Objectives: To determine the frequency and characteristics of seizure-induc
ed cerebrospinal fluid (CSF) abnormalities in children and to identify pote
ntial alternative causes of these findings.
Methods: Consecutive patients (n = 80) who underwent lumbar puncture within
24 hours after a seizure were studied retrospectively. The presence of CSF
abnormalities in total leukocytes, polymorphonuclear cells, and protein wa
s determined by using age-specific reference values. Coexisting conditions
that could affect CSF findings, such as traumatic lumbar puncture, concurre
nt neurologic disease, and undiagnosed meningitis, were identified.
Results: Eighteen of the 80 patients were excluded from the final study gro
up because of the presence of another condition that could alter the CSF. M
ore than 50% of the excluded patients had an abnormal CSF leukocyte count o
r protein level, including 2 patients with initially undiagnosed meningitis
, which was subsequently detected by post-hoc polymerase chain reaction tes
ting. In the remaining 62 patients, postictal pleocytosis was detected in o
nly 3 (5%), and increased protein was detected in only 6 (10%). The maximal
postictal pleocytosis and protein level were 8 x 10(6) leukocytes/L (8 leu
kocytes/mm(3)) and 0.52 g/L (52 mg/dL), respectively.
Conclusions: Seizure-induced CSF abnormalities are rare in children, and al
ternative, often unidentified, disease processes may account for many obser
ved postictal abnormalities. All patients with abnormal CSF after a seizure
should be thoroughly evaluated for other causes of the abnormality.