Meningitis is a common cause of convulsive status epilepticus with fever.
OBJECTIVE
In children with convulsive status epilepticus (CSE) with fever, to determine the likelihood of acute bacterial meningitis (ABM), the proportion that are treated with antibiotics, and the proportion that have diagnostic CSF sampling.


METHODS
Patients with an incident episode of CSE with fever were identified as part of an ongoing prospective population based study of CSE in childhood.


RESULTS
There were 49 incident cases of CSE in the first six months. Ascertainment was 96%. Twenty four had CSE with fever, 16 had early parenteral antibiotics, nine had diagnostic CSF sampling, and four had ABM. The population risk of ABM in CSE with fever was significantly higher than that of short seizures with fever (17% v 1.2%).


CONCLUSIONS
The classical symptoms and signs of ABM may be absent in CSE with fever. A high index of suspicion for ABM in the child with CSE with fever is paramount. The most appropriate management is suggested to be early parenteral antibiotics and a lumbar puncture when there are no contraindications.
Chin
R F M
RF
Neurosciences Unit, Institute of Child Health, University College London, and Great Ormond Street Hospital for Children NHS Trust, London, UK. r.chin@ich.ucl.ac.uk
Neville
B G R
BG
Scott
R C
RC
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D005334:Fever / Q000382:microbiology*; D006801:Humans; D007223:Infant; D008297:Male; D008585:Meningitis, Meningococcal / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D008586:Meningitis, Pneumococcal / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D009345:Neisseria meningitidis; D011446:Prospective Studies; D013226:Status Epilepticus / Q000382:microbiology*; D013296:Streptococcus pneumoniae
D000900:Anti-Bacterial Agents