First Episode Of Seizure Research Articles

Etiological Profile of First Episode Seizures in Paediatric Patients at a Tertiary Care Centre: A Descriptive Cross-sectional Study

Introduction: Seizures are the most common neurological emergency and one of the most common reasons for paediatrics hospital admissions. This study aimed to identify the etiology, clinical profile, and immediate outcome of children with the first episode of seizure in Eastern Nepal. Methods: This was a prospective descriptive study carried out in the Tertiary Care Centre from September 2022 to August 2023. Ethical clearance was taken from the Institutional Review Committee (Ref no:654/2022). Convenience sampling was done to include 170 children presenting with the first episode of seizure at age 6 months to 15 years. Variables collected were demographics, clinical presentations, family history, trauma history, laboratory tests, neuroimaging, EEG, final diagnosis, and immediate outcome.Results: A total of 170 patients were admitted with the first episode of seizure with 123 (72.36%) males and 47 (27.64%) females. The mean age of the patients was 5.13±2.95 years with 104 (61.18%) patients under 5 years of age. The most common seizure was generalized tonic-clonic type in 132 (77.64%) patients. The most common associated symptom was fever in 150 (88.23%) children. Neuroimaging was abnormal in 52 (30.59%) patients, with neurocysticercosis seen in 27 (15.88%). The most common etiology was febrile seizure in 92 (54.17%) patients, neurocysticercosis in 27 (15.88%), and meningitis in 12 (7.05%).Conclusions: Febrile seizures, neurocysticercosis, infection, and trauma were the major causes of seizures in children. When simple febrile seizures were unlikely, lumbar puncture, neuroimaging, and laboratory tests were useful tools for diagnosing etiologies of seizures.

The Spectrum of First-onset Seizures in Children Presenting at a Tertiary Care Centre

Abstract Introduction: Seizure is the most common paediatric neurological condition with an increased predilection for early childhood. The recent definition of epilepsy includes first-onset seizures with an increased probability of future episodes. Thus, stringent evaluation of the initial episode of seizure is essential. Hence, this study estimated the aetiology, clinical profile, treatment and outcome of the first seizure episode in children at a tertiary hospital. Materials and Methods: This prospective observational study was carried out at a tertiary hospital in Barabanki, India. Children in the age group of 1 month to 12 years who presented with the first seizure episode and those admitted for other illnesses and developed the first seizure episode during hospital stay were included. Data collected were sociodemographics, clinical presentations, laboratory tests, brain imaging studies, electroencephalography (EEG), diagnosis, treatment and short-term outcomes. Results: A total of 113 patients were enrolled presenting with first-onset seizures. There were 78 (69%) males, 86 (76.1%) were below 5 years of age and 60 (53.1%) presented with fever. Most seizures had a generalised onset (58.4%). Febrile seizures (29.2%) were the most common type, followed by neurocysticercosis (20.3%). Central nervous system (CNS)-infective aetiology (58.7%) was the most common etiological classification. Abnormal findings were observed in cerebrospinal fluid examination of 24 out of 56, in brain imaging of 53 out of 80 and in EEG of 70 out of 113 cases examined. Anti-seizure medication (ASM) was prescribed to 68 patients, of which 10 had a recurrence in the 6-month follow-up period. Conclusion: The first episode of seizure in children usually had a generalised onset, with younger children of the male sex at an increased risk. CNS infections and febrile seizures were common causes. Complete history and neurological evaluation can guide the relevant investigations. ASM tailored to the aetiology controls the seizures in most cases.

“Frequency of Meningitis in Children Aged 06 Months to 59 Months Presenting with First Episode of Fits with Fever in Pediatric Emergency Department”

Objective: The study was aimed to determine the frequency of bacterial meningitis in children aged six months to 5 years presenting with fever and fits for the first time in emergency department. Materials and Methods: This cross sectional study was conducted at the Aga Khan Hospital Karachi and its secondary hospitals including Kharadar, Hyderabdad, Garden, Karimabad sites. Using a non-probability consecutive sampling method the data was collected from 135 children over a period of 12 month from august 2019 to April 2020. In this study, we included the male and female children aged between 6 month to 60 months, Children presenting with fever and first episode of seizure, CSF examination done prior for inclusion in the study. Results: Out of 135 children in the study, 71 (52.30%) children were male, 51(38.46%) were aged between 6months to 24 years, 55(40%) children were in age range 13 to 36 months, 69 (51.50 %) children were completely immunized, 33 (24.60 %) partially immunized. Out of of 135 children ,130 (96%) presents with fits less than 15 minutes duration, whereas 5(4%) children presented with fits more than 15 min duration. Among 50(37%) children who were meningitis positive, 8(6%) were bacterial, 13(10%) were viral and 29 (21%) were partially treated meningitis. Conclusion: Substantial number of children presented with seizures had meningitis. Significant proportion of unimmunized children presenting with seizures had meningitis. , 8(6%) reported with bacterial Meningitis Keywords: Febrile Seizures, Meningitis, Bacterial Meningitis

