Study of intracranial structural lesions diagnosed by computed tomography among children with unprovoked seizure disorder

Background: Seizures are the most common pediatric neurological disorder. The objectives were to know the prevalence and types of intracranial structural lesions diagnosed by Computed Tomography in children with unprovoked seizures.Methods: It is hospital based cross-sectional study done in Patna Medical College, India from August 2005- July 2007. All patients aged 6 months to 12 years admitted in pediatrics department with at least 2 episodes of unprovoked seizures were undergone Computed Tomography brain.Results: Out of total 112 patients admitted, 66.1% had abnormal CT scan. Prevalence of abnormal CT scan increased with advancing age and significant, with maximum percentage found in age group 10-12 years (43.2%). Males had more seizures and intracranial lesion than females but this association was statistically non-significant. 65.2% had generalized seizure and 34.8% had partial seizure. Among patients with abnormal CT scan, generalized seizure (70.3%) and partial seizure (29.7%).The commonest' probable diagnosis was tuberculoma (47.3%) followed by neurocysticercosis (25.7%) and brain abscess (4%). Other were atrophy, gliosis and hydrocephalus, 2.5% each; arachnoid cyst, extradural hematoma, sturge weber syndrome, tuberous sclerosis, infarct, hemiatrophy, caudate lobe hemorrhage, basal ganglia calcification, corpous callosum agenesis, 1.35% each.Conclusions: Inflammatory granuloma is the leading cause of unprovoked seizure in this part of the country. Every seizure case should undergo a CT scan examination. Preventive measures can be applied for tuberculoma and NCC so as to lower down the burden of seizure disorder.

Hyperhomocystetenemia, MTHFR Mutation Presenting as Unprovoked Pulmonary Embolism.

Introduction: For MTHFR as with homocysteine testing,no official guidelines exist as to who should be tested.Homozygosity for the MTHFR C677T mutation has beenassociated with an increase in blood clotting together withplasma homocysteine increase and DVT occurrence risk.Case report: A 28 year young male patient presented withcomplaints of sudden onset breathlessness for 5 days. Theepisodes of breathlessness were associated with diffuseanterior chest pain. There was no history of leg pain, cough,sputum, hemoptysis, fever. No history of prior hospitalization,trauma, surgery and immobilization could be elicited from thepatient. He was a non smoker with no other comorbidities.On presentation his pulse rate was 120 per minute, respiratoryrate was 22 per minute, blood pressure 146/92 mm Hg,temperature 98.8 ° F, SpO2 of 94% at room air. His generalphysical examination was unremarkable.Conclusion: Although it has been observed that elevatedhomocysteine levels are a common finding in patientswith cardiovascular disease and thrombosis, its role in itspathogenesis is still under evaluation. Homozygosity forthe MTHFR C677T mutation has been associated withincreased homocysteine levels. Testing for this mutation is animportant parameter in thrombophilia workup of patients withunprovoked VTE.

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 first episode of seizure for management. The aim was to study the etiology and the causes of recurrence after a first episode seizure.Methods: A prospective observational study was done on 135 children for a period of two 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 classified 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.Results: Electroencephalogram tracing 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 significant (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 first episode of afebrile seizure have more chance of recurrence. Children with seizure secondary to remote symptomatic etiology had more recurrences.

Valoración del niño con una primera crisis no provocada / Evaluation of a child with a first unprovoked seizure

Los episodios paroxísticos son uno de los trastornos neurológicos más frecuentes en niños. Es importante diferenciar entre los trastornos paroxísticos no epilépticos, las crisis sintomáticas agudas, las crisis febriles y las crisis no provocadas. La historia clínica permite, en la gran mayoría de los casos, poder llegar al diagnóstico. Las crisis no provocadas únicas son frecuentes en el niño. La tasa de recurrencia tras una primera crisis no provocada varía entre un 23-96% en los dos años siguientes a la primera crisis. El objetivo de este trabajo es describir cómo evaluar al paciente con una primera crisis no provocada y revisar el valor predictivo de los distintos factores de riesgo de recurrencia. Entre dichos factores de riesgo, se evalúan datos como la presencia de antecedentes familiares de epilepsia, historia previa de crisis febriles, edad de debut, tipo de crisis, presencia de crisis prolongadas o crisis agrupadas, crisis de presentación en sueño, anomalías neurológicas, evidencia de una etiología definida, y presencia de anomalías epileptiformes en el electroencefalograma. Los factores de riesgo de recurrencia más importantes son la etiología de las crisis y la presencia de anomalías epileptiformes en el electroencefalograma.

