Investigators at Children’s Hospital of the King’s Daughters, Eastern Virginia Medical School, Norfolk, VA; Albert Einstein College of Medicine, Bronx, NY; Columbia University, NY; and other centers on behalf of the FEBSTAT Study Team assessed CSF findings in 154 (77%) of 200 patients with fever-associated status epilepticus (FSE). LP was performed at the discretion of the attending physicians, and 136 children had a nontraumatic LP (<1000 red blood cells; 116 (96.2%) of the 136 had </= 3 white blood cells/mm3). Likelihood of an LP performed in the ED was significantly higher in younger children, in those with the first FS, a longer median duration of FSE, febrile status epilepticus, and a focal FSE. Mean CSF protein level was 22 mg/dL (range, 8-137 mg/dL); 3 (2.3%) had a protein level >60 mg/dL. Mean CSF glucose level was 89.6 mg/dL (range, 46-201 mg/dL). Excess WBCs in the CSF should not be attributed to the seizure. [1]

COMMENT. LP performed at the discretion of the attending physician confirms that the CSF is usually normal in children with FSE. Abnormal CSF results should not be attributed to the seizure and should prompt close investigation and treatment for suspected meningitis.

Clinical manifestations and complex seizures are the principal indications for lumbar puncture, not patient age, in a study of 100 consecutive febrile seizure patients treated in a tertiary hospital ED [2]. Eleven (78.6%) patients undergoing LP had complex FS, 3 manifesting prolonged seizures and FSE, with durations of 43, 45, and 60 minutes. CSF findings were normal and bacterial cultures were negative. A child aged 3 months to 5 years who presents with a first or recurrent FS should be considered for LP if one or more of the following indications are present: neurologic signs of meningitis, systemic signs of toxicity, complex seizure with prolonged postictal obtundation of consciousness, or pretreatment with antibiotics. Complex FS alone is not an absolute indication for LP.

In a retrospective study at Children’s Hospital Boston to assess the rate of acute bacterial meningitis among 526 children who present with their first complex febrile seizure, 2.7% had CSF pleocytosis and 3 patients (0.9%) had acute bacterial meningitis. One appeared well clinically; of 2 with Streptococcus pneumoniae cultured from CSF, 1 was nonresponsive clinically, and the other had a bulging fontanel and apnea. [3]