Mutação no gene scn1a e suas diferentes expressões fenotípicas - comparação de dois casos

INTRODUCTION: Heterozygous mutations in the SCN1A gene are linked to a wide spectrum of epileptic disorders, ranging from self-limited conditions to epileptic encephalopathies, such as Dravet Syndrome. Seizure control is important to prevent both sudden death and morbidity associated with prolonged seizures. Current evidence suggests that sodium-channel blockers should be avoided. OBJECTIVES: To report on two cases of patients with a mutation in the SCN1A gene associated with Dravet Syndrome, emphasizing the importance of genetic testing for the diagnosis, prognosis, and correct choice of antiepileptic medications. CASE REPORT: Case 1: male patient with onset of seizures at four months old following vaccination. After this, he developed prolonged generalized seizures and, over time, other types of seizures. He also developed a severe intellectual deficit and drug-resistant epilepsy exacerbated by infections and use of sodium-channel blockers. Case 2: female patient with first episode of seizure at 26 days. At 13 months, she developed prolonged generalized crises exacerbated by small temperature variations and euphoria or irritability. Aged two, she had an episode of prolonged status epilepticus. As a result, she developed hypoxic-ischemic encephalopathy and drug-resistant epilepsy. DISCUSSION: The two patients have a mutation in the SCN1A gene associated with Dravet syndrome and their clinical history reveal similar and discrepant points. The most significant contributions of genetic testing are the identification of precipitating factors, greater attention to the possibility of unfavorable evolution, and guidance for choosing anticonvulsants, including avoidance of sodium-channel blockers.

Acute Mycoplasma Pneumoniae Encephalitis in an Adult

Mycoplasma pneumonia is an atypical bacterium that causes mild respiratory tract infections, especially in the upper respiratory system. Mycoplasma pneumoniae infection is infrequently associated with various CNS manifestations such as encephalitis, meningoencephalitis, myelitis, Guillain-Barre syndrome and acute disseminated encephalomyelitis (ADEM). Here we report a rare case of mycoplasma encephalitis in an adult who presented with a first episode of seizure following fever and neck stiffness for one week. Mycoplasma pneumoniae antibody titer was markedly elevated at >1:320 and MRI brain revealed encephalitic changes with a lesion in the splenium. Interestingly, there was no associated respiratory infection and his stay in the hospital was also complicated by SIADH. The patient improved after treatment with a macrolide antibiotic.

Tramadol-Induced Acute Seizures: A Report of Three Cases

There is a rise in substance abuse in Nigeria and prescription drugs, particularly opioid analgesics, which are increasingly becoming a target of abuse. Abuse of the opiod tramadol has the potential to precipitate seizures. We present 3 cases of tramadol-induced seizures presenting at Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife. The three patients were men, aged 22-40 years and abused other drugs including alcohol, cannabis and Rohypnol. This report illustrates the fact that tramadol abuse may be associated with acute seizures and it is reasonable to consider drug/opiod-induced seizure in every case of unexplained first episode of seizure in a young adult
 Authors
 M B Fawale 1, A A Adebowale 1, A O Idowu 1, S A Balogun 2, A A Sanusi 1, M A Komolafe 1

An Adult Patient with Seizure and Supraventricular Tachycardia (SVT) - Occam’s Razor or Hickam’s Dictum

This is a case report describing a young lady presenting with both seizure and supraventricular tachycardia (SVT) to the emergency department (ED). She was previously well, asymptomatic with no risk factors for both conditions. A 33-year-old lady presented to the emergency department (ED) with her first episode of seizure. She was found in the kitchen with up rolling of eyes, jerking of all four limbs which self-aborted after two minutes. Electrocardiogram (ECG) performed showed supraventricular tachycardia, which reverted to sinus rhythm after administration of intravenous adenosine. Post conversion ECG showed normal sinus rhythm, absence of pre-excitation and normal QTc. Laboratory tests and computed tomography of the brain were normal. This case highlights the complex relationship between seizure and cardiac arrhythmia. SVT and seizure occurring at the same time is unusual. Clinicians need to rule out hypoxic convulsions. Epilepsy and seizures could also have a profound effect on cardiac function. Drug therapy for epilepsy is not without influence on heart rhythm. Both alcohol and illicit drugs could also precipitate concurrent seizure and SVT. Is this a case of Occam’s razor or Hickam’s dictum?