Paroxysmal episodes are one of the most common neurological disorders in children. It is important to distinguish between paroxysmal non-epileptic events, symptomatic seizures, febrile seizures, and unprovoked seizures. Patient's history is the key to proper diagnosis in most of the cases. A single unprovoked seizure is a frequent phenomenon in the pediatric population. Studies of recurrence after a first unprovoked seizure show percentages between 23% and 96% over a median follow-up of two years. The aim of this study is to define how to evaluate the first unprovoked epileptic seizure in a child and to review the weight of the different recurrence risk factors. Several factors enable us to predict the recurrence risk after a first unprovoked seizure including family history of epilepsy, prior history of febrile seizures, age at onset, type of seizure, prolonged seizures at onset, multiple seizures in a single day, sleep state, neurological abnormalities, etiology, and abnormalities in the electroencephalogram. The most important of these risk factors are the etiology of the seizures and the evidence of epileptiform abnormalities in the electroencephalogram.

Computed tomography scan findings among pediatric patients with unprovoked seizures: A hospital-based study

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To describe the radiologic findings in pediatric patients who underwent cranial CT scan for unprovoked seizures at the Philippine General Hospital (PGH) and determine whether there is any association between the demographic characteristics such as age, age at onset, gender, as well as normal or abnormal neurologic examination findings, and the abnormal CT scan findings.</p><p style="text-align: justify;"><b>METHODS:</b> Official results of all pediatric patients who underwent cranial CT scan for unprovoked seizures from January 1, 2015 to December 31, 2015 in PGH were reviewed. Data were described and statistically analyzed for differences in CT scan findings between different sexes, age groups, ages at onset, and presence or absence of neurologic findings.</p><p style="text-align: justify;"><strong>RESULTS AND CONCLUSION:</strong> Of the 88 cases included, 29 (32.95%) had abnormal CT findings. The most common finding was volume loss. No statistically significant difference was noted for the frequency of abnormal CT findings between categories. There was a trend towards more frequent abnormal CT scan findings among males, and among patients exhibiting abnormal neurologic findings.</p>

The Prognostic Factors Affecting the Occurrence of Subsequent Unprovoked Seizure in Patients Who Present with Febrile Seizure after 6 Years of Age / 대한소아신경학회지

PURPOSE: Few reports have described the prognostic factors affecting the occurrence of subsequent unprovoked seizure in patients who present with febrile seizure (FS) after 6 years of age. We investigated the prognostic factors affecting the development of unprovoked seizures after FS among patients from Jeju Island. METHODS: We included patients who developed FS after 6 years of age, who presented to our outpatient clinic between January, 2011 and June, 2017. Clinical data were obtained through chart reviews and phone call interviews. We used logistic regression analysis to analyze the risk factors associated with the occurrence of subsequent unprovoked seizure. RESULTS: Of the 895 patients who presented to our hospital due to their febrile seizure, 83 developed FS after 6 years of age. Among them, 3 patients were prescribed antiepileptic drugs before the onset of the unprovoked seizure, and 4 patients developed an unprovoked seizure before 6 years of age. Thus, overall, 76 patients were included in the study. 51 patients developed first FS before 6 years of age. In the remaining patients, the first FS developed after 6 years of age. The mean observational period since the last outpatient follow-up visit was 3.2 years (median 3.04 years, range: 1.42-4.71 years). Among them, 21% developed an unprovoked seizure. Logistic regression analysis showed that electroencephalographic (EEG) abnormalities served as an independent risk factor for a subsequent unprovoked seizure. CONCLUSION: EEG is the proper diagnostic tool to predict the risk of a subsequent unprovoked seizure in patients with FS after 6 years of age.

