Clinico Etiological Profile of “First Seizure” in Children. Experience from an Armed Forces Tertiary Care Hospital in Eastern India

Introduction: Seizure in the pediatric group is one of the most common emergencies encountered. The aim of this study was the evaluation of the etiology of a first episode of seizure in children so as to assess the short term as well as long‑term prognosis. MaterialsandMethods: We evaluated 86 children 2 months − 12 years presenting to the emergency/outpatient department with the first episode of seizure. Children were further sub‑grouped into two age groups of 2 months − 5 years (n = 60) and 5–12 years (n = 26) and acute symptomatic versus unprovoked seizures. Variables assessed were demographics, seizure semiology, laboratory tests, neuroimaging, and outcome at discharge. Results: 69.7% and 30.2% of children were in the age group 2 months to 5 years and 5–12 years, respectively. The mean age of the children was 4.11 ± 3.44 years. 45.3% of cases of acute symptomatic seizures and 54.6% of cases of unprovoked seizures were observed. Acute symptomatic seizures predominated in 2 months − 5 years (60%) while unprovoked seizures predominated in 5–12 years (88.4%). Focal seizures were predominant in the older age group (46.1%) as compared to the younger age group. About 10.4% of cases of seizures first presented as status epilepticus. The most common etiology identified was febrile seizures (27.9%) followed by central nervous system (CNS) structural lesions (19.7%) and CNS infections (10.4%). CSF was done in 18.6% of patients out of which 56.25% samples were positive for CNS infections. 68.6% of children underwent neuroimaging and abnormalities were reported in 67.7% of cases. About 18.6% of children had focal neurological deficits at discharge. Mortality in the entire cohort was 2.3% with 1 child in each vascular and CNS infections group. Conclusions: Children with a first episode of seizure should be evaluated for co‑existence of fever, preexisting developmental delays, other associated symptomatology, head trauma, and seizure semiology. Investigations should be done based on a detailed history and clinical examination. Despite a meticulous approach allowing identification of etiology of the first episode of seizure in children, it is possible that no etiology be identified in a substantial number of children, especially in the older age group

First unprovoked seizure: clinical and electrographic aspects

OBJECTIVE: To evaluate classification, EEG tracings and neuroimage following the first episode of unprovoked epileptic seizure in a pediatric population. METHODS: Patients diagnosed with first episode of unprovoked epileptic seizure from May 2000 to May 2005 were included. All subjects were submitted to EEG and cranial CT in the first 72 hours after the event. Seizures were classified according to the ILAE classification criteria of 1981. RESULTS: 387 patients, 214 (55.3 percent) male, average age 4.2 years. Neuropsicomotor development was normal in 315 (81.4 percent) patients. Seizure classification: 167 (43.15 percent) generalized, tonic-clonic being the most frequent of these (105/62.85 percent), followed by typical absence (22/13.17 percent), clonic (20/11.98 percent), tonic (13/7.78 percent) and atonic (7/4.19 percent). Focal seizures: 220 (56.85 percent), complex partial with secondary generalization as the most common of these (81/36.82 percent). EEG was normal in 208 (53.75 percent) cases. Brain atrophy was the most frequent abnormality on cranial CT. DISCUSSION: The majority of the children had normal neurodevelopment after a first unprovoked epileptic seizure. Partial seizures were more frequent than generalized seizures. Early EEG identifies interictal paroxysms or focal slowing in virtually half the patients.

