DOI: https://dx.doi.org/10.18203/2349-3291.ijcp20214867
Published: 2021-12-24

The rationality behind performance of routine lumber puncture in simple febrile seizure in 6-18 months old children

Sarful Ali, Kalpana Datta, Balai Chandra Karmakar

Abstract


Background: Pediatrics seizures can be either due to febrile seizure or underlying serious infection such as meningitis. It is important to rule out meningitis in children presenting with fever and seizure. The aim of the study was conducted to assess the necessity of routine lumber puncture and to determine the incidence of meningitis among children aged 6 to 18 months presenting with first episode of febrile seizure.

Methods: This prospective observational study was conducted among 47 children with first episode of simple febrile seizure presenting to emergency in Medical College Kolkata, West Bengal from April 2018 to September 2019.

Results: Total 47 children were studied among 32 (68%) children were between 6-12 months and 15 (32%) were between 12-18 months of age. Only 1 child (2.1%) diagnosed as meningitis. Clinically 7 children (14.9%) showed signs of sepsis and meningitis like picture and 6 children (12.8%) were in 6-12 months of age and only 1 child (2.1%) was in 12-18month of age. Only 1 child in 6-12 months of age showed CSF positive and all other CSF studies were within normal limit. A significant association was seen between age group and hyponatremia and family history of febrile seizure (p<0.05). There was no statically significant between clinical diagnosis and CSF results (p=0.15).

Conclusions: The risk of meningitis in children presenting with simple febrile seizure between 6-18 months of age is very low, specially in 12-18 months of age. Therefore, current guidelines regarding lumber puncture in simple febrile seizure should be reconsidered.

 


Keywords


Meningitis, Lumber puncture, Simple febrile seizure

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References


Watemberg N, Sarouk I, Fainmesser P. Acute meningitis among infants and toddlers with febrile seizures: time for a reappraisal of the value of a lumbar puncture. Isr Med Assoc J. 2012;14(9):547-9.

Royal College of Obstetricians and Gynaecologists, National Collaborating Centre for Women’s, Children’s Health. Bacterial meningitis and meningococcal septicaemia in children. London: FiSH Books; 2010.

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.

Nozicka C. Lumbar puncture and the first simple febrile seizure. Pediatrics. 1997;99(2):306-7.

Rosenberg NM, Simon JE, Felter R, Davis AT. Lumbar puncture for first febrile seizure? Pediatr Emerg Care. 1992;8(5):300-1.

Trainor JL, Hampers LC, Krug SE, Listernick R. Children with first-time simple febrile seizures are at low risk of serious bacterial illness. Acad Emerg Med. 2001;8(8):781-7.

Zadeh A, Dubos F, Hue V, Pruvost I, Bennour A, Martinot A. Risk of bacterial meningitis in young children with a first seizure in the context of fever: a systematic review and meta-analysis. PLoS One. 2013;8(1):55270.

Oluwabusi T, Sood SK. Update on the management of simple febrile seizures: emphasis on minimal intervention. Curr Opin Pediatr. 2012;24(2):259-65.

Millichap JJ, Gordon MJ. Methods of investigation and management of infections causing febrile seizures. Pediatr Neurol. 2008;39(6):381-6.

Lewis HM, Parry JV, Parry RP, Davies HA, Sanderson PJ, Tyrrell DA, et al. Role of viruses in febrile convulsions. Arch Dis Child. 1979;54(11):869-76.

Bhandari NR. Febrile Convulsion. Indian J Child Health. 1959;580-4.

Deng CT, Zulkifi HI, Azizi BHO. Febrile seizures in Malaysian children: Epidemiology and clinical features. Med J Malaysia. 1994;49(4):341-7.

Winkler AS, Tluway A, Schmutzhard E. Febrile seizures in rural Tanzania: hospital-based incidence and clinical characteristics. J Trop Pediatr. 2013;59(4):298-304.

Ojha A, Shakya K, Aryal U. Recurrence Risk of Febrile Seizures in Children. J Nepal Paediatr Soc. 1970;32(1):33-6.

Chung B, Wat LC, Wong V. Febrile seizures in southern Chinese children: incidence and recurrence. Pediatr Neurol. 2006;34(2):121-6.

Sweeney A, Gibbs J, Monteil F, Appleton R, Choonara I. The management of febrile seizures in the Mersey Region. Dev Med Child Neurol. 1996;38(7):578-84.

Simpson H, Habel AH, George EL. Cerebrospinal fluid acid-base status and lactate and pyruvate concentrations after short (less than 30 minutes) first febrile convulsions in children. Arch Dis Child. 1977;52(11):836-43.

Sehgal H, Bala K. Febrile convulsions in children. (a clinical profile of 150 cases). Indian Pediatr. 1979;16(6):479-82.

Tavasoli A, Afsharkhas L, Edraki A. Frequency of Meningitis in Children Presenting with Febrile Seizures at Ali-Asghar Children's Hospital. Iran J Child Neurol. 2014;8(4):51-6.

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.

Lima EG. A Critical Analysis of Lumbar Puncture in the Emergency Management of Febrile Seizures: A Cross- Sectional Study. EC Paediatr. 2018;737-46.

Offringa M, Moyer VA. Evidence based paediatrics: Evidence based management of seizures associated with fever. BMJ. 2001;323(7321):1111-4.

Chang YC, Guo NW, Wang ST, Huang CC, Tsai JJ. Working memory of school-aged children with a history of febrile convulsions: a population study. Neurology. 2001;57(1):37-42.

Rutter N, Smales OR. Role of routine investigations in children presenting with their first febrile convulsion. Arch Dis Child. 1977;52(3):188-91.

American Academy of Pediatrics. Provisional Committee on Quality Improvement, Subcommittee on Febrile Seizures. Practice parameter: the neurodiagnostic evaluation of the child with a first simple febrile seizure. Pediatrics. 1996;97(5):769-72.

Shaked O, Peña 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.

Shaked O, Peña 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.

Kimia A, Joseph EP, Rudloe T, Capraro A, Sarco D, Hummel D, et al. Yield of lumbar puncture among children who present with their first complex febrile seizure. Pediatrics. 2010;126(1):62-9.