Abstract
Introduction: Febrile seizure accounts for the majority cases of the pediatric seizure. Fever with seizure can be either due to febrile seizure or underlying serious infection as meningitis. As seizure may be the only manifestation of meningitis it is important to rule out meningitis in children presenting with fever and seizure.Objective: The objective of this study was to determine the incidence of meningitis among children aged 6 to 18 months presenting with first episode of febrile seizure.Methodology: A prospective observational study was conducted among 94 children with first episode of febrile seizure presenting to the emergency and observation wards of Kanti Childrens' Hospital and subjected to lumbar puncture (LP) as per the American Academy of Pediatrics (AAP) recommendations. The proportion of children with meningitis and no meningitis among the study population was determined, clinical characteristics were compared among these groups and the incidence of meningitis in simple febrile seizure and complex febrile seizure was calculated. The collected data was analysed using SPSS.Results: Twenty (21.3%) cases were diagnosed with meningitis among 94 children enrolled in our study. Meningitis was detected in 38.1% of the cases of complex febrile seizure and 7.7% of cases of simple febrile seizure. In the age group 6 to 12 months, 11 (17.4%) had meningitis while in 12 to 18 months of age, 9 (29%) were detected with meningitis. Meningitis was 7.38 times more likely in cases presenting with complex febrile seizure than simple febrile seizure (OR=7.58; 95% CI 2.24-24.4; p<0.001). Regarding the clinical characteristics, vomiting, fever of more than 48 hours duration prior to onset of seizure, impaired consciousness and complex features of seizure were found to be significantly associated with meningitis in our study.Conclusion: The probability of meningitis among children aged 6 to 18 months presenting with first episode of febrile seizure episode is high. In febrile convulsing children less than 18 months of age, meningitis should be considered even in the absence of signs of meningeal irritation. BJHS 2018;3(2)6:399-402.
Highlights
METHODOLOGYFebrile seizure is the most common form of childhood seizure
Meningi s was detected in 38.1% of the cases of complex febrile seizure and 7.7% of cases of simple febrile seizure
The incidence of meningi s was compara vely higher in our study than others. It may be because about a large propor on i.e. 45.7% of the cases in our study presented with complex febrile seizure which poses a greater risk of meningi s than simple febrile seizure
Summary
Febrile seizure is the most common form of childhood seizure. Febrile seizure is seizure that occurs between 6 months to 5 years of age with a temperature of 38 degrees cen grade or higher that is not the result of CNS infec on or metabolic imbalance that occur in the absence of history of prior afebrile seizure.[1] Febrile seizure can be classified as either simple or complex. A simple febrile seizure is primarily generalized, usually tonic-clonic a ack associated with fever, las ng for a maximum of 15 minutes and not recurrent within a 24 hours period. Complex febrile seizure is more prolonged (>15 min), is focal and recurs within 24 hours. Febrile seizure accounts for 1-5% of emergency department visits.[2,3] The precise annual incidence of febrile seizure worldwide is not known. In western Europe and USA the incidence is reported to be 2-5% whereas it is between 5-10% in India, 8.8% in Japan, 14% in Guam, 0.5-5% in China and 6.6% in Nepal.[4,5,6]
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