OBJETIVO: Avaliar a classificação, resultados de EEG e de neuroimagem após a primeira crise epiléptica não-provocada em uma população pediátrica. METODOLOGIA: Pacientes atendidos entre maio de 2000 e maio de 2005 com diagnóstico de primeira crise epiléptica não-provocada. Todos foram submetidos a EEG e tomografia de crânio nas primeiras 72 horas após o evento. As crises foram classificadas segundo a Classificação da ILAE, 1981. RESULTADOS: 387 pacientes, sendo 214 (55.30 por cento) do sexo masculino, com idade média de 4.2 anos. O desenvolvimento neuropsicomotor foi normal em 315 (81.40 por cento) pacientes. Classificação das crises: 167 (43.15 por cento) generalizadas, das quais a mais freqüente foi a crise tônico-clônica (105/62.85 por cento), seguida pelas crises de ausência típica (22/13.17 por cento), clônica (20/11.98 por cento), tônica (13/7.78 por cento) e atônica (7/4.19 por cento). Crises focais: 220 (56.85 por cento), sendo a crise parcial complexa com generalização secundária a mais freqüente (81/36.82 por cento). EEG normal em 208 (53.75 por cento) casos. A anormalidade mais observada na tomografia de crânio foi atrofia cerebral. CONCLUSÕES: A maioria das crianças apresentou desenvolvimento neuro-psicomotor normal após a primeira crise epiléptica não-provocada. Crises parciais foram mais freqüentes que as generalizadas. EEG realizado precocemente identifica paroxismos interictais ou alentecimentos focais em praticamente metade dos pacientes.

Characteristics of Children Whose First Seizure Attack Presented as Status Epilepticus / 대한소아신경학회지

PURPOSE: Status epilepticus(SE) is a pediatric and neurologic emergency associated with significant morbidity and mortality. Prompt recognition and management are needed for successful outcomes. We evaluated, clinical manifestations, treatment and prognosis of the patients whose first seizure attacks were presented as SE. METHODS: According to the department of pediatrics and the emergency room in Inha University Medical Center, there were a total of 25 children between 1 month and 5 years old who were diagnosed as status epilepticus from July 1996 to June 2002. Also, their medical records were reviewed and analyzed interms of age distribution, accompaning diseases, the types and duration of convulsion, medications, EEG and MRI findings and prognosis. RESULTS: Twenty-five cases were studied. The mean age at the time of the diagnosis was 20+/-1.6 months and 80% of the patients were less than 3 years old. The most common type of the status epilepticus was generalized tonic clonic seizure comprising 15 cases(60%). 64% of the patients were symptomatic:fever(40%), CNS infection(20%), ischemic injury(4%) while 36% were idiopathic. Seizure attacks were terminated within an hour in seventeen patients(68%) and they controlled by one antiepileptic drug in thirteen patients(52%). Of the 20 EEGs, abnormal findings were shown in 13 cases(65%); namely, electrical seizure(30%), abnormal background(30%), and focal epileptiform discharge(5%). Of the 19 brain MRIs, abnormal findings were shown in 9 cases(47%). CONCLUSION: The children whose first seizure attack were presented as SE were less than 3 years old. The prognosis is good in that most of the seizure attacks were terminated within an hour and controlled by one epileptic drug. However those seizure attacks with longer duration, multiple antiepileptic druge and underlying causeare had poor prognosis.

The Usefulness of Emergency Brain Computerized Tomography in Children with First Seizures

PURPOSE: This study was performed to discover whether emergency brain computerized tomogra phy(CT) is useful for the diagnosis and management of patients with first seizure. METHODS: We studied retrostpectively all children(under 15-year-old) without a history of neu rologic illness who visited Hanyang University Hospital and took a brain CT because of a first seizure attack between January 1996 and June 1999. Total 96 children were enrolled in this study and divided into groups according to seizure type, EEG finding and provoked factor. RESULTS: Among ninety six children with a first seizure(male 60, female 36), 12 patients had brain abnormalities on CT; 3 with arachnoid cyst, 2 with vascular anomalies, 2 with brain atrophy, and so on. Forty seven patients had provoked seizures, and 56 had unprovoked seizures. Abnormalities on CT were more frequently seen in children with their first unprovoked seizure without the statistical significance(P=0.395) and in those children who had focal seizure and/or focal ab normalities on EEG(P=0.016). CONCLUSION: Emergency brain CT is a useful investigative tool for patients with first unprovoked seizure, particularly for the patients with focal seizure and/or focal EEG abnormalities. The decision to perform CT should be based on a detailed history and results of careful neurologic examination. (J Korean Pediatr Soc 2001;44:562-568)