Utility of Lumbar Puncture in Children Presenting With Status Epilepticus. Issue 8 (August 2017)

• Record Type: Journal Article
• Authors: Michelson, Kenneth A.; Lyons, Todd W.; Johnson, Kara B.; Nigrovic, Lise E.; Harper, Marvin B.; Kimia, Amir A.
• Is Part Of: Pediatric emergency care. Volume 33:Issue 8(2017)
• Publication Date: 2017-08
• Subjects: status epilepticus -- seizure -- meningitis -- encephalitis -- lumbar puncture; Pediatric emergencies -- Periodicals; 618.92002505
• DOI: 10.1097/PEC.0000000000001225
• Languages: English
• ISSNs: 0749-5161

Abstract

Abstract : Objectives: Because meningitis may trigger seizures, we sought to determine its frequency in children with first-time status epilepticus (SE). Methods: We performed a retrospective cross-sectional study of children aged 1 month to 21 years who presented to a single pediatric emergency department between 1995 and 2012 with SE and who had a lumbar puncture (LP) performed as part of the diagnostic evaluation. We defined bacterial meningitis as a cerebrospinal fluid (CSF) culture positive for a bacterial pathogen or CSF pleocytosis (CSF white blood cells ≥10 cells/mm 3 ) with a blood culture positive for a bacterial pathogen. We defined viral meningitis or encephalitis using a positive enterovirus or herpes simplex virus polymerase chain reaction test. Results: Among 126 children with SE who had an LP performed, 8 (6%) had CSF pleocytosis. Of these, 5 had received antibiotics before performance of a diagnostic LP. One child in the cohort was proven to have bacterial meningitis (0.8%; 95% confidence interval [CI], 0%–6%). Two other children had enteroviral meningitis (2/13 tested, 15%; 95% CI, 3%–51%), and 1 had a herpes simplex virus infection (1/47, 2%; 95% CI, 0%–15%). Conclusions: Bacterial meningitis is an uncommon cause of SE.