Seizure Episodes Research Articles

Prospective observational study of oral clonazepam to prevent high-dose busulfan-induced seizures in adult patients

BackgroundBusulfan at high doses has been associated with a risk of seizures. Phenytoin has been used traditionally as anti-seizure prophylaxis, and benzodiazepines and levetiracetam have been introduced more recently, providing data from retrospective series. The main purpose of this study was to evaluate the effectiveness of oral clonazepam as anti-seizure prophylaxis in adult patients receiving high doses of intravenous busulfan as part of the conditioning regimen for hematopoietic stem cell transplantation. The secondary objectives were to determine the feasibility of this regimen and to analyze the adverse events associated with the use of clonazepam.MethodsThis prospective, single-center study included 64 adult patients who received conditioning regimens with high doses of intravenous busulfan and anti-seizure prophylaxis with oral clonazepam, at a dose of 1 mg/8 h, from 12 h before starting treatment with busulfan until 48 h after ending administration.ResultsThe effectiveness of the prophylaxis was 100%, with no episodes of seizures during busulfan treatment or in the 72 h afterwards. Treatment was feasible, and oral scheduled administration was completed in all patients. Adverse events that could be associated with clonazepam included the onset of somnolence, dizziness, and confusion, mostly mild.ConclusionThe oral clonazepam regimen described in this study has been prospectively shown to be an effective, feasible anti-seizure prophylaxis option with manageable toxicity.

Hereditary hypomagnesemia with secondary hypocalcemia in a child: a clinical case

Relevance. Magnesium is a vital cation that serves as a cofactor in numerous biochemical reactions within the human body. It plays a crucial role in various intracellular processes, including calcium homeostasis, signal transduction, and energy metabolism regulation. Deficiency of this essential micronutrient can manifest early in life and may result in a range of pathological conditions, some of which pose a significant threat to a child's health.Description of the clinical case. The parents of an 18-month-old child presented to the clinic at Kuban State Medical University, under the Ministry of Health of the Russian Federation, with concerns regarding gingival overgrowth. The child’s medical history revealed seizure episodes of unknown origin that had first occurred at three months of age, necessitating the administration of multiple high-dose anticonvulsant medications. Upon examination, edema of the subcutaneous tissue in the face, trunk, and limbs was noted, along with pronounced gingival hypertrophy in the absence of inflammatory signs. A provisional diagnosis of drug-induced gingival fibromatosis was established. To clarify the diagnosis and optimize anticonvulsant therapy, molecular genetic testing was recommended. The results confirmed autosomal recessive hypomagnesemia with secondary hypocalcemia, attributed to previously unreported genetic mutations. Inpatient treatment included magnesium supplementation with the gradual tapering of anticonvulsant medications. Over the course of treatment, a marked reduction in gingival hypertrophy was observed, and no further seizure episodes occurred.Conclusion. The diagnosis of genetically determined diseases is unattainable without the use of modern high-tech diagnostic methods. Accurate and timely identification of such conditions is essential for effectively managing pathological manifestations, ensuring the selection of appropriate treatment strategies, and preventing potential iatrogenic complications.

Radiation-induced osteosarcoma of the frontoparietal calvaria 6 years after oligodendroglioma treatment: illustrative case.

Radiation-induced sarcoma (RIS) is an exceptionally rare occurrence following radiation therapy, and manifestation usually occurs after a several-year latency period. Herein, the authors report the development of a radiation-induced osteosarcoma of the frontoparietal calvaria following treatment for an oligodendroglioma in an 84-year-old woman. The patient had been diagnosed with a grade III anaplastic oligodendroglioma when she was 78 years old. She had undergone resection and subsequent chemoradiation therapy for treatment of the tumor. In the following years, she experienced progressive neurological decline, which was complicated by multiple ischemic strokes and seizure episodes. When she was approximately 84 years of age, a small mass was noted overlying the previous craniotomy site during examination. Several months later, approximately 5 years after chemoradiation therapy, she presented to the emergency department with a suspected stroke. Examination revealed that the mass had rapidly grown and was pressing into the intracranial space. She underwent craniotomy, and specimens were taken. Pathological analysis demonstrated a high-grade osteosarcoma. Despite the lesion's rarity, suspicion for RIS should be raised with the rapid growth of a mass at the site of previous radiotherapy. Furthermore, it is especially important to carefully monitor vulnerable patients who may not be able to recognize or report the development of a growing mass. https://thejns.org/doi/10.3171/CASE24535.

