Clinical pro � le and cerebrospinal � uid indices in children with complex febrile seizures

Clinical pro le and cerebrospinal uid indices in children with complex febrile seizures Suryavanshi A R.1, Bodhgire S B.2*, Anerao R D.3, Pawar S.4, Patil A T.5, Paranjape M.6 DOI: https://doi.org/10.17511/ijpr.2020.i06.10 1 Amol Ramrao Suryavanshi, Associate Professor, Department of Pediatrics, Government Medical College and Hospital, Aurangabad, Maharashtra, India. 2* Sachin Bapurao Bodhgire, Assistant Professor, Health Department, Government Medical College and Hospital, Aurangabad, Maharashtra, India. 3 Rahul Digambarrao Anerao, Incharge, Health Department, District Urban Leprosy, , Maharashtra, India. 4 Shilpa Pawar, Associate Professor, Department of Pediatrics, Government Medical College and Hospital, Aurangabad, Maharashtra, India. 5 Amit Tukaram Patil, Junior Resident, Department of Pediatrics, Government Medical College and Hospital, Aurangabad, Maharashtra, India. 6 Mugdha Paranjape, Junior Resident, Department of Pediatrics, Government Medical College and Hospital, Aurangabad, Maharashtra, India.


Introduction
Fever with seizure is the most common type of seizure occurring in children [1]. A seizure is a common presentation for which a child may come to the emergency and may occur in up to 10% of children presenting to the emergency [2]. Among all these seizures, Febrile seizures (FS) are the most common type of childhood seizures, affecting 2-5% of children older than 1 month and most commonly from 6 months-5 years old [3,4]. The differential diagnosis of febrile seizure includes non-epileptic events or movements, provoked seizures following a   Examination, and CSF indices. Meningitis was diagnosed in a child presenting with fever and seizure if he/she had a combination of all three of the following: CSF cells >5/mm3, protein more than 40 mg%, and sugar < 2/3 of blood sugar [9].

Material and Methods
The growth of bacteria in the CSF and/or positive Gram's stain was considered as bacterial meningitis.
Ethical Consideration: The study was approved by the institutional ethical committee. Informed verbal and written consent was taken from the parents or the accompanying adults before performing Lumbar Puncture.
Statistical Analysis: Data were analyzed using SPSS version 16. A Chi-square test was used for statistical analysis and a p<0.05 was considered significant.

Results
A total of 120 cases that presented with Complex Febrile Seizures (CFS) between six months to five years of age were included. Among them, 83 (69.1%) were male and 47 (30.9%) were female children.
There were a total of 63 children in 6-12 months age, 32 in 12-24 months, and 25 in the above 12 months age group (Table 1).    Whereas, 2 cases were having atonic seizures (Table   4).  CSF examination was done in all the 120 cases.
Among them raised WBC count (more than 5/mm3) was seen in 29 cases while pus cells were observed in 4 cases and these all were treated as meningitis.
Mean (SD) glucose levels were 56±4.3 found in the age group of 6 to 12 months (Table 5).

Discussion
The younger the patient, the more was the risk of the complex febrile seizure. In the present study, it was found a total of 63 children in A study by Berg AT et.al [11], showing that 57 % of children with complex Febrile Seizures were less than 18 months old.
Other studies have also come to the same conclusion [12,13,14]. Therefore, younger the age more is the chance that a child presenting with fever and seizure may have a complex febrile seizure.

Meningitis is a medical emergency in children and
should not be missed in any children with fever with  290 And treatment.

Limitations
The main limitation of this study was that it was a single hospital-based study. Hence, metacentric and community-based studies are needed to generalize the results in the general population. The other limitation was that the parents may not have been able to give us an accurate past history of whether they had seizures as children.

Conclusion
In conclusion, it was found that age less than 1 year and male gender were the most significant risk factors for Complex Febrile Seizure in our area.
Meningitis is a common presentation in the emergency and in cases of complex febrile seizure, meningitis should always be considered as a differential diagnosis. Lumbar puncture is necessary for the differential diagnosis in all CFS cases to rule out meningitis, even in the absence of meningeal signs.
What study adds to existing knowledge?
Complex Febrile Seizures in children are a common indication for the hospital admission. Early detection of the cause and accordingly the start of appropriate treatment is the basic pillar. CSF examination plays a significant role in early diagnosis in these cases.
Children with CFS should be on regular long term follow up and treatment. This knowledge will facilitate the diagnosis, early educational intervention, and multidisciplinary therapeutic approaches.