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Cerebrospinal fluid analysis in children with seizures
L G Rider1, P B Thapa, M A Del Beccaro
1Department of Pediatrics, Children's Hospital and Medical Center, University of Washington, Seattle, WA 98105, USA.
Insights
Idiopathic seizures in children can alter cerebrospinal fluid (CSF) findings. However, significantly elevated CSF white blood cell (WBC) or polymorphonuclear (PMN) counts are unlikely to be caused solely by 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.
Abstract:
Cerebrospinal fluid (CSF) examinations of 212 children aged two to 24 months with idiopathic nonfebrile seizures, complex febrile seizures, or status epilepticus, who had a lumbar puncture within 24 hours of the convulsion, were reviewed to determine whether an idiopathic convulsion can result in CSF abnormalities. Children with complex febrile seizures had a median CSF white blood cell count of 1 cell/mm3 (range 0-19 cells/mm3) and a median CSF polymorphonuclear (PMN) cell count of 0 cells/mm3 (range 0-8 cells/mm3). The CSF white blood cell (WBC) count was elevated above the upper limit of normal of 5 cells/mm3 in 9.8% and the absolute number of polymorphonuclear cells was more than 0 cells/mm3 in 26.2% of the complex febrile seizure subjects. Values at the 95th percentile were calculated; a total of 8 WBC/mm,3 4 PMN/mm,3 protein of 73 mg/dl and glucose of 119 mg/dl determined the 95th percentile CSF values for the patients with complex febrile seizures. Patients with nonfebrile seizures or with status epilepticus had similar findings. We conclude that complex febrile, idiopathic nonfebrile convulsions or status epilepticus may affect CSF findings in children: CSF with > 20 WBC/mm3 or > 10 PMN/mm3 should not be attributed to seizures.