Estudio de una cohorte de pacientes con enfermedad tromboembólica venosa en seguimiento ambulatorio / Cohort study of pacients with venous thromboembolic disease assisted in ambulatory care / Estudo de umacoorte de pacientes comdoença tromboembólica venosa em acompanhamentoambulatorial

Resumen: La enfermedad tromboembólica venosa (ETEV) es una patología con morbilidad y mortalidad elevadas. Su manejo diagnóstico y terapéutico está en permanente revisión. La ausencia de estudios epidemiológicos en nuestro medio implica un desconocimiento de la forma de presentación, etiología y recurrencia de la misma. Se propone un estudio descriptivo sobre la población de pacientes con ETEV en seguimiento en la policlínica de Trombosis y Hemostasis del Hospital Pasteur de Montevideo, durante el período 2015-2016. Se registraron 35 pacientes con ETEV. La ETEV provocada se asoció predominantemente a factores de riesgo mayor y en los cuales falló la adecuada prescripción de tromboprofilaxis. En los pacientes con ETEV no provocada, las trombofilias diagnosticadas fueron el síndrome de anticuerpos anti fosfolípidos, déficit de Antitrombina y mutación del gen de la protrombina heterocigoto. Los pacientes con ETEV no provocada tuvieron un elevado porcentaje de recurrencias, la mitad de ellas asociadas a trombofilia y la otra mitad sin factor de riesgo predisponente (ETEV idopática).

Abstract: Venous thromboembolic disease (VTD) is a condition with high rates of morbidity and mortality. The etiologic diagnosis and therapeutics are in a continuous review process. In our country there are still no epidemiologic studies about the clinic presentation, etiology and recurrence of VTD. This is a cohort study of patients assisted in ambulatory care at the Thrombosis and Haemostasis Clinic of the Hospital Pasteur in Montevideo, for the 2015-2016 period. 35 patients were registered with VTD. Provoked VTD was associated with major risk factors in which optimal prescription of thromboprofilaxis failed. In patients with unprovoked VTD, testing for trombophiliashowed Antitrombin deficiency, hetrocigotic mutation of the Protrombin and antiphospholipid antibodies. Patients with unprovoked VTD showed a high percentage of recurrences, half of them with associated trombophilia and the otherhalf with no risk factor (idiopatic VTD).

Resumo: O tromboembolismo venoso (VTE) é umadoençacom elevada morbilidade e mortalidade. Diagnóstico e manejo terapêutico está em constante revisão. A ausência de estudos epidemiológicos em nosso ambiente implica uma falta de apresentação, etiologia e recorrência do mesmo. Umestudodescritivonapopulação de pacientes com TEV monitorizaçãoproposto no polyclinic de Thrombosis and Haemostasis Hospital Pasteur em Montevidéu, durante o período de 2015-2016. 35 doentescom tromboembolismo venoso foramregistados. TEV causado predominantemente associada a fatores de risco aumentado e que falhou a prescriçãoadequada de tromboprofilaxia. Em pacientes com TEV não provocado os trombofilia foram diagnosticados síndrome anti fosfolipídiosdeficiência de antitrombina e mutação do heterozigoto protrombina. TEV pacientes nãocausaramuma elevada taxa de recorrência, metade delas associadacom trombofilia e meiasempredispondo factor de risco (idiopática VTD).

