Affiliations: Department of Pediatrics, Faculty of Medicine and
Health Sciences, United Arab Emirates University, United Arab Emirates
Note: [] Correspondence: Hassib Narchi, MD, Department of Pediatrics,
Faculty of Medicine and Health Sciences, United Arab Emirates University, Al
Ain, P.O. Box 17666, United Arab Emirates. Tel.: +971 3 7137 414; Fax: +971 3
7672 002; E-mail: hassibnarchi@hotmail.com; hassib.narchi@uaeu.ac.ae
Abstract: Febrile convulsions are common. Although they have an excellent
long-term prognosis regarding the risk of epilepsy later in life, the main
challenge posed upon presentation is whether a lumbar puncture is indicated in
very young children. Despite several authoritative guidelines over the past 15
years, there is still no consensus, with seemingly contradictory
recommendations. In addition, the practice varies considerably among health
care workers with a trend toward fewer lumbar punctures being performed. The
epidemiology of bacterial meningitis has also changed considerably over the
past two decades, both in its overall prevalence and also in the bacterial
etiology. We believe that all these reasons provide the opportunity to
critically review the available evidence for the likelihood of bacterial
meningitis presenting as an isolated febrile convulsion. We also wish to
estimate its true prevalence, grading the level of that evidence for this
practice and also identify subgroups where meningitis is more likely. Finally,
since most guidelines are based on the assumption that normal cerebral spinal
fluid results would confidently exclude bacterial meningitis, we address the
validity of this assumption. Following the critical review, modified guidelines
are suggested, with support of grading of the level of evidence behind them and
of the strength of those recommendations.
