Febrile Status Epilepticus Does Not

Febrile Status Epilepticus Does Not
Cause CSF Pleocytosis in Children
Cerebrospinal fluid findings were normal in
children with febrile status epilepticus and no
central nervous system infection.
To investigate if fever-associated status
epilepticus (FSE) alone causes cerebrospinal
fluid (CSF) pleocytosis, researchers
characterized CSF findings in children
enrolled in the Febrile Status Epilepticu...s
Study, a prospective, multicenter study of
children presenting to one of five emergency
departments (EDs) with FSE but no identified
central nervous system infection or other
pathologic condition. FSE was defined as a
single seizure or a series of seizures without
interim recovery lasting at least 30 minutes
associated with fever >38.4°C.
Of 200 children (age range, 1 month through
5 years; median age, 16 months), 154 (77%)
underwent lumbar puncture (LP) at the
discretion of the ED attending physician.
Children who underwent LP were significantly
younger than those who did not (median age,
15 vs. 23 months), less likely to have had
prior febrile seizures, and more likely to have
longer duration of FSE and presence of
focality. Of 136 children with nontraumatic
LPs (<1000 CSF red blood cells), 126 (93%)
had CSF with 3 white blood cells/mm .
Mean CSF protein and glucose levels were
within normal limits (22 mg/dL and 90 mg/
dL, respectively).
Comment: The authors correctly conclude
that CSF pleocytosis in children with fever-
associated status epilepticus cannot be
attributed to an ictal phenomenon. Children
with FSE and CSF pleocytosis should receive
prompt intravenous antibiotics for potential
bacterial etiologies as well as antivirals for
suspected herpes simplex virus