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ARTICLES:
Amir A. Kimia, Andrew J. Capraro, David Hummel, Patrick Johnston, and Marvin B. Harper
Utility of Lumbar Puncture for First Simple Febrile Seizure Among Children 6 to 18 Months of Age
Pediatrics 2009; 123: 6-12 [Abstract] [Full text] [PDF]
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[Read eLetters] Lumbar puncture is still necessary for any child with first simple febrile seizure
Huei-Shyong Wang   (14 January 2009)

Lumbar puncture is still necessary for any child with first simple febrile seizure 14 January 2009
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Huei-Shyong Wang,
M.D.
Division of Peatric Neurology, Chang Gung Children's Hospital, Chang Gung University, Taoyuan,Taiwan

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Re: Lumbar puncture is still necessary for any child with first simple febrile seizure

wanghs444{at}cgmh.org.tw Huei-Shyong Wang

The article written by Kimia et al. (1) must raise much discussion of an old issue about the necessity of lumbar puncture for young children with first simple febrile seizure (FSFS). FSFS was defined as a first episode of seizure accompanied by fever, manifested as a primary generalized seizure lasting less than 15 minutes and not recurring within 24 hours. In another study from Nepal (2), of the 175 children who presented with first episode of fever and seizure in the age group of 6 months to 5 years, 17% were diagnosed to have meningitis. Cerebrospinal fluid was positive for a bacterial pathogen in 4.5% of the cases. In the age group of 6 months to 12 months, 30% of the children had meningitis as compared to 20 % and 5% in other age groups of 12- 18 months and above 18 months respectively. All children with culture proven bacterial meningitis were in the age group of 6-12 months and had no evidence of meningeal irritation.

It may be true that Hemophilus influenzae type B and pneumococcal vaccines do protect children from the 2 most notorious bacterial meningites in young children. Not all children received adequate immunization. And not all vaccines work perfect for ever. We need more time to see the long-term efficacy of new vaccines.

It's evident that the AAP (American Academy of Pediatrics) guidelines (3) not being followed in some hospitals of certain specific areas (4), many others follow it well. I personally do not favor any change by AAP at present, because the refusal rate of lumbar puncture by caregivers is raising and will raise more. And there is no other way to replace lumbar puncture in diagnosing meningitis.

REFERENCES: 1. Kimia AA, Capraro AJ, Hummel D, Johnston P, Harper MB. Utility of lumbar puncture for first simple febrile seizure among children 6 to 18 months of age. Pediatrics. 2009;123(1):6-12. 2. Joshi Batajoo R, Rayamajhi A, Mahaseth C. Children with first episode of fever with seizure: is lumbar puncture necessary? JNMA J Nepal Med Assoc. 2008;47(171):109-112. 3. 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(5): 769?72 4. Shaked O, Garcia Peņa BM, Linares MY, Baker RL. Simple febrile seizures: are the aap guidelines regarding lumbar puncture being followed? Pediatr Emerg Care. 2008 Dec 29. [Epub ahead of print]

Conflict of Interest:

None declared