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Utility of Lumbar Puncture in Children Presenting With Status Epilepticus

Kenneth A Michelson1, Todd W Lyons, Kara B Johnson

  • 1From the Division of Emergency Medicine, Boston Children's Hospital Boston, MA.

Pediatric Emergency Care
|July 12, 2017
PubMed

Insights

Bacterial meningitis is rarely the cause of first-time seizures in children. This study found bacterial meningitis in less than 1% of pediatric patients experiencing status epilepticus (SE).

Area of Science:

  • Pediatric Neurology
  • Infectious Diseases
  • Epileptology

Background:

  • Meningitis can precipitate seizures, particularly in children.
  • Status epilepticus (SE) is a neurological emergency requiring prompt diagnosis.
  • Understanding the etiology of SE is crucial for appropriate management.

Purpose of the Study:

  • To determine the frequency of meningitis as a cause of first-time status epilepticus (SE) in pediatric patients.
  • To investigate the diagnostic yield of lumbar puncture in children presenting with SE.

Main Methods:

  • Retrospective cross-sectional study of children (1 month to 21 years) with first-time SE and lumbar puncture (LP).
  • Bacterial meningitis defined by positive cerebrospinal fluid (CSF) culture or CSF pleocytosis with positive blood culture.
  • Viral meningitis/encephalitis diagnosed via enterovirus or herpes simplex virus PCR.

Main Results:

  • Of 126 children with SE and LP, 8 (6%) had CSF pleocytosis; one (0.8%) had confirmed bacterial meningitis.
  • Antibiotics were administered before LP in 5 children with pleocytosis.
  • Viral causes included enteroviral meningitis (15%) and herpes simplex virus infection (2%).

Conclusions:

  • Bacterial meningitis is an uncommon cause of status epilepticus in children.
  • Prompt diagnosis and treatment of SE are essential, considering diverse etiologies.
  • Further research may explore optimal diagnostic pathways for pediatric SE.
Abstract

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