Predicting Seizures Episodes and High-Risk Events in Autism Through Adverse Behavioral Patterns.

Individuals with Autism Spectrum Disorder may display interfering behaviors that limit their inclusion in educational and community settings, negatively impacting their quality of life. These behaviors may also signal potential medical conditions or indicate upcoming high-risk behaviors. This study explores behavior patterns that precede high-risk, challenging behaviors or seizures the following day. We analyzed an existing dataset of behavior and seizure data from 331 children with profound ASD over nine years. We developed a deep learning-based algorithm designed to predict the likelihood of aggression, elopement, and self-injurious behavior (SIB) as three high-risk behavioral events, as well as seizure episodes as a high-risk medical event occurring the next day. The proposed model attained accuracies of 78.4%, 80.68%, 85.43%, and 69.95% for predicting the next-day occurrence of aggression, SIB, elopement, and seizure episodes, respectively. The results were proven significant for more than 95% of the population for all high-risk event predictions using permutation-based statistical tests. Our findings emphasize the potential of leveraging historical behavior data for the early detection of high-risk behavioral and medical events, paving the way for behavioral interventions and improved support in both social and educational environments.

Aspiration of Dental Metallic Crown in a Pregnant Patient with Eclampsia: Case Report and Literature Review

We report a case of a 45-year-old 35-week pregnant woman who presented to the emergency department in a post-ictal state following episodes of seizures at home. She was diagnosed with eclampsia, requiring emergency tracheal intubation, mechanical ventilation, and medical management in the emergency department. The patient underwent an emergency cesarean section due to fetal distress. Postoperatively, the patient was transferred to the intensive care unit, where a chest x-ray showed foreign body aspiration in the left main bronchus. The multidisciplinary team decided to perform a flexible bronchoscopy at the bedside to retrieve aspirated metallic dental crown. We found flexible bronchoscopy safe, effective, and successful to remove aspirated dental crown. Fiberoptic bronchoscopy may be the first-line management of aspirated foreign bodies in pregnant women. We reviewed the published case reports of tracheobronchial foreign body aspiration in pregnant women.

Turner syndrome and neuropsychological abnormalities: a review and case series.

The objective of this study was to establish the genotype-phenotype correlation between karyotype results and the neurological and psychiatric alterations presented in patients with Turner syndrome (TS). A retrospective study was conducted on the medical records of 10/140 patients with TS and neurophysiological abnormalities seen at a university hospital in southern Brazil. In addition, a literature review spanning the period from January 1, 2012 to January 1, 2023 was carried out using the PubMed and Virtual Health Library databases. Our study showed a potential correlation between neurological and psychiatric alterations in patients with TS. These findings are in accordance with those described in literature such as a high prevalence of learning or intellectual disabilities. However, our sample found more seizure episodes than those reported in other studies. The correlation established could be due to X chromosome dose-effect, as the review suggests that sex chromosome number and hormonal development can be associated with verbal, social, and cognitive skills or impairments.

Serum magnesium level in febrile children with or without simple febrile seizures from 6 months to 5 years of age: A case-control study