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. Materials and Methods: 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.

Clinico-etiological profile of first episode of seizure and its correlation with electroencephalogram in children aged 2 months to 18 years

Background: Seizure is one of the commonest neurological illnesses. About 4-10% of children experience at least one episode in the first 16 years of life. Approximately 30% of children who experience, first afebrile seizure later develop epilepsy. Risk is approximately 20% if neurological examination, electroencephalogram (EEG) and neuroimaging is normal. The objective of the study is to determine the age of onset, etiology of first episode of seizure in children between the age group of 2 months to 18 years and the pattern of EEG changes in the above group of children.Methods: In a prospective single centre observational study at Cheluvamba tertiary care hospital in Mysore, around 80 children who were admitted with first episode of afebrile seizure to our emergency department between October-2020 to July-2021 (10 months) were studied. Seizures defined using international league against epilepsy (ILAE) and EEG was done for all 80 children and their records were analysed.Results: A total of 80 children presenting with first episode of seizure were included in the study. Toddlers represented the major portion of our study with male gender predominance. Idiopathic seizure was the most common etiology identified (81.2%), followed by meningitis (7.5%). EEG abnormality was seen in 58.7% of the children which was statistically significant (p<0.05). MRI was done in 72.5% of the children, of which abnormality was seen in only 8.6% of the children.Conclusions: Seizure is mainly diagnosed clinically and EEG can be normal in many children. First episode of seizure is common in the age group of 1-3 years. Normal EEG at present may not indicate the non-recurrence in future. Though EEG interpretation is useful, treatment can be started based on clinical diagnosis and has to be individualized.

Cohort of Phenotype, Genotype, and Outcome of SCN Developmental and Epileptic Encephalopathies from Southern Part of India.

The SCN encephalopathies are one of the rare early childhood intractable epileptic encephalopathies associated with pleomorphic seizures, cognitive decline, motor, and behavioral abnormalities that begin in early infancy. There is a dearth of data on phenotype and genotype of SCN encephalopathies from the Indian subcontinent, hence we are reporting clinical and molecular profile and outcome of SCN developmental and epileptic encephalopathies. This is a retrospective chart review of SCN developmental and epileptic encephalopathies in a tertiary care center, Bangalore, India between January 2015 and March 2020. All children with clinical features of SCN developmental and epileptic encephalopathies and confirmed with pathogenic variants were included. A total of 50 cases of SCN developmental and epileptic encephalopathies were analyzed, 31 of them were male and the mean age of presentation was 7.8 months. Precipitating factors for the first episode of seizure were fever and vaccination accounting for 33 and 8 children, respectively. Forty (80%) children had prolonged seizures and 15 (30%) had epileptic spasms. All children had a normal birth history and normal development before the onset of seizures, which was followed by developmental delay and regression. Thirty (60%) children had behavioral difficulties, notable hyperactivity, and autistic features. Neuroimaging and the initial electroencephalogram (EEG) were normal in all patients. The mean age of abnormal EEG was 14 months. The various subtypes of SCN variants were SCN1A in 31 children followed by SCN2A and SCN9A in eight children each and SCN1B in three children. Frameshift and nonsense mutations were associated with more severe phenotype and poor outcome compared with missense mutations. Thirty-four patients partially responded to treatment and the rest were refractory. The results of genetic testing were used to guide treatment; sodium channel blocking antiepileptic drugs were discontinued in 15 patients and sodium channel blocking agents were started in 3 patients with partial response. Three out of four children on stiripentol had a partial response. The SCN developmental and epileptic encephalopathies can present with epileptic spasms in addition to other types of seizures. Epileptic spasms are more common in nonsense and frameshift mutations. The outcome is poor in children with epileptic spasms compared with those without epileptic spasms. Genetic testing helps to select antiepileptic drugs that lead to seizure reduction.

