The majority of febrile seizures are simple (generalised and brief, lasting less than 10 minutes), occurring in children aged 6 months to 5 years. The risk of acute bacterial meningitis (ABM) in association with simple febrile convulsions is reported to be about 1–2%.¹ Approximately one quarter of febrile convulsions are complex, defined as prolonged (>10 minutes), having a focal onset, recurring in the same illness, or followed by a neurological deficit. It is generally believed that the risk of ABM with a complicated febrile seizure is higher than with a simple febrile convulsion, but the exact figure is not known. At the most severe end of the spectrum are children with convulsive status epilepticus (CSE) and fever, usually defined on the basis of a seizure lasting more than 30 minutes or a series of seizures lasting at least 30 minutes from which they do not regain consciousness in between. There are many causes of CSE with fever, but it is important to consider and identify those for which delayed treatment may have deleterious consequences—specifically all central nervous system infections, including ABM, cerebral abscess, viral meningoencephalitis, tuberculous meningitis, and other less common infections.

Chin et al have studied children with CSE with fever as part of an ongoing study into status epilepticus, the North London convulsive STatus EPilepticus in childhood Surveillance Study (NLSTEPSS).² Until recently, little information has been available on how likely this group of children are to have ABM. The authors have identified that 15–18% of children presenting with CSE and fever have ABM, but this is may be an underestimate as only one third of patients in the …