Objectives: Febrile seizure is the most common type of seizure (2–4%) in children. Imbalance in electrolytes, especially hypocalcemia and hypomagnesemia predispose to all seizures, including febrile seizures. The objective of this study was to compare the serum electrolytes, especially magnesium levels in febrile children presenting with and without episodes of simple febrile seizure. Materials and Methods: An institution-based age- and sex-matched case-control study done between May and October of 2022, involved 60 children aged 6 months to 5 years, divided into 30 cases (febrile children with seizure) and 30 controls (febrile children without seizure). Detailed history including past, birth, and family history was obtained, and serum magnesium, sodium, potassium, and calcium level estimations were done for each participant. Results: The mean serum magnesium of the febrile seizure group was 1.6 ± 0.8 mg/dL, while that for the control group was 2.2 ± 0.3 mg/dL. Similarly, the mean serum calcium levels of the study participants recruited to the febrile seizure group was 8.4 ± 1.1 mg/dL, while that for the participants recruited to the control group was 9.4 ± 0.5 mg/dL. On analysis, it was seen that the serum magnesium and calcium levels were significantly lower among cases than controls (P < 0.001). However, participants did not differ significantly between the two groups with respect to serum sodium and potassium levels. Conclusion: Mean serum magnesium and calcium levels of children suffering from simple febrile seizures were significantly lower than that of the control children, therefore maintaining optimum serum magnesium and calcium levels should be prioritized in febrile children to prevent the development of simple febrile children among them febrile seizure.

Challenges in early diagnosis of methanol poisoning in the emergency room - A case report

Background. Methanol is a toxic alcohol that causes severe poisoning due to its metabolites — formic and lactic acid — which lead to metabolic acidosis with a high anion gap and toxic encephalopathy. The severity of clinical features typically manifests within 6 to 72 hours and may include seizures and altered mental status. Case report. We present the case of a 45-year-old patient, a chronic alcoholic with no significant medical history, who was admitted to the Emergency Department in a comatose state (Glasgow Coma Scale [GCS] 4), tachypneic, and following a seizure episode. The patient also had a history of a minor head trauma 24 hours prior. Laboratory results revealed severe metabolic acidosis with a high anion gap, hepatocellular injury, renal insufficiency, and elevated serum levels of amylase and lipase. Toxicology screening, including a urinary sample, ethanol measurement (0 mmol/L), and imaging (MRI), strongly suggested methanol poisoning as the likely diagnosis. The patient was transferred to the Intensive Care Unit, where hemodialysis was performed. Subsequent brain scans revealed typical methanol toxicity patterns, including symmetrical necrosis of the basal ganglia and gliosis of the occipital and optic nerves. These findings underscore the importance of not attributing a low GCS solely to ethanol abuse, highlighting the need for a broader differential diagnosis.

West Syndrome: spectrum of disorders with diagnostic and therapeutic challenges

Introduction: West syndrome (WS) is a rare epileptic encephalopathy of multifactorial etiology, characterized by epileptic spasms, psychomotor delay, and hypsarrhythmia on electroencephalogram. Its prevalence is 1.5 to 2 per 10,000 children under 10 years, with an incidence of 1 per 2,000-4,000 live births. Objective: This article describes the clinical characteristics of a pediatric patient with WS in a developing country context. Materials and methods: With informed consent, the clinical history was performed, detecting psychomotor delay at 6 months, manifested by loss of social smile and gross motor skills. Physical examination revealed generalized hypotonia, desaturation, and bradycardia. Neuroimaging ruled out organic abnormalities; however, the electroencephalogram (EEG) showed hypsarrhythmia, confirming the diagnosis of West syndrome by meeting the classic clinical triad. Results and discussion: Male patient of 6 months, firstborn, born by cesarean section at 39 weeks due to hypoxic encephalopathy, with negative STORCH and toxicological tests. He presented to the emergency room with four episodes of spastic movements in the upper limbs, which spontaneously resolved without loss of consciousness, during the previous month. Currently, at 12 years old, the patient is in remission, without seizure episodes for over 10 years. He shows adequate social and family adaptation, with academic performance appropriate for his age group. Cognitive tests indicate borderline performance, suggesting the presence of ADHD, with no evidence of underlying cognitive deficit.