Risk of recurrence after a first unprovoked seizure in children / Risco de recorrência após uma primeira crise epilética não provocada em idade pediátrica

Abstract Objectives: This study aimed to evaluate the first episode of unprovoked epileptic seizure in children and assess recurrence risk factors. Methods: This was a retrospective observational study, based on the analysis of medical records of patients admitted between 2003 and 2014, with first epileptic seizure, at the pediatric service of a secondary hospital. The data were analyzed using the SPSS 20.0 program. Results: Of the 103 patients, 52.4% were boys. The median age at the first seizure was 59 (1-211) months. About 93% of children were submitted to an electroencephalogram at the first episode and 47% underwent neuroimaging assessment. Treatment with an antiepileptic drug was started in 46% of patients. The recurrence rate was 38% and of these, 80% had the second seizure within six months after the first event. Of the assessed risk factors, there was a statistically significant association between seizure during sleep and recurrence (p = 0.004), and between remote symptomatic etiology seizure and occurrence of new seizure (p = 0.02). The presence of electroencephalogram abnormalities was also associated with the occurrence of new seizures (p = 0.021). No association was found between age, duration of the seizure, and family history of epilepsy with increased risk of recurrence. Conclusions: Most children with a first unprovoked epileptic seizure had no recurrences. The risk of recurrence was higher in patients with seizure occurring during sleep or remote symptomatic ones and those with abnormal electroencephalogram results.

Resumo Objetivos: Este trabalho teve como objetivos estudar o primeiro episódio de crise epilética não provocada em idade pediátrica e avaliar os fatores de risco de recorrência. Métodos: Estudo observacional retrospectivo, baseado na análise dos processos clínicos dos pacientes internados entre 2003 e 2014, num serviço de pediatria de um hospital de nível 2, com primeira crise epilética. Os dados foram trabalhados com o programa SPSS Statistics 20.0. Resultados: Dos 103 pacientes, 52,4% eram meninos. A mediana da idade da primeira crise foi de 59 (um-211) meses. Fizeram eletroencefalograma no primeiro episódio 93% das crianças e 47% neuroimagem. O tratamento com fármaco antiepilético foi instituído em 46% dos pacientes. A taxa de recorrência foi 38% e, desses, 80% tiveram a segunda crise nos seis meses seguintes após o primeiro evento. Dos fatores de risco estudados verificou-se uma relação estatisticamente significativa entre a crise durante o sono e a recorrência (p = 0,004), assim como entre as crises de etiologia sintomática remota e a ocorrência de novas crises (p = 0,02). A presença de anormalidades no eletroencefalograma também esteve associada à ocorrência de novas crises (p = 0,021). Não se encontrou relação entre idade, duração da crise e história familiar de epilepsia com risco aumentado de recorrência. Conclusões: A maioria das crianças com uma primeira crise epilética não provocada não teve recorrências. O risco de recorrência foi superior nos pacientes com crise durante o sono ou crise sintomática remota e naqueles com eletroencefalograma alterado.

A Practical Definition of Epilepsy

In 2005, the ILAE conceptually defined epilepsy as a disorder of the brain, characterized by an enduring predisposition to generate epileptic seizures and by its psychosocial consequences. In clinical practice, this definition of epilepsy is usually taken to mean at least two unprovoked seizures more than 24 h apart. The operational definition for special circumstances that do not meet the criteria of two unprovoked attacks has been recommended. In 2014, the ILAE refined the practical definition of epilepsy. With this definition, epilepsy is a disease of the brain with either: (1) at least two unprovoked (or reflex) seizures occurring more than 24 h apart; (2) one unprovoked (or reflex) seizure and a probability of further seizures similar to the general recurrence risk (at least 60%) after two unprovoked seizures, occurring over the next 10 years; (3) diagnosis of an epilepsy syndrome. Epilepsy is considered to be resolved for individuals past the applicable age of an age-dependent epilepsy syndrome or those who have remained seizure-free for the past 10 years, without seizure medicines for the past 5 years.

