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Postictal cerebrospinal fluid abnormalities in children
M Wong1, B L Schlaggar, M Landt
1Department of Neurology, Washington University School of Medicine, St Louis, Missouri, USA.
Insights
Cerebrospinal fluid (CSF) abnormalities after seizures are uncommon in children. Doctors should investigate other causes for any abnormal CSF findings in pediatric patients post-seizure.
Area of Science:
- Pediatric Neurology
- Neuroimmunology
- Clinical Diagnostics
Background:
- Seizures in children can sometimes lead to changes in cerebrospinal fluid (CSF) composition.
- Understanding these changes is crucial for accurate diagnosis and to rule out other serious conditions.
Purpose of the Study:
- To determine the frequency and characteristics of seizure-induced CSF abnormalities in children.
- To identify potential alternative causes for observed CSF findings in pediatric patients.
Main Methods:
- Retrospective analysis of 80 children who had lumbar puncture within 24 hours of a seizure.
- CSF analysis for leukocytes and protein, using age-specific reference values.
- Identification of coexisting conditions that could affect CSF results, such as meningitis or traumatic lumbar puncture.
Main Results:
- 18 patients were excluded due to confounding conditions; over 50% had abnormal CSF.
- Two excluded patients had undiagnosed meningitis.
- In the remaining 62 patients, postictal pleocytosis (5%) and increased protein (10%) were rare and mild.
Conclusions:
- Seizure-induced CSF abnormalities are infrequent in children.
- Alternative disease processes often explain postictal CSF abnormalities.
- Thorough evaluation for other causes is essential for any child with abnormal CSF after a seizure.
Objectives:
To determine the frequency and characteristics of seizure-induced cerebrospinal fluid (CSF) abnormalities in children and to identify potential alternative causes of these findings.
Methods:
Consecutive patients (n = 80) who underwent lumbar puncture within 24 hours after a seizure were studied retrospectively. The presence of CSF abnormalities in total leukocytes, polymorphonuclear cells, and protein was determined by using age-specific reference values. Coexisting conditions that could affect CSF findings, such as traumatic lumbar puncture, concurrent neurologic disease, and undiagnosed meningitis, were identified.
Results:
Eighteen of the 80 patients were excluded from the final study group because of the presence of another condition that could alter the CSF. More than 50% of the excluded patients had an abnormal CSF leukocyte count or protein level, including 2 patients with initially undiagnosed meningitis, which was subsequently detected by post-hoc polymerase chain reaction testing. In the remaining 62 patients, postictal pleocytosis was detected in only 3 (5%), and increased protein was detected in only 6 (10%). The maximal postictal pleocytosis and protein level were 8 x 10(6) leukocytes/L (8 leukocytes/mm(3)) and 0.52 g/L (52 mg/dL), respectively.
Conclusions:
Seizure-induced CSF abnormalities are rare in children, and alternative, often unidentified, disease processes may account for many observed postictal abnormalities. All patients with abnormal CSF after a seizure should be thoroughly evaluated for other causes of the abnormality.