A Clinical Profile and Diagnostic Management of First-time Seizures in Children Aged 1–12 Years - A Tertiary Hospital-based Study in Kerala
Journal Title: INTERNATIONAL JOURNAL OF SCIENTIFIC STUDY - Year 2018, Vol 6, Issue 6
Abstract
Background: First-time seizures in children present a complex situation in the family that may have profound emotional, social, and vocational consequences. The seizures are unlikely to recur if the first seizure is provoked an acute disturbance of brain function (acute symptomatic or provoked); however, if it is unprovoked meta-analyses suggest that 30–50% will recur. Among the second unprovoked seizures, 70–80% will recur, justifying the diagnosis of epilepsy (a tendency for recurrent seizures). Seizures can be either generalized or focal. Types of seizures such as absence or complex partial seizures typically occur several times before the person or family become concerned. Aim of the Study: The study aimed to study the prevalence and clinico-demographic profile of children with first-time seizures and its diagnosis in a tertiary care hospital of Kerala. Materials and Methods: A thorough clinical history taking was done to include the information of age (from 1 year to 12 years), gender, type of seizure, loss of consciousness, with or without status epilepticus, associated symptoms (fever, headache, vomiting, and altered sensorium), developmental history, and family history of seizure or epilepsy. Preliminary investigations such as complete blood count, blood glucose, serum electrolytes, cerebrospinal fluid (CSF) analysis, Malaria parasite test, Chest X-ray, Montoux test, and neuroimaging including computed tomography scan head or cranial magnetic resonance imaging, electroencephalography (EEG), and other tests were undertaken depending the urgency, availability, and necessity being taken into account. Initial treatment given, recurrence of seizures, time taken for disappearance of total seizures, and status at the time of discharge were recorded and analyzed. Classification of seizures including generalized tonic-clonic (GTC), absence, myoclonic, focal, and other seizures types was based on the Commission on Epidemiology and Prognosis, 2010 International League against Epilepsy. Results and Observations: A total of 218 children with first - time seizures included 112 (51.37%) children were male and 106 (48.62%) were females. The male to female ratio was 1.05:1. The overall mean age was 5.28 ± 1.18 years. 94/218 (43.11%) children were of 1–4 years, 65/218 (29.81%) of 5–8 years, and 59 (27.06%) of 9–12 years. Loss of consciousness observed in 49/218 (22.47%) children, status epilepticus history among 27/218 (12.38%), associated symptoms in 86/218 (39.44%) children, and development history in 34/218 (15.59%) children, and family history of seizure or epilepsy in 55/218 (25.22%) children. Generalised convulsions in 118/218 children (54.12%) and focal seizures in 100/218 (45.87%) was obsererved. Among 218 children, 151 (69.26%) had GTC seizures, 46 (21.10%) had tonic seizures, 17 (07.79%) had myoclonic type, and 4 (01.83%) had other types. Conclusions: First - time seizures in children have the reasons for physical, mental, and financial stress for the parents. Both the genders are equally affected. Generalized seizures were the far most common type of all seizures. Central nervous system infections, febrile convulsions, seizure disorders, head injuries, and space-occupying lesions were the main etiological factors in that order. Investigations to rule out metabolic diseases are equally important in the diagnosis. CSF analysis, neuroimaging, and EEG are accepted as investigative procedures by the parents for early diagnosis and remain essential. A continuation of the study is required to detect and follow-up children with recurrences.
Authors and Affiliations
Damodaran Alakkodan
Keywords
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