Profile of children with seizures in a tertiary care hospital at VCSGGIMS and R Srinagar Pauri, Gharwal, Uttarakhand, India

Background: Seizure is one of the common causes of childhood hospitalization with significant mortality and morbidity. Current study is to find the etiology of seizure and classify seizure into various types and age groups presenting to tertiary center in Department of pediatrics VCSGGIMS and R Srinagar Pauri, Gharwal, Uttrakhand, India.Methods: This was a hospital based prospective study carried out from 1st Jan. 2014 to 31st Dec 2014. Variables collected were demographics, clinical presentations, laboratory tests, brain imaging studies, electroencephalography, diagnosis and hospital course.Results: A total of 276 patients were admitted for seizures with 172 (62.3%) males and 104 (37.7%) females. Among these patients, 148 (53.5%) presented with fever and 157 (56.8%) of children were less than 5 years of age. Generalized tonic-clonic seizure was the most common seizure type (69.2%) followed by partial (19.2%), absence (2.8%), myoclonus (1.6%) and others (6.9%). Seizure disorder (33.7%), febrile seizures (30%), CNS infections (meningitis 6.1%, encephalitis 6.5% and Tubercular meningitis 1.8%) and neurocysticercosis were other common etiologies. Abnormal brain images were noted in 55 (45.45%) out of 121 patients and most common abnormality was neurocysticercosis 33(12%).Conclusions: Acute episode of seizure is one of the causes for hospitalization. It can be concluded from present study that most of seizures caused by febrile seizures and CNS infections (meningitis and encephalitis, neurocysticercosis) can be managed better with prompt interventions. Children presenting with unprovoked seizure need prolonged follow up with neurophysiologic studies and neuroimaging (CT or MRI) for better understanding of childhood seizure.

Evaluation of levetiracetam and valproic acid as monotherapy on quality of life in patients of generalized tonic clonic epilepsy

Background: Quality of life plays an important role in patients of epilepsy and is the most neglected part during management. The antiepileptic drugs treatment results in seizure control but adversely affect the quality of life in patients.Methods: An observational analytical study was conducted in the Department of pharmacology with Department of Neurology of Himalayan Institute of Medical Sciences, Dehradun over 12 months. 85 patients fulfilling the inclusion criteria with diagnosis of generalized tonic clonic seizures (GTCS) were enrolled and divided into two groups based on physicians discretion and followed up for 12 weeks. Patients were evaluated for quality of life by QOLIE-10 self administered questionnaire at 0 and 12 weeks, assessed for seizure control and drug related adverse effects.Results: 85 patients were enrolled and divided into two treatment arms as per physician discretion, levetiracetam (41) and valproic acid group (44). Study drugs showed significant improvement in quality of life, levetiracetam showed mean change that was significantly greater than valproic acid (p=0.003) at 12 weeks. Patients who failed to achieve seizure control at 6 weeks were 17% patients in levetiracetam and 20% in valproic acid group, reason being non-adherence which was 17% and 20% respectively. Adverse events recorded with Levetiracetam (10), most common being increased sleep and with valproic acid (18), with most common being increased sleep and weight gain.Conclusions: Levetiracetam treatment resulted in better quality of life, with similar seizure control but decreased number of adverse effect then Valproic acid.

The Clinical Presentations and Prognosis of Non-Ketotic Hyperglycemia Induced Seizure

BACKGROUND: Seizure can be triggered by the non-ketotic hyperglycemia (NKH). Recently we analysed 18 cases of NKH induced seizure to identify the causes for NKH, seizure types, prognosis, and the differences of clinical presentation between the patient with chronic brain structural lesion (CBSL) and the patient without. METHODS: Eighteen patients with NKH induced seizure were selected from the database. Data regarding brain images, clinical symptoms, co-morbid illnesses, blood laboratories, and prognosis were collected. Patients were divided into two groups according to the presence of CBSL. RESULTS: The patients with CBSL showed more generalized tonic-clonic seizure (GTCS) than without. Focal seizures in this group appeared to be originated from the pre-existing lesion in many situations. The poor compliance to anti-diabetic treatment and physical stresses were most common causes for NKH. One year seizure remission without anti-epileptic drug treatment was achieved in 17 of 18 patients. CONCLUSIONS: The patients with CBSL might have more GTCS than without. The impairment of inhibitory mechanism surrounding the focal irritative zone might be one of plausible explanation for this phenomenon. The prognosis was favorable. Further large studies are required.

