Febrile seizures: clinical course and diagnostic evaluation.

A study was done on 111 children admitted in a university hospital in Tehran with fever and seizures to document the pattern of illness and to define indications for performing a lumbar puncture in children with fever and convulsions. Bacterial meningitis was diagnosed in 4 patients, aseptic meningitis in 2 and 105 children had febrile seizures. The cause of fever was gastro-enteritis in 39 patients and upper respiratory tract infection with or without Otitis media in 40. Although most patients were drowsy on admission (n = 93), none had any signs of meningeal irritation, except one child with slight nuchal rigidity. Out of the 4 children with bacterial meningitis, 3 had meningeal signs, but in one 10 month old baby with no signs, the diagnosis was made on the cerebro-spinal fluid findings after a lumbar puncture. These results support the view that a lumbar puncture should be performed on all infants under 12 months who present with fever and convulsions and strongly considered between 12 and 18 months. After 18 months a lumbar puncture is mandatory in the presence of signs of meningeal irritation.