The study of etiological profile in new onset seizures in Indian scenario.

A seizure (Latin word which means “to take possession of”) is a paroxysmal event due to abnormal excessive or synchronous neuronal activity in the brain. Seizure is a medical emergency and about 1 in 10 persons will experience a seizure in their lifetime. Etiological contribution to seizures in developing countries is different from developed countries. Epilepsies related to malaria, neuroinfections, tuberculosis, HIV, meningitis, trauma and perinatal difficulties more prevalent in India and other developing countries. Neurocysticercosis is the most common cause of seizures/epilepsy in the developing countries and designated as a “biological marker” of the social and economic development of a community. In India, Single Small Enhancing CT Lesions (SSECTL) being the most common radiological finding and dying cysticercus larva in histopathological studies. Aim: To study the etiological profile in new onset seizures. Methods: This was an observational and prospective study. The present study enrolled 100 patients above 15 years of age with new onset seizures. All the patients and their relatives were interviewed regarding history and thorough clinical examination was done. Routine blood investigations, blood urea, serum creatinine, blood sugar, liver function tests, serum electrolyte were done. Special investigations like electroencephalography (EEG), CT scan brain, MRI, and lumbar puncture were done in selected cases. Results: Out of 100 patients included in the study, neuroinfection is leading cause of seizure in 36%, Cerebrovascular accidents (25%) and metabolic in (12%). Majority of seizures in neuroinfections were due to neurocysticercosis in 15 patients (42%) followed by meningoencephalitis in 14 patients (38%). Among Cerebrovascular accidents, stroke accounted for 84% (21) (Infarct-12, Haemorrhage-9), followed by cerebral venous thrombosis 12% (3). Out of 12 patients with metabolic seizures, hypoglycaemia and hyponatremia constituted 33% each. Conclusions: Etiological spectrum of seizures includes neuroinfection, CVA, tumour, metabolic, poisoning and alcohol withdrawal. Neuroinfection accounted for significant number of seizures in all the age groups. Neurocysticercosis is the most common etiology among neuroinfections. Cerebrovascular accidents common in 4th & 5th decades. Limitation: Patients <15 years with new onset seizures were not included in the study.

Hennekam lymphangiectasia syndrome.

Hennekam lymphangiectasia syndrome is a rare autosomal recessive condition. Onset is usually in childhood. The prevalence is unknown but less than 50 cases have been reported in the literature. Incidence is about 1 in 100000 and occurs in all ethnic groups. The syndrome is characterized by the association of lymphedema, intestinal lymphangiectasia, intellectual deficit and facial dysmorphism. Here is a case presented with distension of abdomen with ascites, bilateral pedal oedema, macrocephaly, left half facial edema, left half hypertrophied tongue, dental anomalies, acanthosis nigricans, acrochordons and syndactyly consistent with a diagnosis of Hennekam syndrome. The diagnosis of Hennekam is suspected on the basis of clinical phenotypic features. This is one of the very few cases reported from India.

Incidence, severity, prognostic significance of thrombocytopenia in malaria.

Background: Malaria is an infectious disease caused by plasmodium parasite. P. falciparum account for majority of morbidity and mortality. Thrombocytopenia and anaemia are the most frequently associated hematological complications in malaria. The low platelet count together with acute febrile syndrome emerged as the strongest predictor of malaria a finding that is frequent and present even before anemia and splenomegaly sets in. Severe thrombocytopenia is a good predictor of poor prognosis than mild and moderate thrombocytopenia. The aim is to study the incidence, severity, prognostic significance of thrombocytopenia in malaria. Methods: This was an observational and prospective study. The study enrolled 100 patients with thrombocytopenia and fever who were proven to have malaria either by peripheral smear or Quantitative Buffy Coat (QBC) test or malarial antigen assay were included in the study and patients with thrombocytopenia due to other causes were excluded from the study. Platelet count was estimated on a fully automated quantitative analyzer. All the 100 patients were followed during the hospital stay and upto discharge or till the outcome. Results: The incidence of thrombocytopenia was 73% indicating a common association in malaria. Complicated malaria was observed in 58.80% of P. falciparum infection whereas 66% of P. vivax infection was associated with uncomplicated malaria. Severe thrombocytopenia showed positive correlation with severity of malaria. Thrombocytopenic patients with effective anti-malarial treatment showed 95.90% recovery and 3 patients 4.10% had mortality. Patients with severe thrombocytopenia were 8.5 times more likely to have complicated malaria with P <0.001 according to student „t‟ test. Conclusion: Thrombocytopenia is the most common hematological finding in malaria. Severe thrombocytopenia showed positive correlation with complicated malaria and a good predictor of poor prognosis. Patients with classical malarial fever and thrombocytopenia who were negative for malaria parasite were not included in the study.