Study of intelligence quotient and influencing factors on the children with idiopathic generalized tonic-clonic seizure / 中华行为医学与脑科学杂志

ObjectiveTo study the intelligence quotient(IQ) profile of the children with idiopathic generalized tonic-clonic seizure (GTCS) and the factors influencing IQ of them.MethodsAll 28 children with GTCS were selected who were aged 9 ～ 16 years in 20 GTCS families in a mountain area of the south of Anhui Province,all available healthy siblings of the children included in the epilepsy group,did not have epilepsy,and were nearest in age to the children with GTCS ( control group 1 ),and thirty children aged 9 ～ 16 years old who had lived in the same village ( control group 2) entered into our study.The IQ was studied of the three groups of children and the factors influencing IQ of children with GTCS at the same time.The data were input SPSS12.0 and analyzed.ResultsThe IQ of children with GTCS(85.64 ±20.57)was lower than that control group 1( 103.39 ± 11.17)and the control group 2 ( 106.17 ± 11.67).The difference between children with GTCS and the two control groups were significant for almost all the subtest quotients except completion of drawing and picture arrangement.No significant differences were found between the control group 1 and the control group 2 on the IQ and the subtest quotients.IQ scores of children with GTCS showed significant linear correlation with father's education( r=0.453,P＜0.01 ),age at onset of epilepsy( r=0.506,P＜0.01 ),duration of seizure disorder( r=-0.533,P＜0.0l ),status epilepticus( r=-0.732,P＜0.01),total number of seizures( r=-0.761,P＜0.01) and seizure frequency ( r=-0.708,P ＜ 0.01 ).ConclusionThe IQ scores of the children with idiopathic GTCS are lower significantly than general children population.Epilepsy-related variables affecting IQ scores of the children with idiopathic GTCS are duration of seizure disorder,status epilepticus,age at onset of epilepsy,total number of seizures,seizure frequency.

Generalized tonic-clonic seizure following spinal anesthesia for Cesarean section with bupivacaine: A case report

Regional anesthesia for Cesarean section is a popular anesthetic method and a subarachnoid injection of local anesthetics provides rapid onset and a reliable block. Furthermore, it maintains airway reflexes and consciousness of the parturient and is associated with less neonatal depression. Complications related with spinal anesthesia are most often postdural puncture headache, back pain, hematoma, abscess, paresthesia or motor weakness and very rarely, myoclonus. Generalized seizures as a complication following epidural anesthesia with bupivacaine has been reported, but rarely following spinal anesthesia. We present a case of a parturient who was well antenatally, but presented with generalized tonic-clonic seizures following delivery. Although the possible etiologic factors of these transient seizures after spinal anesthesia are difficult to clarify, we emphasize that careful airway monitoring after regional anesthesia is important.

Papillary Meningioma with Leptomeningeal Seeding

A 43-year-old male presenting with headache and dizziness underwent craniotomy and gross total resection of an extraaxial tumor was achieved via left occipital interhemispheric approach. The tumor was diagnosed as papillary meningioma arising from the left falcotentorium with such pathologic characteristics of bronchoalveolar adenocarcinoma. At postoperative day 40, he developed generalized tonic clonic seizure and then progressed to a status epilepticus pattern. Brain magnetic resonance imaging showed irregular leptomeningeal enhancement with a significant peritumoral area. Through a cerebrospinal fluid (CSF) study, we identified the meningioma cells of the papillary type from the CSF. At the postoperative day 60, he fell into semicomatose state, and the computed tomography imaging showed low density on both cerebral hemispheres, except the basal ganglia and cerebellum, with overall brain swelling and an increased intracranial pressure. He died on the following day. We experienced a rare case of a papillary meningioma with leptomeningeal seeding.

Dislocation of the Bilateral Temporomandibular Joint due to Generalized Tonic-Clonic Seizures / 대한간질학회지

Dislocations or fractures of the limbs can arise from muscle contraction during epileptic seizures. Dislocation complication of the bilateral temporomandibular joint from seizures is reported very rarely. A 36-year-old woman, who had no history of epilepsy, presented recurrent dislocations of the bilateral temporomandibular joint and generalized tonic-clonic seizures. EEG showed intermittent generalized slow activity. We report a case of bilateral temporomandibular joint dislocation that occurred during generalized tonic-clonic seizures, which has not previously been reported in Korea.

The Relationship between Hippocampal Damage on MRI and Secondarily Generalized Tonic Clonic Seizures in Temporal Lobe Epilepsy : Quantitative and Qualitative MRI Study / 대한간질학회지

PURPOSE: It has been suggested that recurrent seizures may cause the hippocampal formation (HF) damage in temporal lobe epilepsy (TLE). To evaluate whether secondarily generalized tonic clonic seizure (SGTC) is related to the degree of the HF damage on MRI we performed this study. METHODS: We found 42 patients with TLE who had HS on qualitative MRI from epilepsy database. They were divided into unilateral HS (UHS) and bilateral HS (BHS) on qualitative MRI by visual analysis. We performed HF volumetry in 20 and T2 relaxometry in 22 (17 patients were lateralized by quantitative MRI and ictal or interictal EEG). RESULTS: The frequency of status epilepticus and SGTCs in BHS were significantly higher than that in UHS (14% vs 3%, p<0.05 and 60% vs 6%, p<0.05 respectively). Of 17 patients who were lateralized, the frequency of SGTCs was significantly correlated to the ipsilateral (r=0.58, p<0.05) and contralateral (r=0.35, p<0.05) T2 relaxometry as well as inversely to the ipsilateral (r=-0.59, p<0.05) and contralateral (r=-0.52, p<0.05) HF volume. CONCLUSIONS: BHS has the higher frequency of status epilepticus and SGTCs, and the frequency of SGTCs was related to the HF damage.