Comparison of Clinical and Imaging Characteristics and Outcomes between Provoked and Unprovoked Acute Pulmonary Embolism in Koreans

This study was performed to compare clinical and imaging parameters and prognosis of unprovoked pulmonary embolism (PE), provoked PE with reversible risk factors (provoked-rRF), and provoked PE with irreversible risk factors (provoked-iRF) in Koreans. Three hundred consecutive patients (mean age, 63.6 +/- 15.0 yr; 42.8% male) diagnosed with acute PE were included. The patients were classified into 3 groups; unprovoked PE, provoked-rRF, and provoked-iRF; 43.7%, 14.7%, and 41.7%, respectively. We followed up the patients for 25.4 +/- 33.7 months. Composite endpoint was all-cause mortality and recurrent PE. The provoked-iRF group had significantly higher all-cause mortality, mortality from PE and recurrent PE than the unprovoked and provoked-rRF groups (P 1.2 mg/dL; P 5 mg/L; P = 0.002; HR, 5.308; 95% CI, 1.824-15.447) and computed tomography (CT) obstruction index (P = 0.034; HR, 1.090; 95% CI, 1.006-1.181). In conclusion, provoked-iRF has a poorer prognosis than unprovoked PE and provoked-rRF. Renal insufficiency, high CRP, and CT obstruction index are poor prognostic factors in unprovoked PE.

Comparison of Clinical and Imaging Characteristics and Outcomes between Provoked and Unprovoked Acute Pulmonary Embolism in Koreans

This study was performed to compare clinical and imaging parameters and prognosis of unprovoked pulmonary embolism (PE), provoked PE with reversible risk factors (provoked-rRF), and provoked PE with irreversible risk factors (provoked-iRF) in Koreans. Three hundred consecutive patients (mean age, 63.6 +/- 15.0 yr; 42.8% male) diagnosed with acute PE were included. The patients were classified into 3 groups; unprovoked PE, provoked-rRF, and provoked-iRF; 43.7%, 14.7%, and 41.7%, respectively. We followed up the patients for 25.4 +/- 33.7 months. Composite endpoint was all-cause mortality and recurrent PE. The provoked-iRF group had significantly higher all-cause mortality, mortality from PE and recurrent PE than the unprovoked and provoked-rRF groups (P 1.2 mg/dL; P 5 mg/L; P = 0.002; HR, 5.308; 95% CI, 1.824-15.447) and computed tomography (CT) obstruction index (P = 0.034; HR, 1.090; 95% CI, 1.006-1.181). In conclusion, provoked-iRF has a poorer prognosis than unprovoked PE and provoked-rRF. Renal insufficiency, high CRP, and CT obstruction index are poor prognostic factors in unprovoked PE.

Risk Factors of Unprovoked Seizures after Acute Symptomatic Seizures in Children / 소아과

PURPOSE: Acute symptomatic seizure is defined as a temporary seizure together with acute systemic, metabolic, or toxic insult in association with an acute central nervous system insult. And unprovoked seizure is defined as seizure without provocating factors. We studied the risk factors of unprovoked seizures after acute symptomatic seizure in children. METHODS: We retrospectively reviewed the records of one hundred and ten children with acute symptomatic seizures who were admitted to the pediatric department of Chungbuk National University Hospital between January, 1998 and December, 2003. We analyzed overall risk factors of unprovoked seizures after acute symptomatic seizures involving etiology, incidence, type of seizure, duration and neuroimaging. RESULTS: We analyzed records of 110 children with acute symptomatic seizures aged from 1 month to 17 years. 24 children had unprovoked seizures (21.8%) after acute symptomatic seizures. Causes in order of frequency were encephalopathy, central nervous system infection, brain tumor, cerebrovascular disease. The risk of unprovoked seizure was significantly greater for those with status epilepticus (68.4%) than without status epilepticus, with partial seizure (64.7%) than generalized seizure. And the risk of unprovoked seizure was strongly associated with abnormal finding of electroencephalogram (79.1%) and neuroimaging (41.6%). CONCLUSION: In conclusion, the leading cause of subsequent unprovoked seizure in children with acute symptomatic seizure was encephalopathy and age specific incidence was high in the group aged 24-72 months. The risk for subsequent unprovoked seizure was greater for those with partial seizure, status epilepticus, abnormal finding of neuroimaging and electroencephalography.

