Seizure Episodes Research Articles

Artificial intelligence applied for the diagnosis of absence epilepsy with simultaneously tested patient’s consciousness level in ictal event

Background. Given the difficulties in identifying absences and assessing the level of consciousness in epilepsy patients, it is extremely relevant to develop digital programs for automatic registration and testing of this type of epileptic seizures and related electroencephalographic (EEG) patterns, including those based on artificial intelligence.Objective: development of an algorithm for automatic detection of absence seizures to test real time patient's consciousness level during long-term video-EEG monitoring.Material and methods. The work on creating an algorithm was carried out during joint doctor/engineer cooperation. Doctors prepared a set of labeled EEG recordings of patients with verified absence epilepsy. Two independent experts in the generated examinations database mapped typical episodes of absence seizures that allowed to develop training and testing samples for a neural network algorithm to detect EEG absence epiactivity. Next, trained neural network was incorporated into Neuron- Spectrum.NET software to compare its accuracy with similar approaches published elsewhere.Results. A neural network algorithm was developed and trained using a mapped database to detect EEG absence epiactivity. A comparative analysis of the effectiveness for the proposed method vs. other approaches showed that the former is comparable in quality, whereas in some aspects – even superior to the latter. Accuracy was assessed using a publicly available database with mapped epiactivity episodes.Conclusion. A hardware and software system for automated assessment of patient’s consciousness level during absence seizure in continuous video-EEG monitoring was proposed. Potentially, neural networks may be applied not only to assess patient’s consciousness level, but also to stop stimulation-mediated seizure onset in the future.

Seizure and Intracranial Hemorrhage: An Early Complication of Bee Sting – A Case Report

Background: Bee sting is a common entity during the summer season and is rarely associated with devastating complications such as myocardial infarction, pulmonary edema, bleeding, and rhabdomyolysis, neurological complications can occur after multiple stings. However, single bee venom infestation resulting in such complications is rare. Patient’s Concern: Here, we are describing a young male, who presented to us with a seizure episode, soon after bitten by a bee sting around his lips. The patient did not have hypertension, diabetes, other risk factors for seizure, or any history of trauma but the patient’s computed tomography head showed cerebral hematoma. Intervention: The patient was managed immediately with an injection of antiepileptics with intravenous (IV) fluids, antihistaminics, and IV steroids. The patient had gross improvement in the sensorium and was seizure free for 48 h under observation. The patient was discharged on the 4th day of admission with 100% recovery. Conclusion: This case report emphasizes the potential for severe neurological complications following bee stings in the form of cerebral hematoma which is clinically important to recognize early and further research is required to better understand the mechanism and management strategies.

Astrocyte switch to the hyperactive mode.

Increasing pieces of evidence have suggested that astrocyte function has a strong influence on neuronal activity and plasticity, both in physiological and pathophysiological situations. In epilepsy, astrocytes have been shown to respond to epileptic neuronal seizures; however, whether they can act as a trigger for seizures has not been determined. Here, using the copper implantation method, spontaneous neuronal hyperactivity episodes were reliably induced during the week following implantation. With near 24-h continuous recording for over 1 week of the local field potential with in vivo electrophysiology and astrocyte cytosolic Ca2+ with the fiber photometry method, spontaneous occurrences of seizure episodes were captured. Approximately 1 day after the implantation, isolated aberrant astrocyte Ca2+ events were often observed before they were accompanied by neuronal hyperactivity, suggesting the role of astrocytes in epileptogenesis. Within a single developed episode, astrocyte Ca2+ increase preceded the neuronal hyperactivity by ~20 s, suggesting that actions originating from astrocytes could be the trigger for the occurrence of epileptic seizures. Astrocyte-specific stimulation by channelrhodopsin-2 or deep-brain direct current stimulation was capable of inducing neuronal hyperactivity. Injection of an astrocyte-specific metabolic inhibitor, fluorocitrate, was able to significantly reduce the magnitude of spontaneously occurring neuronal hyperactivity. These results suggest that astrocytes have a role in triggering individual seizures and the reciprocal astrocyte-neuron interactions likely amplify and exacerbate seizures. Therefore, future epilepsy treatment could be targeted at astrocytes to achieve epilepsy control.

