AETIOLOGICAL EVALUATION OF NEW ONSET SEIZURES IN ADULTS IN EAST GODAVARI DISTRICT OF ANDHRA PRADESH

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AETIOLOGICAL EVALUATION OF NEW ONSET SEIZURES IN ADULTS IN EAST GODAVARI DISTRICT OF ANDHRA PRADESH

Journal Title: Journal of Evidence Based Medicine and Healthcare - Year 2018, Vol 5, Issue 35

Abstract

BACKGROUND Seizures are common disorder found all over the world and are encountered frequently during medical practice in a variety of settings. At the global level, it is estimated that nearly 70 million people suffer from epilepsy and the prevalence of epilepsy across the globe is estimated to be 5-9 per 1,000 populations. About 12 million persons with epilepsy live in India. Numbers of deaths attributed to epilepsy in 2015 were 7419 for 10,000 population and deaths attributable to epilepsy were 0.21% of total deaths globally. Idiopathic seizures account for most of the hospital admissions. Aetiological spectrum of acute symptomatic seizure in developing countries is different from developed countries. Studies from developed countries showed CVA as the leading cause of new onset seizures. CNS infections like Malaria, Tuberculosis, HIV, Neurocysticercosis account for significant number of cases in developing countries like India. Since these infections vary from region to region. Aetiology of seizure may vary from region to region. Single small enhancing CT lesions (SSECTL) are important cause of seizures in India. Initially it was thought that SSECTL were because of Tuberculosis focal encephalitis and micro abscess were due to Cysticercosis but now studies suggest that, in most of the cases of SSECTL Neurocysticercosis predominates. So, aetiology changes over time. Focal seizures are more common, but they may generalize to life threatening status epilepticus. Most common causes for this type of presentation include subdural haemorrhage, stroke, central nervous system infections, degenerative disorders like Alzheimer’s disease and space occupying lesions including malignancy (glioma and brain metastasis). They also occur in systemic metabolic conditions like uremia, hyperglycemia, hypoglycemia, hypernatremia, alcohol withdrawal. Seizures can be a presenting feature in TB meningitis which is most common type of chronic meningitis in India. More than 60% patients with intracranial TB may have seizures. Our medical college is located in a predominantly coastal area. The ongoing disease spectrum and their complications are likely to be different from those encountered in metropolitan area. Hence this effort is made to know the various aetiologies of new onset seizures in adults in coastal area. MATERIALS AND METHODS During this period of prospective observational study, 100 newly diagnosed seizure patients either admitted or attending as our patients to Medicine department in RMC General Hospital, Kakinada were enrolled in the study. RESULTS Out of 100 patients, 7% were in age group of 18-19 years, 25% in the age group of 20-29 years, 20% in the age group of 30- 39 years, 16% in the age group of 40-59 years and 9% in the age group of 50- 59 years, and 23% in the age group of 60-79 years. Majority of patients presented between age group 20-29 years, (i.e.; in 3rd decade), there after incidence decreased from 4 th decade to 6th decade and again incidence increased thereafter. Out of 100 patients, males (64%) were more affected than females (36%). GTCS (Generalized Tonic Clonic Seizures) (62%) was more common than Focal Seizures (38%). Out of 38 patients who presented with focal seizures, focal seizures without dyscognition were more common. Comparing both CT and EEG findings, out of 100 patients (n=100), 26 patients had both abnormal epileptiform discharges and abnormal finding in CT scan brain. Forty patients had both normal EEG & CT scan brain results. Twenty-one patients had CT scan brain focal lesion with normal EEG. Thirteen patients had normal CT scan brain findings in spite of epileptiform discharges on EEG and 60 patients had either abnormal CT scan brain focal lesion or epileptiform discharges on EEG. CONCLUSION Incidence of seizures is more common in males than in females. Incidence is more common in the third decade and thereafter decreases up to sixth decade and incidence again increased after sixth decade. Neurocysticercosis and calcified granuloma were most commonly seen in 18-39 years age group, Tuberculoma was evenly distributed from 2nd to 6th decade and cerebrovascular disease was the commonest cause in the 60-70 years age group. Generalized tonic-clonic seizure was the commonest type of seizure (62%). Among focal seizures, focal seizures without dyscognition are more common (65.78%). CT scan brain was abnormal in 47% of the patients with new onset seizures in adults without apparent cause clinically. Forty percent patients were found to have idiopathic seizures and no abnormality was identified clinically, biochemically, CT scan brain and EEG. Six percent of patients had recurrent seizures during the follow up period of this study and all were due to drug noncompliance and had no specific correlation with underlying CT/EEG abnormality.

Authors and Affiliations

Atchin Naidu M

Keywords

Epilepsy C10.228.140.490 Electroencephalography E01.370.376.300 Tomography E01.370.350.825

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EP ID EP571154
DOI 10.18410/jebmh/2018/524
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