Lumbar Puncture in Children With Convulsions Associated With Fever

Lorber, John; Sunderland, R

doi:10.1016/s0140-6736(80)91290-8

Cited by 77 publications

(37 citation statements)

References 6 publications

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“…A study conducted in Children's Hospital at Sheffield among 452 children concluded that lumbar puncture should be considered for those who present with neurological signs and symptoms pointing to intracranial disease, other than seizure itself but not in children with simple febrile convulsion. 9 The presence of PMN cells raises the suspicion of pathologic process. An elevated PMN count suggests bacterial meningitis or the early phase of aseptic meningitis.…”

Section: Lumbar Puncturementioning

confidence: 99%

Etiological evaluation of convulsions in children between 1 month to 5 years of age

Mamillapalli

Penchalaiah

2017

Int J Contemp Pediatr

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Background: Convulsions are the most common pediatric neurological disorder worldwide. The incidence is highest in children younger than 3 years of age with a decreasing frequency in older children. The different causes of seizures are febrile convulsions, CNS infections, neurologic or developmental, metabolic, traumatic or vascular, idiopathic or epilepsy, oncologic. The objective of our study is to find out the various etiologies of convulsions in children between 1 month to 5 years of age.Methods: 200 consecutive cases admitted to the hospital with convulsions in this particular age group were studied by detailed history, thorough examination and stepwise investigations including blood counts, CSF analysis, EEG and neuroimaging studies.Results: The most common cause for seizures in our study was febrile seizures (34.5%). Hypocalcemic seizures were the predominant cause (13%) between 1 month to 1 year of age. Other causes included viral encephalitis (20%), pyogenic meningitis (11%), TB meningitis (8.5%), epilepsy (8%), hypoglycemia (2%), neurocysticercosis (1%), head injury (1%) late HDN (0.5%). Cerebral palsy, mental retardation syndromes with developmental delay and epilepsy constituted 5.5% of the cases.Conclusions: Convulsions in children can be due to various underlying pathology. A detailed history, thorough examination and certain investigations helps to recognize the cause for the convulsions and can be treated accordingly.

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Section: Lumbar Puncturementioning

confidence: 99%

Etiological evaluation of convulsions in children between 1 month to 5 years of age

Mamillapalli

Penchalaiah

2017

Int J Contemp Pediatr

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“…Rutter and Smales [18] recommended that LP should be done routinely on all children under 18 months when presenting with their first febrile seizure. In contrast, Lorber and Sunderland [20] reported that LP should not be carried out as a routine procedure but only after the child has been examined by an experienced member of the staff. This view was shared by Gururaj who reported that the decision to perform an LP should be individualized, based on clinical findings and good judgement [21].…”

Section: The Evaluation Of the Child With Febrile Seizuresmentioning

confidence: 99%

Febrile Seizures: A Revisit to an Old Problem

Mahdi

1992

Ann Saudi Med

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“…2 Since a seizure in the context of fever may be associated with bacterial meningitis, 3 deciding whether a lumbar puncture (LP) should be performed in children presenting with febrile seizure may be a challenge, especially in infants under 12 months of age in whom the clinical features of bacterial meningitis may be less specific. 4 Because of the fear of an occult bacterial meningitis, in the 1970s and early 1980s, LP was performed in 67% 5 to more than 90% 6 of children presenting with febrile seizures. The United Kingdom 7 and the American Academy of Pediatrics (AAP) guidelines 8 published in 1991 and 1996, respectively, suggested that a systematic LP be performed in infants under 12 months of age with simple febrile seizures.…”

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confidence: 99%

Risk of Bacterial Meningitis in Children 6 to 11 Months of Age With a First Simple Febrile Seizure: A Retrospective, Cross‐sectional, Observational Study

Guedj

Chappuy

Titomanlio

et al. 2015

Academic Emergency Medicine

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Objectives: National and international guidelines are very heterogeneous about the necessity to perform a lumbar puncture (LP) in children under 12 months of age with a first simple febrile seizure. We estimated the risk of bacterial meningitis in children aged 6 to 11 months with a first simple febrile seizure.Methods: This multicenter retrospective study was conducted in seven pediatric emergency departments (EDs) in the region of Paris, France. Visits of patients aged 6 to 11 months for a first simple febrile seizure from January 2007 to December 2011 were analyzed. Bacterial meningitis was sequentially sought for by 1) analyzing bacteriologic data at the time of the visit, 2) looking for data from a second visit to the hospital after the index visit, and 3) phone calling the child's parents to determine the symptom evolution after the index visit. Infants lost to this follow-up were searched for in a national bacterial meningitis database.Results: From a total of 1,183,487 visits in the seven pediatric EDs, 116,503 were for children 6 to 11 months of age. From these, 205 visits were for a first simple febrile seizure. An LP was performed in 61 patients (29.8%). The outcome bacterial meningitis was ascertainable for 168 (82%) visits. No bacterial meningitis was found among these patients (95% confidence interval = 0% to 2.2%). None of the 37 infants lost to our follow-up were registered in the national database as having bacterial meningitis.Conclusions: Among children between 6 and 11 months of age with a first simple febrile seizure, the risk of bacterial meningitis is extremely low. These results should encourage national and international societies to either develop or endorse guidelines limiting routine LP in these infants and contribute to All authors declare that 1) none have support from any company for the submitted work; 2) they have no relationships with any company that might have an interest in the submitted work in the previous 3 years; 3) their spouses, partners, and children have no financial relationships that may be relevant to the submitted work; and 4) they have no nonfinancial interests that may be relevant to the submitted work. RG received a grant from Guigoz to work on this study. Guigoz did not participate in any of the following: design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript. There were no financial relationships with any organizations that might have an interest in the submitted work and no other relationships or activities that could appear to have influenced the submitted work.

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Lumbar Puncture in Children With Convulsions Associated With Fever

Cited by 77 publications

References 6 publications

Etiological evaluation of convulsions in children between 1 month to 5 years of age

Etiological evaluation of convulsions in children between 1 month to 5 years of age

Febrile Seizures: A Revisit to an Old Problem

Risk of Bacterial Meningitis in Children 6 to 11 Months of Age With a First Simple Febrile Seizure: A Retrospective, Cross‐sectional, Observational Study

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