Role of Lumbar Puncture in First Episode of Seizures with a Febrile Illness in Children Aged 6 -18 Months

Background: Fever with seizures in children may be due to simple febrile seizure, complex febrile seizures or secondary to a neuroinfection. The likelihood of acute bacterial meningitis (ABM) in febrile children with seizures ranges from 0.6 % to 6.7 %. Objectives: To identify the group of 6-18 month old children with the first episode of fever with seizure who would benefit from cerebrospinal fluid (CSF) examination. Method: The study groupcomprised6-18 month old children, admitted with a febrile illness and first episode of convulsion with the admission occurring within 24 hours of the convulsion. Children with previously documented intracranial infection or neurological abnormality were excluded. Results: Of the 29 children included in study, 4 (13.8 %) were diagnosed as having ABM. In the 6-12 month age group, 3 (25 %) children had ABM compared to one (6 %) in the 12-18 month age group. In the 6-12 month age group 2 of the 3 children with ABM had no meningeal signs and 1 had meningeal signs. In the 12-18 month age group the child with ABM had meningeal signs. Signs of meningeal irritation had high specificity in diagnosing ABM. Conclusions: Lumbar puncture (LP) and CSF examination are important in ruling out ABM, when a child of age 6-18 months presents with first seizure associated with a febrile illness, particularly so in children aged 6-12 months. Whenever meningeal signs occur in such children, there is a significant chance of ABM.