Late Infantile Neuronal Ceroid Lipofuscinosis: Two Case Reports

Neuronal ceroid lipofuscinoses (NCLs) are a group of lysosomal storage disorders characterized by progressive, neurodegenerative course. NCLs are classified into four subtypes according to age of onset. Among them, late infantile variety is the second most common condition. Patients typically manifest with seizures, cognitive, motor deterioration and vision loss. Here, we reports two cases of NCLs, because of rarity of this disease in such a young age. As the disease advanced, patients experienced repeated episodes of seizures, ataxia, gradual deterioration of vision and loss of ambulation and speech. The electroencephalogram showed focal epileptiform discharges over left central and parietal region. Magnetic resonance imaging of Brain revealed extensive cerebral and cerebellar atrophy. A skin biopsy extracted from the armpit area displayed periodic acid-schiff (PAS) stained eosinophilic intracytoplasmic inclusions (curvilinear like). These findings are compatible with neuronal ceroid lipofuscinoses. Genetic testing for NCL is the gold standard investigation but patient can also be diagnosed by clinical correlation and positive histopathology findings in low income countries. Bangladesh J Child Health 2023; Vol 47 (2) : 113-116

A Review on Functional Foods and Nutraceuticals in the Management of Epilepsy

Epilepsy is a persistent neurological disorder distinguished by repetitive episodes of seizures that presents notable complexities for patients and healthcare providers. While phar-macotherapy remains fundamental in its management, the emergence of functional foods and nutraceuticals has garnered attention as adjunctive therapeutic options. This review examines the role of functional foods and nutraceuticals in epilepsy management, examining their mech-anisms of action, evidence-based efficacy, and safety profiles. The review delineates various functional foods and nutraceuticals exhibiting promise in epilepsy management, encompassing omega-3 fatty acids, the ketogenic diet, flavonoids, vitamins, and minerals. Mechanically, these substances modulate neuronal excitability, neurotransmitter release, and neuroinflamma-tion, thus exerting anticonvulsant effects. Furthermore, they may augment the efficacy of con-ventional antiepileptic drugs while mitigating their adverse effects. Clinical investigations as-sessing the efficacy of functional foods and nutraceuticals in epilepsy management have yield-ed encouraging findings, albeit necessitating further inquiry to ascertain optimal dosing proto-cols and long-term safety considerations. Additionally, challenges such as bioavailability, formulation standardization, and patient adherence warrant attention to optimize therapeutic outcomes.

Pelvic/Sacral Chondrosarcoma with Brain Metastasis: A Case Report

Introduction: Chondrosarcomas are cartilaginous tumors primarily known for metastasizing to the lungs and bones. Their spread to the central nervous system is infrequent. Case Presentation: We present the case of a 32-year-old woman with a history of pelvic/sacral grade III chondrosarcoma (L4-S2; T3N0MX; Ki67; 30%), who underwent surgical resection and radiotherapy. She presented to the emergency department with a 2-day history of thunderclap headache accompanied by fever and chills. Computed axial tomography (CT) scan revealed a left occipital intraparenchymal lesion, subsequently confirmed as suggestive of a neoplastic lesion on magnetic resonance imaging. Ten days after admission, she experienced a two-minute generalized tonic-clonic seizure episode, followed by postictal stupor, tachycardia, hypertension, and anisochoric pupils. A follow-up CT scan demonstrated progression of the metastatic lesion, with evidence of uncal and foraminal herniation. Compression of the cardiorespiratory center at the bulbar level led to her death. Conclusion: This case report offers insight into the clinical presentation, behavior, and prognosis of a metastatic brain lesion derived from grade III chondrosarcoma. It is important to correlate the patient’s medical history with imaging findings to achieve an accurate diagnosis, especially in situations where biopsy may not be feasible.

Clinico-etiological profile of seizures in the pediatric age group

Background: The etiologies of pediatric seizures are multifaceted, involving infections, structural brain abnormalities, or genetic factors. The objective of this study was to find the clinico-etiological profile of seizures in children and to estimate the association of different seizure etiology with demographic factors Methods: This cross-sectional study was conducted over 18 months on 400 children aged between 1 month and 18 years presenting with their first episode of seizures at Hind Institute of Medical Sciences, Sitapur. Data was collected on predesigned Performa which included history, clinical examination, and laboratory investigations. The data was analyzed using SPSS-22 software. A p-value<0.05 was considered significant. Results: The mean age of children was 5.51 (4.43) years. The majority of children were from the age group 3-6 years (164, 41%). Males were 242 (60.5%). Most were birth order >3 (153, 38.2%). Most were from joint families (259, 64.8%), from rural livelihood (349, 87.3%), and from lower socioeconomic status (134, 33.5%). Family history of seizures was positive in 78 (19.5%). Generalized tonic-clonic seizures were the most common type (159, 39.8%). The leading causes of seizures were febrile seizures (153, 38.2%), and CNS infections like meningitis (97, 24.2%). Fever was the most common symptom (282, 70.5%). A significant association of etiology of seizures was seen with lower age groups, lower socioeconomic status, rural livelihood, and positive family history. Conclusions: Seizures are common in <6 years of age with male preponderance and febrile seizure is the most common cause. Most of these seizures are generalized in nature.

