Febrile convulsions: When is a lumbar puncture indicated?

Abstract

Febrile convulsions are common. Although they have an excellent long-term prognosis regarding the risk of epilepsy later in life, the main challenge posed upon presentation is whether a lumbar puncture is indicated in very young children. Despite several authoritative guidelines over the past 15 years, there is still no consensus, with seemingly contradictory recommendations. In addition, the practice varies considerably among health care workers with a trend toward fewer lumbar punctures being performed. The epidemiology of bacterial meningitis has also changed considerably over the past two decades, both in its overall prevalence and also in the bacterial etiology. We believe that all these reasons provide the opportunity to critically review the available evidence for the likelihood of bacterial meningitis presenting as an isolated febrile convulsion. We also wish to estimate its true prevalence, grading the level of that evidence for this practice and also identify subgroups where meningitis is more likely. Finally, since most guidelines are based on the assumption that normal cerebral spinal fluid results would confidently exclude bacterial meningitis, we address the validity of this assumption. Following the critical review, modified guidelines are suggested, with support of grading of the level of evidence behind them and of the strength of those recommendations.

Keywords

Febrile convulsion - lumbar puncture - bacterial meningitis