients presenting with new onset complex febrile seizures. West J Emerg Med. 2013;14(3):206-11.
16. Guedj R, Chappuy H, Titomanlio L, et al. Do All Children Who Present With a Complex Febrile Seizure Need a Lumbar Puncture? Ann Emerg Med. 2017;70(1):52-62 e6.
17. Rotbart HA. Viral meningitis. Semin Neurol. 2000;20(3):277-92.
18. Ben Abid F, Abukhattab M, Ghazouani H, et al. Epidemiology and clinical outcomes of viral central nervous system infections. Int J Infect Dis. 2018;73:85-90.
19. Hudson JA, Broad J, Martin NG, et al. Outcomes beyond hospital discharge in infants and children with viral meningitis: A systematic review. Rev Med Virol. 2020;30(2):e2083.
20. Benschop KS, Schinkel J, Minnaar RP, et al. Human parechovirus infections in Dutch children and the association between serotype and disease severity. Clin Infect Dis. 15 2006;42(2):204-10.
21. Han TH, Chung JY, You SJ, Youn JL, Shim GH. Human parechovirus-3 infection in children, South Korea. J Clin Virol. 2013;58(1):194-9.
22. Wolthers KC, Benschop KS, Schinkel J, et al. Human parechoviruses as an important viral cause of sepsislike illness and meningitis in young children. Clin Infect Dis. 1 2008;47(3):358-63.
23. Chakrabarti P, Warren C, Vincent L, Kumar Y. Outcome of routine cerebrospinal fluid screening for enterovirus and human parechovirus infection among infants with sepsis-like illness or meningitis in Cornwall, UK. Eur J Pediatr. 2018;177(10):1523-1529.
24. Song JY, Nam SO, Kim YA, et al. Cerebrospinal fluid non-pleocytosis in pediatric enteroviral meningitis: Large-scale review. Pediatr Int. 2018;60(9):855-861.
Comments (0)