Essential oil related seizures (EORS): A multi-center prospective study on essential oils and seizures in adults

ObjectiveEssential oils (EOs) like eucalyptus and camphor have pro-convulsant properties. These EOs are present in many over- the- counter balms and oils. The effect of exposure to these EOs and occurrence of seizure is not systematically studied. The aim of this study was to evaluate the relationship between essential oils and the first episode of seizure and breakthrough seizures in known epileptic patients. MethodsThis was a multi-center prospective study, conducted in four hospitals over four years. Every person presenting with the first episode of seizure or breakthrough seizure was asked about exposure to EOs, mode of exposure, time to onset of a seizure in relationship to exposure, duration of seizure, type of seizure, and antiepileptic drug therapy. ResultsDuring the four-year period there were 55 patients with essential oil-related seizure (EORS). 22(40 %) had essential oil-induced seizures (EOIS) and 33(60 %) had essential oil-provoked seizures (EOPS). The female: male ratio was 1:1.1, the age of the patients ranged from 8 months to 77 years. In the EOIS group, 95 % had generalized tonic-clonic seizures and 5% had focal impaired awareness seizures. In the EOPS group, 42.4 % had focal impaired awareness seizures, 27.3 % generalized tonic-clonic seizures, 15 % focal to bilateral tonic-clonic seizures, and 15 % focal aware motor seizures. EOs implicated were preparations containing eucalyptus and camphor. ConclusionExposure to essential oils of eucalyptus and camphor is an under-recognized cause of the first and breakthrough seizure. Identifying the true causative factor will prevent unnecessary antiepileptic drug therapy and future recurrence.

Eucalyptus Oil-Induced Seizures in Children: A Single-Center Prospective Study.

ObjectiveEucalyptus oil (EO) is known to have proconvulsant properties. EO is present in many over-the-counter preparations and used orally or topically to treat many ailments. In this study, we seek to describe clinical features, neuroimaging, and electroencephalographic findings and follow up outcome in children with eucalyptus oil-induced seizures (EOIS).Materials and methodsThis was a single-center prospective observational study, conducted at a tertiary care hospital from South India over a period of two years. Children (up to 18 years of age) with a first afebrile seizure or breakthrough seizures with preexisting epilepsy and with a recent exposure to EO were included. Data from all the children including demographic data, exposure to EO, mode of exposure, time to onset of seizures in relation to exposure, duration of seizure, type of seizure, investigations, and antiepileptic drug therapy were noted. All the patients were followed up for recurrence of seizures for six to nine months. ResultsDuring the study period of two years, a total of 17 children met the inclusion criteria, with a median (range) age of 3.75 years (23 - 150 months) and 10 (59%) were male. Only one patient had breakthrough seizures and all other 16 children had a first episode of seizure. All the children had generalized tonic-clonic seizures with median duration of three minutes (30 sec - 30 minutes). The median (range) interval between EO exposure and the onset of seizures was 20 minutes (10 - 120 minutes). All the children had taken EO drops orally mixed in either water or milk in different amounts. All the patients' brain neuroimaging was normal. All the patients had normal electroencephalography except for four children. Only five patients were treated with antiepileptic drugs for two weeks and one patient with preexisting epilepsy was continued on the same antiepileptic drug. None of the patients had a recurrence of seizures during the follow-up period of six to nine months.Conclusion EOIS is an underrecognized and rare entity of seizures in children. EOIS can occur as first seizures or as breakthrough seizures in preexisting epilepsy patients. Despite the previous case reports in the literature quoting the seizurogenic potential of EO, this awareness is lacking in both clinicians and parents. We also recommend clinicians inquire about exposure to EO while approaching a child with first afebrile seizures or breakthrough seizures, which can prevent unnecessary investigations and long-term antiepileptic drug therapy.

Clinical Feature and Outcome of Childhood Status Epilepticus in a Teaching Hospital, Odisha, India.

