Abstracts

In children with a prolonged febrile seizure, a lumbar puncture is indicated to exclude the possibilty of an intracranial infection. There is a common belief that some degree of pleocytosis is expected simply as a result of the prolonged seizure and fever. We evaluated the CSF findings in a prospective multicenter study of febrile status epilepticus in children., FEBSTAT is a prospective multicenter study of febrile status epilepticus ([ge]30 min) designed to determine whether prolonged febrile seizures cause acute hippocampal damage with mesial temporal sclerosis. Although not part of the research protocol, many of these children had a lumbar puncture performed. CSF results were coded and analyzed. More than 20 WBCs in the CSF was an exclusion criterion, but no child was excluded solely as a result of having more than 20 WBCs., Of the first 102 children enrolled, 80 (78%) had a lumbar punture performed. At present, CSF data on 73 of these 80 is available for analysis. Of these 73 CSF specimens, 22 (30%) had zero WBCs, 29 (40%) had one WBC, 11 (15%) had two WBCs, 4 (5%) had three WBCs and one (1%) had 4 WBCs. Six (8%) specimens had 5 or more WBCs (two with 6 WBCs, two with 8 WBCs and one each with 11 and 16 WBCs.) However, of the six cases with 5 or more WBCs, 5 were traumatic with 5100 to 51,000 RBCs. In all 5 cases, the number of WBCs was fully consistent with the RBC count. Thus there was only one atraumatic lumbar punture with more than 5 WBCs (6 WBCs) and only 2 children with more than 3 WBCs. The protein and glucose were unremakable in these children. The number of WBCs was not affected by duration of the seizure ([lt]60 minutes vs [gt]60 minutes,) seizure focality, the age of the child ([lt] 18 months vs [ge]18 months) or peak temperature., CSF pleocytosis is very uncommon following even prolonged febrile seizures in children. A finding of more than five WBCs in the CSF from a nontraumatic lumbar punture should be a cause for concern in any child with a seizure and fever., (Supported by: Funded by grant NS 43209 [ldquo]Consequences of Prolonged Febrile Seizures in Childhood[quot] NINDS.)