Quality of life predictors among Moroccan adults with epilepsy

PurposeThis study aimed to determine the factors associated with quality of life (QOL) in adult patients living with epilepsy in Morocco. Methods110 patients with epilepsy aging 18 years old were interviewed using the standard and validated Moroccan version of the Quality of Life in Epilepsy inventory with 31 items (QOLIE-31). Descriptive statistics, one-way ANOVA, and multivariate regression were used for data analysis. ResultsThe mean age of the patients was 35.70 years old (standard deviation (SD)12.2). The mean total score of QOLIE-31 was 43.6±10.2. The highest mean±SD score was the medication effects subscale 52.3±12.1, and the lowest was the overall quality of life subscale 39.2±13.2. Patients with no seizure episode during the last month had a better mean total score of QOLIE-31 (47.6±10.5) than the study participants having a seizure in the last month (40.6±8.9, p≤0.001). These data supported that presence of seizure in the past 4 weeks (β=4.626, CI95 % 1.123; 8.130), memory disorders (β=10.025, IC 95 % 2.811; 17.239), seizure trigger factors such as forgetting to take antiepileptic drugs (AEDs) (β=5.205, IC 95 % 1.769; 8.641), personal problems (β=4.957, IC 95 % 0.604; 9.310), low monthly income (<2000MAD, 194.94$: β= −9.937, IC 95 % −18.536; −1.338), (2000–5000MAD, 194.94$- 487.35$: β= −24.804, IC 95 % −43.171; −6.437), and employment (β= −4.291, IC 95 % −7.976; −0.605) were the factors associated with QOL. SignificanceThe overall QOL of patients with epilepsy was low. This study showed that the presence of seizures, memory disorders, monthly income, trigger factors, and employment status were QOL predictors for epileptic patients.

Neuro-regression Assessment- A Case Report

Introduction: Neuro-regression can occur for various reasons, including neurodegenerative diseases such as Alzheimer's disease, certain genetic disorders, brain injuries, infections, toxic exposures, or metabolic disorders. It is often characterized by a progressive deterioration of neurological function over time. Neuro-regression can be caused by a variety of factors, including, Neurodegenerative diseases, Genetic disorders, Brain injuries, Infections, Toxic exposures, and Metabolic disorders. Objective: The goal of this case report is to highlight the difference between developmental delay and developmental regression also known as Neuro-Regression in terms of differential diagnosis. Case Report: A 2.2-year-old male child, with a background of developmental delay and epilepsy was admitted with multiple episodes of breakthrough seizures. Developmental milestones were age-appropriate till 11 months of age (before the seizure). After the seizure, the child’s motor development regressed and the child was not able to sit, or stand. The speech and language milestones were appropriate to the age before the seizure and regressed after the seizure. Conclusion: In our study, it's very clear that the child experiencing neuro-regression which is evident based on the parents’ report, previous and present clinical assessments as well and clinical observation. Regression is an indication that more investigation is necessary and team members like a Developmental Paediatrician, Neurologist, and Clinical Psychologist should be involved.

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.

Epilepsy secondary to brain injury by electrocution: A case report

Introduction: According to the Yearbook of Accidents of Electrical Origin for the year 2022, 853 accidents due to electric shock were reported in Brazil, of which 592 died, a reduction of 12.2% in mortality compared to the previous year. Three conditions elucidate trauma switches caused by the passage of electric current, the regulatory alterations by the passage of electric current, the conversion of electrical energy into thermal, known as the Joule effect, and muscle damage by the electrical stimulus of exacerbated contractions. Case Report: A 51-year-old male patient was followed up on an outpatient basis due to a nervous breakdown caused by accident with a high-voltage electrical discharge 15 years ago. After the event, he evolved with conduction aphasia, homonymous hemianopia on the right, hypoesthesia on the right side of the body, dysmetria on the right upper limb, and epileptic seizures of focal onset, evolving into tonic-clonic seizures. For seizure control, carbamazepine 200 mg 3 times a day was administered, with complete seizure control since then. Conclusion: Therefore, it is important to emphasize that the damage caused by electrocution to the central nervous system (CNS) is varied. Still, due to the patient’s clinical presentation, his neuroimaging findings, and his history, this is epilepsy secondary to electrocution. Encephalomalacia demonstrates a large scar in the brain tissue, and its control of seizure episodes with the adopted pharmacotherapy also corroborates.

