Febrile seizures: clinical course and diagnostic evaluation
1Department of Pediatrics, Taleghani Hospital, Shaheed Beheshti University of Medical Sciences, Tehran, Iran.
Insights
Lumbar puncture is recommended for infants under 12 months with fever and seizures to diagnose serious infections. This procedure is strongly considered for children aged 12-18 months and mandatory for older children with meningeal irritation signs.
Area of Science:
- Pediatrics
- Neurology
- Infectious Diseases
Background:
- Fever and seizures in children are common reasons for hospital admission.
- Distinguishing between simple febrile seizures and serious central nervous system infections like meningitis is crucial for appropriate management.
- Lumbar puncture is an invasive procedure, and defining clear indications is essential to avoid unnecessary risks while ensuring timely diagnosis of critical conditions.
Purpose of the Study:
- To document the pattern of illness in children presenting with fever and seizures.
- To define specific indications for performing lumbar puncture in this pediatric population.
- To evaluate the diagnostic yield of lumbar puncture in identifying bacterial meningitis.
Main Methods:
- A retrospective study was conducted on 111 children admitted to a university hospital with fever and seizures.
- Clinical data, including symptoms, signs (e.g., meningeal irritation, drowsiness), and diagnostic findings, were collected.
- Cerebrospinal fluid analysis results from lumbar punctures were reviewed.
Main Results:
- Out of 111 children, 105 had simple febrile seizures, 4 had bacterial meningitis, and 2 had aseptic meningitis.
- Common causes of fever included gastro-enteritis (39 children) and upper respiratory tract infections (40 children).
- Most children (93) were drowsy, but only one showed signs of meningeal irritation; however, one bacterial meningitis case lacked these signs.
Conclusions:
- Lumbar puncture should be performed on all infants under 12 months presenting with fever and convulsions.
- Lumbar puncture should be strongly considered for children between 12 and 18 months with fever and convulsions.
- In children over 18 months, lumbar puncture is mandatory if signs of meningeal irritation are present.
Abstract:
A study was done on 111 children admitted in a university hospital in Tehran with fever and seizures to document the pattern of illness and to define indications for performing a lumbar puncture in children with fever and convulsions. Bacterial meningitis was diagnosed in 4 patients, aseptic meningitis in 2 and 105 children had febrile seizures. The cause of fever was gastro-enteritis in 39 patients and upper respiratory tract infection with or without Otitis media in 40. Although most patients were drowsy on admission (n = 93), none had any signs of meningeal irritation, except one child with slight nuchal rigidity. Out of the 4 children with bacterial meningitis, 3 had meningeal signs, but in one 10 month old baby with no signs, the diagnosis was made on the cerebro-spinal fluid findings after a lumbar puncture. These results support the view that a lumbar puncture should be performed on all infants under 12 months who present with fever and convulsions and strongly considered between 12 and 18 months. After 18 months a lumbar puncture is mandatory in the presence of signs of meningeal irritation.
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