Cerebrospinal fluid analysis in children with seizures

Area of Science:

• Pediatric Neurology
• Clinical Neurophysiology
• Cerebrospinal Fluid Analysis

Background:

• Seizures in young children are common, with various types including febrile and nonfebrile seizures.
• Cerebrospinal fluid (CSF) analysis is often performed after seizures to rule out central nervous system infections.
• The potential for idiopathic seizures themselves to cause transient CSF abnormalities is not fully elucidated.

Purpose of the Study:

• To investigate whether idiopathic seizures in children can lead to abnormal findings in cerebrospinal fluid (CSF).
• To establish reference ranges for CSF parameters in children experiencing seizures.
• To determine thresholds for CSF abnormalities that should not be attributed to seizures alone.

Main Methods:

• Retrospective review of CSF examination results from 212 children aged 2-24 months.
• Patients included those with idiopathic nonfebrile seizures, complex febrile seizures, or status epilepticus.
• Lumbar punctures were performed within 24 hours of seizure occurrence.

Main Results:

• Children with complex febrile seizures showed median CSF white blood cell (WBC) counts of 1 cell/mm³ and polymorphonuclear (PMN) counts of 0 cells/mm³.
• Elevated WBC counts (>5 cells/mm³) occurred in 9.8% and elevated PMN counts (>0 cells/mm³) in 26.2% of complex febrile seizure patients.
• 95th percentile CSF values were determined: 8 WBC/mm³, 4 PMN/mm³, 73 mg/dl protein, and 119 mg/dl glucose for complex febrile seizures.

Conclusions:

• Idiopathic nonfebrile seizures, complex febrile seizures, and status epilepticus can influence CSF findings in children.
• CSF findings with >20 WBC/mm³ or >10 PMN/mm³ should prompt consideration of causes other than seizures.
• This study helps differentiate seizure-related CSF changes from those indicative of other neurological conditions.