Risk Factors of Unprovoked Seizures after Acute Symptomatic Seizures in Children / 소아과

PURPOSE: Acute symptomatic seizure is defined as a temporary seizure together with acute systemic, metabolic, or toxic insult in association with an acute central nervous system insult. And unprovoked seizure is defined as seizure without provocating factors. We studied the risk factors of unprovoked seizures after acute symptomatic seizure in children. METHODS: We retrospectively reviewed the records of one hundred and ten children with acute symptomatic seizures who were admitted to the pediatric department of Chungbuk National University Hospital between January, 1998 and December, 2003. We analyzed overall risk factors of unprovoked seizures after acute symptomatic seizures involving etiology, incidence, type of seizure, duration and neuroimaging. RESULTS: We analyzed records of 110 children with acute symptomatic seizures aged from 1 month to 17 years. 24 children had unprovoked seizures (21.8%) after acute symptomatic seizures. Causes in order of frequency were encephalopathy, central nervous system infection, brain tumor, cerebrovascular disease. The risk of unprovoked seizure was significantly greater for those with status epilepticus (68.4%) than without status epilepticus, with partial seizure (64.7%) than generalized seizure. And the risk of unprovoked seizure was strongly associated with abnormal finding of electroencephalogram (79.1%) and neuroimaging (41.6%). CONCLUSION: In conclusion, the leading cause of subsequent unprovoked seizure in children with acute symptomatic seizure was encephalopathy and age specific incidence was high in the group aged 24-72 months. The risk for subsequent unprovoked seizure was greater for those with partial seizure, status epilepticus, abnormal finding of neuroimaging and electroencephalography.

Unprovoked Seizures in Children with Febrile Seizures / 대한소아신경학회지

PURPOSE: The greatest concern for children with febrile seizures is not only the possibility of epilepsy, but also unprovoked seizures. The present study examined the risk and predictors of unprovoked seizures. Study factors include three identified factors of unclear significance-family history of febrile seizures and the number of recurrent febrile seizures and two new factors that are important predictors - the height of temperature and the duration of fever prior to the initial febrile seizure. METHODS: Children(n=333) between 6 months and 5 years of age with first febrile seizures were reviewed to determine the risk and predictors of unprovoked seizures for 10 years. Children with the central nervous system infections(meningitis or encephalitis), past history of febrile seizures or epilepsies were excluded. RESULTS: 10(43.5%) of 23 children with neurodevelopmental abnormalities had epilepsies. 12(10%) of 120 children with complex febrile seizures had epilepsies. 17(6.6%) of 256 children without family history of febrile seizures in 1 degrees relative and 8(10.4%) of 77 children with family history of febrile seizures in 1 degrees relative had epilepsies. CONCLUSION: In our results, there exists a strong association between unprovoked seizures and complex features in neurodevelopmentally abnormal children compared with normal children.

Unprovoked Seizures in Children with Febrile Seizures / 대한소아신경학회지

PURPOSE: The greatest concern for children with febrile seizures is not only the possibility of epilepsy, but also unprovoked seizures. The present study examined the risk and predictors of unprovoked seizures. Study factors include three identified factors of unclear significance-family history of febrile seizures and the number of recurrent febrile seizures and two new factors that are important predictors - the height of temperature and the duration of fever prior to the initial febrile seizure. METHODS: Children(n=333) between 6 months and 5 years of age with first febrile seizures were reviewed to determine the risk and predictors of unprovoked seizures for 10 years. Children with the central nervous system infections(meningitis or encephalitis), past history of febrile seizures or epilepsies were excluded. RESULTS: 10(43.5%) of 23 children with neurodevelopmental abnormalities had epilepsies. 12(10%) of 120 children with complex febrile seizures had epilepsies. 17(6.6%) of 256 children without family history of febrile seizures in 1 degrees relative and 8(10.4%) of 77 children with family history of febrile seizures in 1 degrees relative had epilepsies. CONCLUSION: In our results, there exists a strong association between unprovoked seizures and complex features in neurodevelopmentally abnormal children compared with normal children.