Clinico-etiological profile of first episode of seizure and its correlation with electroencephalogram in children aged 2 months to 18 years

Background: Seizure is one of the commonest neurological illnesses. About 4-10% of children experience at least one episode in the first 16 years of life. Approximately 30% of children who experience, first afebrile seizure later develop epilepsy. Risk is approximately 20% if neurological examination, electroencephalogram (EEG) and neuroimaging is normal. The objective of the study is to determine the age of onset, etiology of first episode of seizure in children between the age group of 2 months to 18 years and the pattern of EEG changes in the above group of children.Methods: In a prospective single centre observational study at Cheluvamba tertiary care hospital in Mysore, around 80 children who were admitted with first episode of afebrile seizure to our emergency department between October-2020 to July-2021 (10 months) were studied. Seizures defined using international league against epilepsy (ILAE) and EEG was done for all 80 children and their records were analysed.Results: A total of 80 children presenting with first episode of seizure were included in the study. Toddlers represented the major portion of our study with male gender predominance. Idiopathic seizure was the most common etiology identified (81.2%), followed by meningitis (7.5%). EEG abnormality was seen in 58.7% of the children which was statistically significant (p<0.05). MRI was done in 72.5% of the children, of which abnormality was seen in only 8.6% of the children.Conclusions: Seizure is mainly diagnosed clinically and EEG can be normal in many children. First episode of seizure is common in the age group of 1-3 years. Normal EEG at present may not indicate the non-recurrence in future. Though EEG interpretation is useful, treatment can be started based on clinical diagnosis and has to be individualized.

Electroencephalogram versus Magnetic Resonance Imaging Brain as the Initial Investigation of Choice in Neurologically Normal Children with First Afebrile Seizure in India

Background and Purpose: To compare the rates of clinically relevant information provided by electroencephalogram (EEG) and magnetic resonance imaging (MRI) brain in first afebrile seizure (FAS) in children.Methods: In this prospective randomized controlled trial, neurologically normal children between the age of 2 and 14 years, presenting with first episode of unprovoked, afebrile generalized or partial seizures, were included. Enrolled patients were randomized into two groups. After stabilization, initial workup and management, group I-patients underwent an EEG followed by MRI, whereas group II-patients underwent an initial MRI brain followed by an EEG. The patients were followed up after results of both the investigations and then every 3 months for seizure recurrence. The primary outcome was the proportion of investigations, providing clinically relevant information. The secondary outcomes were to determine the etiological diagnosis of FAS and record adverse events associated with EEG and MRI.Results: Out of 170 enrolled patients, 52 patients (61.2%) in initial EEG group and 53 patients (70.6%) in initial MRI group had abnormal results on first investigation. An etiological diagnosis could not be made in any patient in initial EEG group. Neuroimaging revealed an etiological diagnosis in 53 patients (70.6%) in initial MRI group. Inflammatory granuloma was found to be the most common cause of FAS, followed by idiopathic epilepsy.Conclusions: The results of our study done in neurologically normal children with FAS showed a high diagnostic yield with an initial MRI. We recommend MRI brain to be considered as the initial investigation for evaluation of FAS in children.

DiGeorge syndrome presenting with seizure in neonatal period: a case report

DiGeorge syndrome is caused by a micro-deletion of chromosome 22q11.2 that disrupts development of the third and fourth pharyngeal pouches during early embryogenesis. Other structures forming at the same period are also frequently affected. So, the phenotypic spectrum shows a wide variability. In this case report, we describe a 1-month and 24-day old male child who presented with history of recurrent afebrile seizure and noisy breathing since early neonatal period. He had history of repeated chest infections. On examination, patient had stridor, facial dysmorphism, pectus excavatum and clinical features of pneumonia. Investigations revealed hypocalcaemia, hypoparathyroidism, consolidation on X-ray chest and cellular immunodeficiency. Echocardiography findings were normal. Fluorescent in situ hybridization (FISH) was performed which confirmed the diagnosis 22q11.2 deletion. Birdem Med J 2021; 11(2): 128-132

ETIOLOGY, CLINICAL PROFILE AND OUTCOME OF FIRST EPISODE OF SEIZURE IN CHILDREN

Background: Seizure is a commonly encountered problem in pediatric practice. Convulsive disorder constitutes a heterogeneous group with a varied etiology. Arriving at the cause of seizure is important as it plays a vital role in managing the child. Chances of recurrence to be analyzed, after the rst episode of seizure for management. The aim was to study the etiology and the causes of recurrence after a rst episode seizure. A Methods: prospective observational study was done on 135 children for a period of six months admitted in tertiary care center. Proper history, complete neurological and other systemic examinations was done. Blood investigations and imaging with EEG was done when indicated. All children were classied according to International League against epilepsy and followed up for recurrence rate and history leading to recurrence. Co- relation between recurrence and risk factors was analyzed. Electroencephalogram tracing Results: was abnormal in 62 out of 105 children. 19 out of 62 had recurrence while only 2 among 43 normal EEG had recurrence. This was statistically signicant (P value 0.001). Children with remote symptomatic etiology constitutes the majority in those with abnormal EEG tracings. In children with remote symptomatic etiology, only one child had normal EEG. Remote symptomatic had higher number of abnormal EEG when compared to others and was found to have more recurrence. Conclusions: Children with EEG abnormalities after the rst episode of afebrile seizure have more chance of recurrence. Children with seizure secondary to remote symptomatic etiology had more recurrences

Risk of Seizures after Immunization with Vaccine in Children

Adverse neurological event particularly seizure after vaccination is not uncommon. The most linked vaccines are Diphtheria, Pertussis and Tetanus toxoid (DPT), Measles, Mumps and Rubella (MMR) and other combination vaccines. It is documented that increased febrile seizure after DPT and MMR vaccine is due to increase febrile episodes precipitating seizure and it is time related. Concomitant administration of vaccines cause seizure due to synergistic effect of those vaccines. When these vaccines are given separately, the risk of seizure is decreased. These type of vaccines are MMR + varicella (MMRV), DTaP-HepB-IPV etc. Regarding etiology, genetic mutation is most important. Some genes are closely related to vaccine induced FS and afebrile seizure like SCN1A, SCN2A, IFI44L, PCDH19 etc. Other causes are endotoxin mediated endothelial damage, IL-1â production and non CNS infection. It is well evident that consequences of not giving vaccine are far more than the adverse events. So Vaccinations should be performed without contraindication in children with previous febrile and afebrile seizures with proper counseling. Bangladesh J Child Health 2020; VOL 44 (1) :40-47