Small cell GBM: Case report

A 33 year old male presented with complaints of Headache, vomiting, and two episodes of seizures with a history of loss of consciousness. The patient was brought to the emergency department and diagnostic MRI was suggestive of a diffuse soft tissue infiltrative neoplastic lesion occupying basifrontal lobes, corpus callosum, temporal lobes, bilateral caudate, and right lentiform nucleus with increased creatine peaks and relatively reduced N-acetylaspertate (NAA) peaks on MR spectroscopy, suggestive of Lymphoma/Glioma.

Discovery of New 3-(Benzo[b]Thiophen-2-yl)Pyrrolidine-2,5-Dione Derivatives as Potent Antiseizure and Antinociceptive Agents-In Vitro and In Vivo Evaluation.

Background/Objectives: To address the unmet clinical needs in the treatment of epilepsy and pain, the continued development of more effective and safer anticonvulsants and analgesics is still necessary. Therefore, herein we report synthesis and antiseizure/antinociceptive evaluation of a focused series of 3-(benzo[b]thiophen-2-yl)pyrrolidine-2,5-dione derivatives. Methods: The anticonvulsant properties were investigated in acute models of seizures, namely the maximal electroshock (MES), the 6 Hz (32 mA), and subcutaneous pentylenetetrazole (scPTZ) seizure models, whereas analgesic activity was tested in the model of a tonic pain/formalin test and oxaliplatin-induced neuropathic pain (in CD-1-mice, i.p.). In addition, a number of in vitro assays were performed, aiming at the evaluation of the drug-like properties of the compounds disclosed herein. Results: We identified 33 as a lead compound with the most promising antiseizure properties, i.e., ED50 (MES) = 27.4 mg/kg and ED50 (6 Hz, 32 mA) = 30.8 mg/kg. Furthermore, 33 at a dose of 100 mg/kg significantly prolonged the latency time to the first seizure episode in the scPTZ model and at high doses did not impaire coordination of mice in the rotarod test (TD50 > 200 mg/kg). Apart from broad antiseizure protection, 33 demonstrated a significant analgesic effect in the formalin test (45 mg/kg, i.p.), and effectively alleviated allodynia in the oxaliplatin-induced neuropathic pain model (30 and 45 mg/kg). The binding assays suggest that the most plausible mechanism of action relies on interaction with the neuronal voltage-sensitive sodium channel (site 2). Furthermore, the drug-like potential of 33 supports favorable in vitro results, i.e., no hepatocytotoxicity and neurocytotoxicity at a high concentration of 100 μM, as well as a lack of mutagenicity at a concentration as high as 500 μM. Conclusions: Compound 33 identified in the current studies is proposed to be an interesting candidate for further preclinical development as therapy for epilepsy and neuropathic pain.

Schaaf-Yang Syndrome Presenting with Prolonged Hyperthermia in a Child: A Case Report