ObjectivesThe main aim is to find out the clinical feature and outcome of status epilepticus (SE) in children managed in a teaching hospital. The secondary aim is to identify the risk factors influencing the adverse outcomes.MethodsIn this prospective cohort, children aged 1 month to 14 years with SE as per the International League Against Epilepsy’s new guideline (2016) who presented to the emergency department during the period of November 2017 to October 2019 were enrolled. Clinical profile, treatment, and outcome of cases (n = 94) were noted.ResultsThe majority of children, 60 (63.82%), were less than five years of age. Prior history of seizures was present in 33 (35.1%) cases, whereas 61 (64.9%) cases presented with SE as the first episode of seizure. In 14 (42.4%) previous seizure cases, SE was due to drug default. No response to first-line antiepileptic drug (AED) was seen in 84 (89.37%) cases. Acute symptomatic etiology was the commonest etiology of SE in 64 (68%) cases, of which neuro-infections accounted for 44 (46.80%) cases. Longer duration (>60 minutes) of status (p < 0.01), ventilator support (p < 0.0001), and circulatory impairment (p < 0.0001) were attributable risk factors for mortality. A total of 28 children died (mortality rate, 29.8%), and 11 showed the persistence of their neuro-deficit.ConclusionsNeuro-infection is the most common etiology of SE in children. Longer duration of SE, more lag time for receiving the first AED, respiratory failure, and presence of shock are independent predictors for poor outcome. Hence, cessation of convulsion at the earliest leads to improved outcomes.

Clinical, epidemiological and laboratory characteristics of children with febrile seizures

Background: Febrile seizure is the most common type of seizure disorder that occurs in children aged 6-60 months. Recurrences are common. This study was conducted to evaluate the epidemiology, clinical profile and laboratory parameters of children presenting with febrile seizure in a teaching hospital.Methods: This was a descriptive retrospective study among children presenting with febrile seizure admitted to KIMS, Bengaluru from March (2018-2019). Children between six months to five years were included in the study while patients with prior episodes of afebrile seizures, abnormal neurodevelopment and not meeting the age criteria were excluded. Patient’s demographic and clinical data were collected from the in-patient records and analysed.Results: Among 60 children with febrile seizures were enrolled in our study with highest prevalence in males (58%) and amongst 13-24 months age group (37%). Majority (20%) presented in the monsoon season (June) and in the morning hours (43%). Simple febrile seizures and complex febrile seizures were observed in 60% and 40% respectively. Majority (73%) who developed first episode of seizure were below 24 months ago with mean age of 18.71±11.50 months. 42% had recurrence and was significantly associated with first episode of febrile seizures at age ≤1 year and family history of seizures. Upper respiratory tract infections were the commonest cause of fever. Anaemia and leucocytosis were seen in 72% and 70% cases respectively.Conclusions: Febrile seizure was observed predominantly in children below two years, simple febrile seizure being the commonest. Recurrence was common and significantly associated with the first episode of febrile seizure at the age one year or below and family history. Majority had anaemia which showed that iron deficiency anaemia could be a risk factor. Leucocytosis was present in most which could be either due to underlying infection or due to the stress of seizure itself.

Essential Oil Related Seizures (EORS): A Multi-Center Prospective Study

Background: Essential oils (EOs) like eucalyptus and camphor are known to have proconvulsant properties. These EOs are present in many over the counter balms and oils. In this study we evaluated the relationship between exposure to these EOs and the first episode of seizure and breakthrough seizures in known epileptic patients. Methods: This was a multi-center prospective study, conducted in four hospitals over four years. Every person presenting with the first episode of seizure or breakthrough seizure was asked about exposure to EOs, mode of exposure, time to onset of seizure in relationship to exposure, duration of seizure, type of seizure and antiepileptic drug therapy. All patients were followed up for recurrence either physically or telephonically for a minimum period of 6 months. Findings: During the four-year period there were 55 patients from four major hospitals who had essential oil related seizure (EORS). 22 had essential oil-induced seizures (EOIS) and 33 had essential oil-provoked seizures (EOPS). Male: Female ratio was 1:1, age ranged from 8 months -77 years. In EOIS group 95% had generalized onset motor tonic clonic seizures and 5% had focal onset impaired unawareness motor seizures while in EOPS group 43% had focal onset impaired awareness motor seizures, 28% generalized onset motor tonic clonic seizures, 14% focal to bilateral tonic clonic seizures and 15 % focal aware motor onset seizures. Essential oils implicated were preparations containing eucalyptus and camphor. Interpretation: Exposure to proconvulsant essential oils of eucalyptus and camphor are an important unrecognized cause of first seizure and breakthrough seizure. Essential oil related seizures can occur as de novo seizures (EOIS) or as breakthrough seizures (EOPS). Identifying the true causative factor will prevent unnecessary antiepileptic drug therapy and future recurrence. Funding Statement: No funding was received. Declaration of Interests: None of the authors has any conflict of interest to disclose. Ethics Approval Statement: Study was approved by the Institutional Review Board of the coordinating centers and informed consent was obtained from all the subjects.