Extensive Cerebral Venous Thrombosis following by COVID-19 Vaccine with Concomitant COVID-19 Infection

Coronavirus disease 2019 (COVID-19) vaccines have been introduced to the masses for just over two years. Majority reported adverse events post vaccination are minor side effect such as pain or inflammation at local injection site. Serious side effects such as thrombotic events or myocarditis are rarely reported. Cerebral venoussinus thrombosis (CVST) is a thrombotic complication that may occur within one to two weeks from vaccine administration. W illustrated a case from our centre involving a healthy young lady who presented with headache and an episode of seizure following by vaccination. She was concurrently diagnosed with CVST and COVID-19 infection later with the aid of neuroimaging. The patient's normal platelet count made the diagnosis of vaccine induced immune related thrombotic thrombocytopenia unlikely. While serious adverse events are reported, such as our case, this should not support the growing vaccine hesitancy among the public as its benefits still greatly outweigh its risk at this juncture.

Calcified Planum Sphenoidale Meningioma Mimicking Stroke in A 64-Year-Old Known Hypertensive: A Case Report

Background: Planum sphenoidale meningiomas are benign, slow-growing intracranial tumours with varied manifestations at any age group. Although it is rare, they usually present late when the size of the tumour is 4cm or more with headache, cognitive impairment, seizure, anosmia, nasal congestion and discharge, and visual disturbances. This type of meningioma constitutes a clinical diagnostic chal-lenge due to the non-specific nature of the subtle signs associated with it. Radiological investigations such as magnetic resonance imaging and computed tomography (CT scan) represent an imaging mo-dality used in the assessment of patients suspected of anterior cranial fossa meningioma and stroke. Case Presentation: We present a 64-year-old retired civil servant who presented to the Emergency Unit of the National Hospital, Abuja, with a history of sudden onset of seizure and loss of conscious-ness that lasted for over 6 hours. The patient had been having a history of recurrent nasal discharge for ten (10) years and one episode of seizure one month before presentation. There is also prior history of nasal discharge that was usually scanty, yellowish, and sometimes purulent. There was an associated feeling of nasal congestion. A clinical diagnosis of transient ischaemic stroke in a known hypertensive was made. However, the further radiological evaluation revealed a tumour mass with histological fea-tures consistent with planum sphenoidale psammomatous grade I meningioma. Conclusion: The clinical presentation of this tumour could mimic other cerebrovascular diseases. Thus, physicians need a high index of suspicion of other possible differential diagnoses, and appropri-ate radiological assessment is crucial with histopathologic examination.

A loss of function mutation in CLDN25 causing Pelizaeus-Merzbacher-like leukodystrophy.

Claudin-25 (CLDN-25), also known as Claudin containing domain 1, is an uncharacterized claudin family member. It has less conserved amino acid sequences when compared to other claudins. It also has a very broad tissue expression profile and there is currently a lack of functional information from murine knockout models. Here, we report a de novo missense heterozygous variant in CLDN25 (c. 745G>C, p. A249P) found in a patient diagnosed with Pelizaeus-Merzbacher-like leukodystrophy and presenting with symptoms such as delayed motor development, several episodes of tonic absent seizures and generalized dystonia. The variant protein does not localize to the cell-cell borders where it would normally be expected to be expressed. Amino acid position 249 is located 4 amino acids from the C-terminal end of the protein where most claudin family members have a conserved binding motif for the key scaffolding protein ZO-1. However, CLDN-25 does not contain this motif. Here, we show that the C-terminal end of CLDN-25 is required for its junctional localization in a ZO-1 independent manner. The A249P mutant protein as well as a deletion mutant lacking its last 5 C-terminal amino acids also failed to localize to the cell-cell border in vitro. Intriguingly, cellular knockout of CLDN25, in vitro, appeared to increase the integrity of the tight junction between 2 contacting cells, while driving highly unusual increased movement of solutes between cells. We propose that the barrier function of CLDN-25 is akin to a decoy claudin, whereby decreasing its expression in "leaky" epithelial cells and endothelial cells will drive dynamic changes in the adhesion and interaction capacity of cell-cell contact points. While it remains unclear how this de novo CLDN-25 mutant induces leukodystrophy, our findings strongly suggest that this mutation induces haploinsufficiency of CLDN-25. Elucidating the function of this uncharacterized claudin protein will lead to a better understanding of the role of claudin proteins in health and disease.

