Cerebrospinal fluid examination in afebrile infants with possible seizures

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Standardized evaluation was performed by neurologists at the Children's National Medical Center in Washington, DC for all infants one to six months of age who had possible first-time seizures from 2000 to 2006. Cerebrospinal fluid examination, however, was performed at the discretion of the caring physician. All infants were hospitalized for a 24-hour period of observation. This report concerns 141 of 1193 (12%) infants who were afebrile; 76 had CSF examinations “deemed necessary,” of which (22%) were abnormal. No infant with an abnormal CSF finding was confirmed to have bacterial meningitis or herpes simplex virus encephalitis (only 2 of these 17 infants had an abnormal neurologic examination). The authors conclude that clinical observation for 24 hours is perhaps more discerning than CSF examination in afebrile infants with a suspected seizure who have a normal neurologic examination.

The obvious limitation of the study is the small number of subjects, many of whom were diagnosed ultimately not even to have had a seizure. It does begin to challenge the tenet that CSF examination should be performed in afebrile infants who have a first seizure merely because of age one to six months.