Abstract
Aim: Seizure is the most common paediatric neurologic disorder. The aim is to study the clinico-etiological profile in children aged 1month to 12 years presenting with first seizure at a tertiary care hospital.
Methods: This is a retrospective observational study carried out on 328 children between age group 1month to 12 year who were admitted with first episode of seizure in our tertiary care hospital over period of one year (Jan 2022- Dec 2022). A detailed case record form was filled which included the sociodemographic profile, clinical features, neuroimaging findings, cerebrospinal (CSF) findings, Electroencephalographic (EEG) findings. This data was analysed by IBM SPSS software. We studied the type of seizure (ILAE classification of seizure 2017), aetiology of seizure and the outcome.
Results: The male–female ratio among patients was 1.2: 1. Highest number of cases were noted in age group 5-12 years (48.1%). Total 10.1% cases had family history of seizure. Abnormal birth history was observed in 27.1% cases and abnormal development was observed in 26.5% cases. Seizures of generalized onset were most common (74.1%).Generalized seizures were present mostly in age group of 5-12 years (31.1%) followed by the age group 1-5 years (28.4%) and the age group 1 month to 1 year (14.6%) respectively. The aetiologies were epilepsy syndrome (32.3%), structural (25%), infective (12.2%), febrile seizure (10%), unknown (10%), and metabolic (8%) with immune (0.6%) being the least common. CSF examination was done in 33 cases of which 79% had abnormal finding. Neuroimaging was done in 146 cases,of which 53% had abnormal finding. EEG was done in 196 cases, with 47% showed abnormal findings. Majority of patient had no neuro-deficit on discharge (93%), 6.7% cases had neuro-deficit and 0.3% cases had mortality.
Conclusions: Male preponderance was noted. Highest number of cases were seen in age group 5-12 years of age. Generalised onset seizure was the most common type. In our study Epilepsy syndrome (32.3%) and structural (25%) were the most common aetiology followed by infective(12.2%) and febrile seizure (10%). About 10 % of children had epilepsy of unknown aetiology. In our study only 6.7 % cases had neurological deficit.
Keywords: First seizure, Epilepsy, EEG,CSF, MRI, outcome.
References
- Fisher RS, van Emde Boas W, Blume W, Elger C, GentonP, Lee P, et al. Epileptic seizures and epilepsy: Definitions proposed by the international league against epilepsy (ILAE)and the international bureau for epilepsy (IBE) Epilepsia.
- Chen CY, Chang YJ, Wu HP. New‑onset seizures in pediatric emergency. Pediatr Neonatol 2010;51:103‑11.
- Vining E. P. Pediatric seizures. Emergency Medicine Clinicsof North America.1994; 12(4):973–88.2005; 46:470–2. [PubMed: 15816939]
- McAbee GN, Wark JE. A practical approach to uncomplicated seizures in children. American family Physician. 2000; 62(5):1109–16.
- Kroczka S, Skowronek-Bała B, Zajac A. [Causes of symptomatic epilepsy in two first years of life children hospitalized in 2006-2007 years]. Przegl Lek 2008; 65: 745-750.
- Hauser WA. The prevalence and incidence of convulsive disorders in children. Epilepsia 1994;35:S1-6.
- Idro R, Gwer S, Kahindi M, Gatakaa H, Kazungu T, NdirituM, et al. The incidence, aaetiology and outcome of acute seizuresin children admitted to a rural Kenyan district hospital. BMCPediatr2008;8:5.
- Provisional Committee on Quality Improvement and Subcommittee on Febrile Seizures. Practice parameter: the neurodiagnostic evaluation of the child with a first simplefebrile seizure. Pediatrics. 1996; 97(2):769–72.
- Adhikari S, Sathian B, Koirala DP, Rao KS: Profile of children admitted with seizures in a tertiary care hospital of Western Nepal. BMC Pediatr. 2013, 13:43. 10.1186/1471-2431-13-43
- Gowda VK, Vasanna SH, Kumar P, Lakskman RR, Govindraj P. Study of etiological profile of infantile and childhood focal seizures at a tertiary care centre in South India. J PediatrNeurol2013;11:235-40
- Kumar MM, Ramesh S, Sundari S. Etiological evaluation of convulsions in children from 1 month to 14 years of age. Indian J Child Health 2018;5:537-9.
- Alakkodan D: A clinical profile and diagnostic management of first-time seizures in children aged 1-12 yearsa tertiary hospital-based study in Kerala. Int J Sci Stud. 2018, 6:24-30. 10.17354/ijss/2018/243
- Arundhati et al: Clinicoetiological profile of seizures in children from 1 month to 18 years, Medica Innovatica , jan-june 2022, volume 11,issue 1. Volume 11, Issue 1
- Singh RK, Gaillard WD. Status epilepticus in children. CurrNeurolNeurosci Rep 2009;9:137‑44.
- Berg AT, Shinnar S, Levy SR, Testa FM. Status epilepticus in childrenwith newly diagnosed epilepsy. Ann Neurol 1999;45:618‑23.
- Kumar M, Kumari R, Narain NP. Clinical profile of status epilepticus (SE) in children in a tertiary care hospital in Bihar. J Clin Diagn Res2014;8:PC14-7.
- Gupta A, Solanki R, Roy S, Chakrabarty S.Clinico etiological profile of “first seizure” in children. Experience froman armed forces tertiary care hospital in Eastern India. Acta Med Int2022;9:49-53.
- Mondal B, Sarkar O, Halder PK, Deb S, Guha D, Mandal AS. Etiological profile of seizure in children of age group 1 month to18 years with special reference to neuroimaging in a tertiary care hospital.MGM J Med Sci 2022;9:368-73.
- Sartori S, Nosadini M, Tessarin G, Boniver C, Frigo AC, Toldo I, et al. First‑ever convulsive seizures in children presenting to the emergency department: Risk factors for seizure recurrence and diagnosis of epilepsy. Dev Med Child Neurol 2019; 61:82‑90.
Corresponding Author
Dr. Arpita D. Adhikari
Associate Professor, Department of Paediatrics, Division of Neurology and Developmental Paediatrics, Lokmanya Tilak Municipal General hospital and Medical College (Sion Hospital), Mumbai, Maharashtra, India
DOI: https://dx.doi.org/10.18535/jmscr/v11i3.31
