Utility of lumbar puncture for febrile seizure among infant under oine year old.


Faten Tinsa
Ahmed El Gharbi
Nesrine Ncibi
Chaker Bouguerra
Wafa Ben Aissia
Bechir Zouari
Khadija Boussetta
Souad Bousnina


Background:This retrospective study was conducted in the department of pediatrics B in the Children Hospital of Tunis on eightyear period (2000 - 2008). In all statistical tests, significance level was set at 0.05.
Aim: to define the utility of lumbar puncture in the management of febrile seizures in infants under 12 months and to identify risk factors of meningitis and to respond to this question:” lumbar punction should be done in which infant with febrile seizure?”
Methods: This retrospective study was conducted in the department of pediatrics B in the Children Hospital of Tunis on
Results: One hundred and six cases were collected during the period of study. Seizures related to bacterial meningitis were seen in 11 cases (10%). We have separated two groups: G1 infants presented bacterial meningitis, and G2 infants with febrile seizure. The comparison between the two groups G1 and G2 showed the following predictors factors of meningitis: age ²7 months (p=0.035), partial seizure (p=0.028), duration of seizure > 5min (p<0.001), recurrence of seizure in the same day(p=0,006), neurological abnormalities p<0.001), CRP> 20 mg / l(p=0.03), hyponatremia ² 125mmol/l (p=0.01).
The risk of meningitis is very low: 3.1 x 10 -3, if this condition is met: infants older than 7 months, having a unique and short seizure ²5 min, and with a CRP ²
20mg / l.
Conclusion: If the infant is older than 7 months, presenting a unique, febrile and short (² 5min) seizure, having a normal neurological examination with CRP ² 20mg / l, lumbar puncture should be discussed a case by case but an hospitalization for 24 hours is required for monitoring.


Febrile seizure, , , Meningitis, Lumbar punction



  1. Febrile Seizures. NIH Consens Statement 1980;3:1-10.
  2. American Academy of Pediatrics, Provisional Committee on Quality Improvement, Subcommittee on Febrile Seizures. Practice parameter: the neurodiagnostic evaluation of the child with a first simple febrile seizure. Pediatrics 1996;97: 769-772
  3. Sadleir LG, Scheffer IE. Febrile seizures. BMJ 2007;334:307-11
  4. Carroll W, Brookfield D. Lumbar puncture following febrile convulsion. Arch Dis Child 2002;8:238-240
  5. Kimia AA, Capraro AJ, Hummel D, et al. Utility of Lumbar Puncture for First Simple Febrile Seizure Among Children 6to 18 Months of Age Pediatrics 2009;123;6-12
  6. Depiero AD, Teach SJ. Febrile seizures. Ped Emerg Care 2001;17:384-7
  7. Joffe A, McCormick M, DeAngelis C. Which children with febrile seizures need lumbar puncture? A decision analysis approach. Am J Dis Child. 1983;137:1153-6
  8. Lorber J, Sunderland R. Lumbar puncture and febrile convulsions. Lancet 1980 5;2:38
  9. Offringa M, Beishuizen A, Derksen-Lubsen G, et al. Seizures and fever: can we rule out meningitis on clinical grounds alone? Clin Pediatr (Phila) 1992 S;31:514-22
  10. Green SM, Rothrock SG, Clem KJ, et al. Can seizures be the sole manifestation of meningitis in febrile children? Pediatrics 1993;92:527-34.
  11. Nedey-Saiag MC, Poisson-Salomo AS, Blum-Boisgard C. Evaluation des procedures de diagnostic et de prise en charge en urgence des enfants présentant une première convulsion fébrile. Rean Soins Intens Med Urg 1994;10:5-11
  12. Hampers LC, Trainor JL, listernick R, et al. Setting-based practice variation in the management of simple febrile seizure. Acad Emerg Med 2000 ; 7 :21-27