Simple febrile seizures – a generalised seizure lasting no more than 15 minutes and not recurring within 24 hours – are common in infants and young children, the researchers say, affecting two to five percent of children six months to five years old. "This means we might see at least one case per day in the emergency room," says Amir Kimia, the study's first author. "When it is a first event, it is pretty scary for parents."
Current American Academy of Pediatrics recommendations, issued in 1996, call on physicians to consider doing a lumbar puncture in children twelve to 18 months old with a first simple febrile seizure and to "strongly" consider lumbar puncture for infants six to twelve months old. But when Amir and colleagues reviewed the medical charts of 704 babies seen at Children's emergency department for a first simple febrile seizure between 1995 and 2006, they found no cases of bacterial meningitis.
Of the 704 babies, 271 (38 percent) underwent lumbar puncture. Of these, ten babies (3.8 percent) were found to have an elevated white-blood-cell count in their cerebrospinal fluid, indicating a possible viral infection, but no pathogen was identified in cerebrospinal fluid cultures, and no patient was diagnosed as having bacterial meningitis.
Lumbar puncture requires local anaesthesia and often sedation. "It is a safe procedure with an extremely low rate of complications," says Kimia. "But it is a needle and it is not fun. We are trying not to do it unless it is absolutely necessary."
However, the researchers caution that their findings do not necessarily extend to patients with complex febrile seizures, patients with concerning symptoms or signs, or patients who have an underlying illness.
"Lumbar puncture should be considered based on clinical presentation, rather than being done routinely," says Kimia. "If a child appears very ill, is lethargic, fussy, non-responsive, has neurologic symptoms, or has certain clinical signs (such as a certain type of rash or a bulging fontanelle), lumbar puncture should be considered no matter how old the child is."
MEDICA.de; Source: Children's Hospital Boston