Clinical spectrum of seizures and efficacy of anticonvulsive treatment in children

Objective: To study the clinical spectrum of seizures and efficacy of anticonvulsive treatment in children

Study Design: A descriptive study

Place and Duration of Study: Military Hospital [MH] Rawalpindi from October 2011 to March 2012

Material and Methods: One hundred children of either gender aged 1 month to 12 years presenting with seizures at Military Hospital Rawalpindi were evaluated and consented to participate in the study. All children with a febrile seizures were evaluated. The seizures were classified according to international league against epilepsy guidelines. Antiepileptic treatment regimen was evaluated in terms of number of drugs, correct dosage and efficacy in control of seizures

Results: It was observed that generalized seizures were [58%] followed by focal seizures [32%] in children. Valproic acid was prescribed in [51%] cases. Epilepsy was diagnosed in [56%] followed by cerebral palsy [20%], post meningoencephalitis sequalae [11%], intracranial hemorrhage [7%] and leukodystrophies [3%] as underlying cause of seizures. Statistically significant association was seen between age groups and diagnosis [p value=0.001]; age groups and types of seizures [p value=0.046]; correct dosage of antiepileptics and control of seizures [p value=0.007]; compliance to treatment and control of seizures [p value=0.007]

Conclusion: Generalized seizures are the commonest form followed by focal seizures. Epilepsy was the common etiology of seizures in all age groups in children. Cerebral palsy was the second leading cause of seizures in children followed by post meningoencephalitis, stroke and leukodystrophies. Valproic acid was the most commonly prescribed antiepileptic. Normal delivery with delayed cry was the major risk factor for cerebral palsy. Prescription of appropriate antiepileptics according to diagnosis in optimum dosage and compliance to treatment affect control of seizures in children

Effect of place of birth, mode of transport and medical skills of the accompanying person on mortality of neonates

Objective: To determine the effect of place of birth, mode of transport and medical skills of the accompanying person on mortality of neonates

Study Design: A descriptive study

Place and Duration of Study: Military Hospital [MH], Rawalpindi from October 2011 to March 2012

Patients and Method: One thousand two hundred and ninety three neonates of either gender under the age of 28 days admitted to NICU either as indoor or outdoor were entered in the study. Data included high risk obstetric factors, gestational age, birth weight, APGAR score, gender, need for resuscitation, diagnosis, complications, place of delivery, mode of delivery and outcome. The associations between the place of delivery, mode of delivery and medical skills of the accompanying person with the neonatal mortality were associated using the Pearson Chi-Square method

Results: A total of 1293 neonates were included in the study and their data regarding place of delivery and mode of transport was evaluated. Four hundred and two [402/1293] cases died in our NICU and the mortality rate of the neonates admitted in our setup was 31.1%. The breakup of neonatal deaths was further subdivided into the patients born in health care with NICU facility [25%], those born in health care without NICU facility [33.60%] and those born in the community setting [40.54%]. The aforementioned percentages were calculated out of the total live births in that particular setup and do not represent mere breakup of total mortality. A total of 50.32% neonates brought to hospital in an unequipped vehicle expired versus 2.28% mortality of neonates that were brought in a medically equipped vehicle. The neonatal mortality rate in patients accompanied by unskilled personnel was 40% versus skilled personnel which was 1.62%. Statistically significant associations using Pearson Chi-Square method were seen between the place of delivery, mode of transport, the skills of the person accompanying the patient in the transport and neonatal mortality [p value = 0.001 each]

Conclusion: Results of this study prove that the quality of birth services and patient transport mechanisms directly affect the neonatal survival and babies who are born in community setting, transported in unequipped vehicle without a skilled medical attendant are at a higher risk for mortality than the patients born in NICU facility, transported in an equipped vehicle and accompanied by skilled medical attendant

Neonatal seizures; types, etiology and long term neurodevelopmental outcome at a tertiary care hospital

To study the types, etiology and long term neurodevelopmental outcome in neonates with seizures.A descriptive cross-sectional study. PNS Shifa Naval hospital Karachi from Jan 2011 to Feb 2014.Population: Ninety six neonates of either gender presented with seizures at NICU PNS Shifa Naval hospital Karachi were studied. Method: All neonates with seizures were evaluated. The seizures were classified according to the simiology. They were investigated according to NICU protocol to confirm the underlying diagnosis and timely management. The patients after discharge were regularly followed up for one year to assess the long term neurodevelopmental outcome. A total of 96 neonates with seizures were studied and it was observed that 60 [62.5%] were male babies and 56 [58.33%] were term with a male to female ratio of 1.6:1. Majority of the neonatal seizures were seen in 1stweek of life [85%]. The most common type of seizures was clonic 40 [41.67%] followed by subtle 20 [20.84%], mixed 16 [16.67%], tonic 10 [10.41%], myoclonic 5 [5.20%] and unclassified 5 [5.20%]. Antiepileptics were used in 82 [85.41%] patients. Phenobarbitone 49 [59.76%] was most commonly prescribed drug. The most common cause of seizures was birth asphyxia 48 [50%] followed by metabolic 16 [16.68%], sepsis 10 [10.41%], intracranial hemorrhage 6 [6.25%], bilirubin encephalopathy 4 [4.16%], inborn errors of metabolism 2 [2.08%], birth trauma 2 [2.08%] and unknown etiology 5 [5.20%]. 25 [26.04%] patients develop adverse neurodevelopmental outcome i.e. cerebral palsy with epilepsy 10 [40%] and cerebral palsy without epilepsy 05 [20%], developmental delay 10 [40%]. Mortality in the study was 12 [12.5%]. Clonic seizures are commonest in neonates apart from infants and children who have GTCS. The most common etiology of seizures in neonates is birth asphyxia. Phenobarbitone is still the most commonly prescribed antiepileptic. Quick assessment, timely diagnosis and aggressive management according to the etiology are necessary to prevent the morbidity and mortality associated with neonatal seizures. Long term neurodevelopmental outcome is worse in patients with birth asphyxia especially with low Apgar score at 5 minutes. Normal delivery and birth asphyxia were the major risk factors for cerebral palsy

five years old girl child with takayasu arteritis

Takayasu arteritis is a systemic vasulitis of large vessels that mainly involves the aorta and its branches. It normally presents in third decade of life and has rarely been reported in children under 10 years of age. We report here a case of Takayasu arteritis in a 5 years old girl who presented with headache, generalized body swelling, severe hypertension, proteinuria and minimal functioning kidneys. Conventional angiography demonstrated narrowing of descending aorta, right subclavian artery and right common iliac artery. She responded steroids, diuretics, antiplatelets and digoxin and discharged home on maintenance therapy.