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Título

RECOMMENDATION OF LUMBAR PUNCTURE IN INFANTS UNDER TWO YEARS OLD WITH FEBRILE SEIZURES

Introdução

A febrile seizure (FS) is an epileptic event that occurs due to fever resulting from an infection, not from the nervous system, in children aged between six months and five years without metabolic disorders or previous history of afebrile seizures. Seizures in a febrile context may be related to meningitis or meningoencephalitis, however, it is uncommon for children with bacterial meningitis to have only seizures, without oder suggestive clinical signs. For this reason, the decision to perform a lumbar puncture is a challenge, especially in children younger than 12 months, when clinical signs of meningitis are less specific. The emergency care of a children’s Hospital in Curitiba performs lumbar puncture in all children under 18 months with fever and seizures. However, guidance on recommendation for lumbar puncture in children with seizures is scarce and heterogeneous.

Objetivo

The objective of this study was to assess the prevalence of meningitis in this context to assist in the assessment of indication for lumbar puncture in cases of infants with FS in the emergency room of a children’s Hospital in Curitiba.

Método

There were evaluated 236 medical records of children under the age of 24 months attended from 2016 to 2018 with febrile seizure. Thus epidemiological, clinical and laboratory variables were analyzed, which were assessed considering a significance level of 0,05. Medical records of children with previous neurological disease and incomplete information were excluded.

Resultados e Conclusões

There were evaluated 208 medical records of children aged under 24 months with fever and seizures, of whom 1.4% had bacterial meningitis, 2.9% meningoencephalitis and 5.8 % viral meningitis. The mean age was 11 months, 57.7% of these patients were male and 11.50% of the infants had previous febrile seizures. Among this sample, age, type of seizure and its specific characteristics, previous use of antimicrobials and analysis of blood count and blood culture did not prove to be effective characteristics for the diagnosis of meningitis. As well as the presence of meningism, which does not exclude meningitis, especially in younger children. However, drowsiness or irritability before the seizure, vomiting and the absence of well defined disease seem to be significant risk factors for meningitis. Therefore, in a vaccinated urban population, the prevalence of meningitis is low in children with only fever and seizures, which suggests a review of the indications for performing lumbar puncture in these infants.

Palavras Chave

Febrile seizure, pediatrics, lumbar puncture, meningitis.

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