Introduction: Schaaf-Yang syndrome (SYS) is a rare autosomal dominant disorder, first identified in 2013, resulting from mutations in the paternal allele of the MAGEL2 gene. Schaaf-Yang syndrome exhibits clinical features similar to those of Prader-Willi syndrome (PWS), including hypotonia, joint contractures, developmental delay, and intellectual disability. However, SYS is also characterized by unique manifestations, such as recurrent hyperthermia, feeding difficulties, respiratory distress, and seizures. This case report describes the first SYS case identified in Iran. Case Presentation: A one-year-old female, born to consanguineous parents, presented with recurrent episodes of hyperthermia, respiratory distress, and seizures since the neonatal period. Despite initial empirical treatment with broad-spectrum antibiotics for suspected infections, her symptoms persisted. Physical examination revealed hypotonia, camptodactyly, and hand contractures. Genetic testing confirmed SYS with a MAGEL2 gene mutation (c.1923dupC, p.V643Gfs*70) and probable pathogenic variants in ASPM and KIF7. The hyperthermia was attributed to hypothalamic dysfunction, a hallmark of SYS, rather than an infectious cause. The patient remains under follow-up without specific pharmacological intervention. Conclusions: This case emphasizes the importance of considering SYS in patients presenting with unexplained fever, seizures, and neurodevelopmental delays. Early genetic testing is crucial for diagnosing SYS and differentiating it from conditions such as PWS or infection-related disorders. Timely diagnosis can improve management strategies and help reduce the risk of lasting neurological impairments associated with this genetic disorder.

PATH-34. IT NEVER RAINS BUT IT POURS - DIAGNOSING ANAPLASTIC PLEOMORPHIC XANTHASTROCYTOMA TWICE IN A FORTNIGHT - OUR EXPERIENCE IN A RESOURCE CONSTRAINED SETTING

Abstract Grade 3 Pleomorphic Xanthastrocytoma is a rare tumour (less than 1% of all astrocytic glial neoplasms). Present most commonly with seizures. Surgery and Radiation remain the mainstay of treatment with no clear role for traditional systemic chemotherapies; BRAF inhibitors show some benefit. We report two cases who were diagnosed within a month of each other - one was initially diagnosed in 2017- presented with altered smell, headache and diplopia. Found to have a well-defined lobulated heterogeneously enhancing suprasellar parasellar lesion. After Gross Total Resection, was diagnosed from various centers as Anaplastic Ependymoma WHO Grade III; Gllioblastoma WHO Grade IV; Anaplastic Pleomorphic Xanthastrocytoma WHO Grade III. Based on immunohistochemistry, was considered Anaplastic Ependymoma WHO Grade III. Spine screening was negative; received adjuvant Radiation 60Gy in 30 fractions. After a disease free interval of 6 years, developed a recurrence at the post op site. He underwent repeat decompression and the histopathology showed Grade 3 Pleomorphic Xanthastrocytoma. Immunohistochemistry- OLIG2: diffuse positive; R132H p.IDH1: negative; ATRX: intact nuclear expression; Mismatch repair proteins (MSH2, MSH6, MLH1, PMS2); intact nuclear expression; MIB-1 labelling index: 10-12%; H3 p.K27M: negative; GFAP: variable positivity; Podoplanin and p53 shows focal positivity; EMA, CD 34 are negative. He competed Reirradiation in January 2024. He is asymptomatic and on follow up. The second case -15 year old boy presented with episodes of absence seizures. Imaging showed a predominantly extraaxial lesion at tentorial apex. He underwent decompression and histopathology showed Grade 3 Pleomorphic Xanthastrocytoma. Immunohistochemistry - cells positive for S100 and variably positive for GFAP, OLIG2 and vimentin; ATRX: Retained expression, IDH1p.R132H, EMA, Synaptophysin, Neu N: Negative, p53: Focally positive, CD34: Positive in few tumour cells, Ki-67: 14-16 %.V600 mutation detected in the BRAF gene. Had Adjuvant RT 60 Gy in 30 fractions -completed in March 2024. MRI at 1 month - no significant change in overall tumour burden compared to post operative MRI. Was offered Dabrafenib with Trametinib.

