title: Pediatric status epilepticus: how common is cerebrospinal fluid pleocytosis in the absence of infection?
abstract: OBJECTIVE
  To determine the rate of cerebrospinal fluid (CSF) pleocytosis among children presenting with status epilepticus (SE) without proven central nervous system infection.
  
  
  METHODS
  We performed a retrospective cross-sectional study of all patients aged one month to 21 years of age who were evaluated in a single pediatric emergency department (ED) for SE between 1995 and 2012. We limited our study to those children who had a CSF culture obtained and excluded those children with proven viral or bacterial infection. We defined SE in a patient who had a single seizure or a cluster of seizures without regaining consciousness which lasted 30 min or longer. We defined CSF pleocytosis as a CSF white blood cells (WBC)>10 cells/mm(3) and a peripheral leukocytosis as WBC ≥ 15,000 cells/mm(3). We compared the rate of CSF pleocytosis between children with and without peripheral leukocytosis using the Fisher's exact test.
  
  
  RESULTS
  We identified 289 ED visits for SE, of which 178 (62%) met study inclusion criteria. Seven children (4%, 95% confidence interval 1.7-8.2%) had CSF pleocytosis. More children with peripheral leukocytosis had CSF pleocytosis: (8.6% with peripheral leukocytosis vs. 0.9% without leukocytosis, p=0.01).
  
  
  CONCLUSIONS
  CSF pleocytosis is relatively uncommon among children with prolonged seizures, even in the presence of peripheral leukocytosis. Therefore, all children with CSF pleocytosis after status epilepticus need comprehensive evaluation for central nervous system infection.
authors.affiliation: Boston Children's Hospital Medicine, Division of Emergency Medicine, Boston, MA 02446, United States.
authors.forename: Kara B
authors.initials: KB
authors.lastname: Johnson
authors.affiliation: Boston Children's Hospital Medicine, Division of Emergency Medicine, Boston, MA 02446, United States.
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Michelson
authors.affiliation: Boston Children's Hospital Medicine, Division of Emergency Medicine, Boston, MA 02446, United States.
authors.forename: Todd W
authors.initials: TW
authors.lastname: Lyons
authors.affiliation: Boston Children's Hospital Medicine, Division of Emergency Medicine, Boston, MA 02446, United States.
authors.forename: Lise E
authors.initials: LE
authors.lastname: Nigrovic
authors.affiliation: Boston Children's Hospital Medicine, Division of Emergency Medicine, Boston, MA 02446, United States.
authors.forename: Assaf
authors.initials: A
authors.lastname: Landschaft
authors.affiliation: Boston Children's Hospital Medicine, Department of Neurology, Boston, MA 02446, United States.
authors.forename: Tobias
authors.initials: T
authors.lastname: Loddenkemper
authors.affiliation: Boston Children's Hospital Medicine, Division of Emergency Medicine, Boston, MA 02446, United States. Electronic address: amir.kimia@childrens.harvard.edu.
authors.forename: Amir A
authors.initials: AA
authors.lastname: Kimia
mesh_terms: D000293:Adolescent; D020805:Central Nervous System Viral Diseases / Q000134:cerebrospinal fluid* / Q000175:diagnosis; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007958:Leukocyte Count; D007964:Leukocytosis / Q000134:cerebrospinal fluid*; D008297:Male; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D013226:Status Epilepticus / Q000134:cerebrospinal fluid* / Q000175:diagnosis; D055815:Young Adult
keywords: Cerebrospinal fluid (CSF); Emergency department (ED); Status epilepticus (SE); White blood cell (WBC)