Febrile seizure in infancy: Is lumbar puncture necessary?

There exist wide variations among clinicians as to management of the child who presents with the first febrile convulsion. Most experts recommend lumbar puncture for infants with febrile seizure. However the risk of meningitis is very low in these patients. These indicate that a large number of “unnecessary” lumbar punctures would be done. Finding risk factors of meningitis in infants with febrile seizure can help physician to select patients for lumbar puncture. 45 patients with febrile convulsion and 15 with meningitis, 3 to 18 months of age between Jan. 2002 to Nov.2002 enrolled in a cross sectional study. Patients with electrolyte abnormality, afebrile seizure, history of neonatal seizure or developmental delay and CNS abnormality excluded. Clinical and laboratory data between the two groups were analyzed. 16 of 60 had less than 6 months age which 8 of them had meningitis (p=.007). 28 patients had complex seizure but 11 of them had meningitis (p=.017). Positive CRP in meningitis group was significantly different with febrile convulsion group (7 of 15 and 3 of 45, respectively). WBC count in 10 patients with meningitis was greater than 10000/mm3 and in febrile convulsion group only 14 of 45 had leukocytosis(p=.015). Although there is some statistically differences between clinical and laboratory data in meningitis and febrile convulsion group, lumbar puncture is still necessary in FC. Studies with large number of cases are recommended.