Related Experiment Videos
Lumbar puncture and febrile convulsions
Insights
Fever and seizures in young children can indicate meningitis. Bacterial or viral meningitis is more likely in infants under 6 months, even without neurological signs. Older children with bacterial meningitis are usually identifiable by clinical signs.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
Background:
- Febrile seizures are common in children.
- Distinguishing between simple febrile seizures and meningitis can be challenging.
- Early diagnosis and treatment of meningitis are crucial in pediatric populations.
Purpose of the Study:
- To analyze the incidence of bacterial and viral meningitis in children presenting with their first febrile seizure.
- To identify clinical factors that differentiate meningitis from simple febrile seizures in children.
- To assess the diagnostic utility of clinical presentation and lumbar puncture in young children with febrile seizures.
Main Methods:
- Retrospective analysis of 878 children (1 month to 6 years) with a first febrile seizure.
- Comparison of clinical findings and cerebrospinal fluid (CSF) analysis in children who underwent lumbar puncture (LP) versus those who did not.
- Evaluation of age, neurological signs, and seizure characteristics as predictors of meningitis.
Main Results:
- Bacterial meningitis was diagnosed in 7 children and viral meningitis in 14 children who underwent LP.
- In children not undergoing LP, clinical course excluded bacterial meningitis in 598 out of 623 cases.
- Children under 6 months had a higher probability of meningitis, irrespective of initial neurological signs. Complex seizures were significant in differentiating viral meningitis in children aged 6 months to 3 years without neurological signs.
Conclusions:
- Meningitis should be strongly considered in children under 6 months presenting with febrile seizures, even without focal neurological deficits.
- Clinical assessment is often sufficient to rule out bacterial meningitis in older children with febrile seizures.
- Complex seizures may aid in identifying viral meningitis in specific pediatric age groups.
Abstract:
We report the data of 878 selected children between 1 month and 6 years, presenting a first episode of seizure with fever. Two-hundred-fifty-five children underwent lumbar puncture. In 7 cases the CSF findings showed a bacterial meningitis, in 14 cases a viral meningitis. In 598 of the 623 children who did not undergo LP, a bacterial meningitis could be excluded on the basis of the clinical course. The data show that the probability of finding a bacterial or viral meningitis is high in children under 6 months of age even if no significant neurological signs are found on examination performed shortly after the seizure. In our study, older children affected by bacterial meningitis were clinically identifiable. In children aged 6 months to 3 years without important neurological signs, a complex seizure has been found to be a significant discriminating factor between patients with and without viral meningitis.