Hypsarrythmia – Do Age Have Any Relevance

Hypsarrhythmia is a classical electroencephalographic finding in patients of infantile spasm and related syndromes like West syndrome and Otahara syndrome. It usually develops in early infancy and persists up to age of two years, after that it gets completely resolved or gets converted into other kinds of epilepsy. Persistence of hypsarrhythmia beyond this age group has rarely been reported in literature. In the present article we have noticed that hypsarrhythmia is present in older age group and it has also been noticed that these patients have first episode of seizure after the age of three years. Exact pathophysiology behind persistence of hypsarrhythmic pattern in patient more than 3 years and new onset of hypsarrhythmic pattern in older patients on electro encephalography is not known. Although it has been suggested that immaturity of thalamocortical synaptic pathway is responsible for hypsarrhythmia in infantile spasm.

Etiology of the Neonatal Seizures: An Epidemiological Study

Background: Neonatal seizure is a rare neurologic condition. The current study aimed at determining the etiology of neonatal seizure. Methods: The current study evaluated the data of 100 neonates who were hospitalized at neonatal intensive care unit (NICU) during 2015-2017. A pediatric neurologist made the final diagnosis of seizure. Patients’ medical records were used to review neonatal seizure variables. SPSS (version 16) was used to perform the statistical analyses. Results: The current study enrolled 100 newborns (41% female) admitted to the NICU following the first episode of seizure and the body temperature of 36.8-39.2°C (mean: 37.2°C). Of 100 participants, 94 (94%) had acute symptomatic seizure and 6 (6%) were compatible with neonatal epilepsy syndrome criteria. According to the results, the commonest etiologies were the neonatal encephalopathy and hypoxic-ischemic encephalopathy constituting 82% of participants. Conclusion: The consequences of acute symptomatic seizures in neonates are determined mainly by the etiology of the seizures. Seizure burden and use of anti-seizure drugs may also have some impact, but this has yet to be fully defined.

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.

Prevalence of adult epilepsy in a general Japanese population: The Hisayama study.

SummaryThe aim of the present study was to examine the prevalence and causes of adult epilepsy in a general Japanese population. We examined a total of 3333 Japanese residents in the town of Hisayama aged ≥40 years in 2012‐2013. The examination was performed mainly at the municipal center for health promotion, but some subjects were examined in their homes, hospitals, or nursing homes. Twenty‐three subjects had a diagnosis of epilepsy. The prevalence (95% confidence interval [CI]) of epilepsy per 1000 was 6.9 (4.1‐9.7) in total, 4.9 (1.3‐8.5) in men, and 8.4 (4.3‐12.5) in women (P = 0.23 between sexes). The prevalence of epilepsy was significantly higher in the elderly (aged ≥65 years; 10.3 per 1000 [95% CI 5.4‐15.1]) than in the middle‐aged (aged 40‐64 years; 3.6 per 1000 [95% CI 0.7‐6.4]; P = 0.02). The major cause of epilepsy was cerebrovascular diseases (n = 11; 48% of the epilepsy patients). More than half of the epilepsy patients experienced the first episode of seizure in older age (≥65 years; n = 13; 57%). The findings of this study suggest the clinical importance of the prevention of cerebrovascular diseases to reduce the burden of epilepsy in the future.

Symptomatic neurocutaneous melanosis with unusual benign course: A case report and review

Neurocutaneous melanosis (NCM) is a rare, congenital, noninherited neurocutaneous syndrome characterized by the presence of “multiple or large congenital nevi” with central nervous system melanocytic deposits. Majority of cases are asymptomatic. Symptomatic cases present with hydrocephalus and signs and symptoms of increased intracranial pressure. The latter is associated with poor prognosis. We herein report an asymptomatic patient with giant congenital melanocytic nevi. He had a screening magnetic resonance imaging study at the age of 2 months that showed T1 hyperintensities in the region of amygdala of both temporal lobes. He was asymptomatic until the age of 4 years when he presented with seizure activity. A diagnosis of NCM was made. He was discharged on emergency antiepileptic medication. On regular follow-up, he remained seizure free for 1 year after the first episode of seizure. Unlike other cases reported in literature, this, to the best of our knowledge, is the first report of nonprogressive symptomatic NCM.