Bilateral slipped capital femoral epiphysis in a cerebral palsy patient: a Case Report

BackgroundSlipped capital femoral epiphysis (SCFE) is usually seen in patients with high body mass index (BMI) and endocrine diseases. SCFE is exceedingly rare among Cerebral palsy (CP) patients due to spasticity present in those patients. Percutaneous in situ fixation is the treatment option for SCFE patients. According to the literature, there’s no single case report with SCFE in a spastic CP patient with no prior history of trauma, seizure episodes, or endocrine disease.Case presentationWe report a case of an 11-year-old spastic cerebral palsy (CP) patient with a physical status of level 5 motor function on the gross motor function classification system. He was brought by his mother to the clinic complaining of bilateral hip pain. The mother denied any history of trauma or any seizure episodes. The pain had started spontaneously. Physical examination showed severe spasticity and bilateral hip abduction with external rotation. Drehmann’s sign was positive. Bilateral hip radiographs revealed bilateral partial open femoral capital physis with evidence of SCFE bilaterally. Also, the Southwick angle was measured, and it was severe. The patient was taken to the operating room and treated with closed reduction and percutaneous in situ fixation. He was seen multiple times following surgical intervention, reporting pain relief, and showing complete wound healing.ConclusionThis report concludes that paraplegic spastic CP patients may present with SCFE spontaneously without trauma, seizures, or an underlying endocrine disease. Also, severe spasticity might potentially be a risk factor for SCFE, although further investigations would be necessary to establish a conclusive link.

Association of Iron Deficiency Anaemia With the First Episode of Febrile Seizure in Children.

Introduction Febrile seizures are the most common type of seizure in neurologically healthy children under six years of age. Iron deficiency is a prevalent micronutrient deficiency worldwide, though it is medically preventable and treatable. In many developing countries, anaemia remains a significant concern in young children. Iron plays a crucial role in neurodevelopment and overall bodily growth, and low levels of serum ferritin may lower the seizure threshold. Methods The study aimed to determine the correlation of iron profiles between patients with their first episode of febrile seizures and patients with only febrile illnesses. This case-control study enrolled children between 6 and 60 months of age. The case group comprised children who experienced their first episode of febrile seizure, while the control group included children presenting with febrile illness without seizures. The cost of the iron profile was waived for patients enrolled in the study. The study was conducted at a tertiary care centre and charitable hospital. Total blood counts and iron profiles were analyzed to find the association between the risk of febrile seizures and anaemia. Results The study included 150 children, with 50 febrile seizure cases and 100 controls with only febrile illness. The mean age of cases was 2.15 years, while that of the controls was 1.73 years. Males were more prevalent in the febrile seizure group, with 31 (62%) compared to 19 (38%) females. The mean serum transferrin value in cases was 22.46, compared to 28.42 in controls, indicating lower levels in cases (p=0.029). The mean TIBC in cases was 434.84, higher than the control group's 334.46 (p<0.001). The mean serum iron level in cases was 77.64, lower than that of controls at 86.63, though the difference was not significant (p=0.195). RDW >15% was observed in 46 (92%) cases compared to 57 (57%) controls (p<0.001). Conclusion Iron deficiency anaemia is a correctable risk factor for children with febrile seizures between 6 and 60 months of age. Timely diagnosis and correction of anaemia may help prevent febrile seizures in these children. Further research is needed to evaluate effective prevention strategies.

Isolated Intracranial Rosai-Dorfman Disease: A Diagnostic Challenge

Rosai-Dorfman disease (RDD) is a benign condition characterized by abnormal proliferation of white blood cells called histiocytes and an uncommon biological process called emperipolesis, in which a living cell penetrates inside another living cell. Central nervous system involvement in RDD is extremely rare. We report one such rare case of 47-year- old man who presented with right sided focal seizure from 1 year. MRI Brain showed a dural based lesion. On the basis of clinical presentation and radiological findings initial diagnosis made was of en plaque meningioma. Gross total resection of lesion was performed. Initial histopathological diagnosis was of IgG4 related HPM. Post surgery there was significant improvement in patients clinical condition. Intensity of seizure episodes were reduced. However due to persistence of right sided focal seizures, tissue blocks were reviewed and diagnosis of intracranial Rosai-Dorfman disease was made. Upon which further hematologist opinion was taken and whole body PET CT was done which showed solitary uptake in brain. It was observed that characteristic feature of RDD emperipolesis is sometimes masked by storiform fibrosis and lymphocytic infiltration leading to misdiagnosis. Therefore close follow up is required, in case of persistence of symptoms tissue blocks should be reviewed and possibility of intracranial Rosai-Dorfman disease should be considered while dealing with dural based lesions.