The Clinical, Etiological, and Demographic Profile of Children Aged 1 to 14 Years with Seizures Attending a Tertiary Care Hospital in Gwalior District, India: A Cross-Sectional Study

Purpose: The clinical profile of seizures among children exhibits ethnic and geographical variations. The objective of this study was to examine the clinical, etiological, and demographic profiles of childhood seizures.Methods: This was a hospital-based, cross-sectional study. Data were collected on the socio-demographic profile, details of the clinical presentation of seizure episodes, past history of meningitis, and neuroimaging (i.e., computed tomography [CT] scans), as well as the history of risk factors. Numbers, percentages, the chi-square test, and the Fisher exact test statistic were calculated. A P value of &lt;0.05 was considered significant.Results: This study included 102 patients, of whom 82 experienced generalized tonic-clonic seizures (GTCS) and the remaining 20 had focal seizures. The most common age at presentation was between 1 and 4 years (55.9%). Approximately 70.0% of the children experienced postictal confusion and drowsiness, 38.2% had fever or sleep deprivation, and 25.5% suffered from headaches or vomiting. Postictal confusion and drowsiness were significantly more prevalent in children with GTCS (76.8%) compared to those with focal seizures (45.0%). Cerebral edema was the most common abnormality detected on CT scans in children with GTCS (n=6). Conclusion: Younger age, neonatal brain insult, and family history were found to be associated with a higher risk of seizure episodes. Postictal confusion and drowsiness were identified as the most common clinical features. Postictal confusion and drowsiness were significantly more prevalent in GTCS compared to focal seizures. Cerebral edema was the most common abnormality observed in GTCS on CT neuroimaging.

Clinical and laboratory parameters associated with febrile seizure recurrence within the first 24 h: a ten-year cohort study.

We assessed clinical and laboratory parameters associated with early recurrence of febrile seizure in patients presenting at the Emergency Department with a first episode. Case series of patients admitted to the emergency department with the first episode of febrile seizure for ten consecutive years. Exclusion criteria were focal features and prolonged duration (>15 min). We included 693 patients, 284 (41%) female. Median age of 20 (IQR 15-27) months. Fifty-two (8%) patients had a recurrence within 24 h. At univariate analysis, patients with recurrent seizures had higher use of antipyretics (88% vs. 74%, P = 0.03, OR 2.6, 95% CI: 1.1-7.7), higher median maximal body temperature (39.3 °C, IQR 38.9-39.9, vs. 38.9, IQR 38.4-39.3, P < 0.001, OR 2.3, 95% CI: 1.5-2.6) and presented with a lower proportion of respiratory tract infections (54% vs. 70%, P = 0.02) compared to patients without recurrence. A maximal body temperature equal to or higher than 39 °C was associated with a higher recurrence (11% vs. 4%, P < 0.001, OR 2.9, 95% CI: 1.6-5.6). Hyponatremia was not associated with a risk of recurrence. The multivariate analysis confirmed a direct association with body temperature (OR 2.3, 95% CI: 1.5-3.7, P < 0.001), and an inverse association with respiratory tract infections (OR 0.4, 95% CI: 0.2-0.9, P = 0.01), while antipyretic use was not correlated (OR 1.9, 95% CI: 0.8-5.2, P = 0.2). High body temperature and respiratory tract infections were (directly and inversely) associated with recurrences. Consideration of these conditions might help for anticipating the probability of recurrence.

Seizures Associated with Povidone-Iodine Impregnated Antral Pack in a Child: a Case Report and Review of Literature

This is a case of 11 years-old patient diagnosed of suppurative osteomyelitis of the right maxilla. He had incision and drainage with sequestrectomy under general anaesthesia, and povidone-iodine-impregnated antra pack. About 60 hours after surgery, patient began to have seizures, about 6 episodes on the first night, generalized, tonic-clonic, each lasting about 1 minute with post-ictal vomiting. An initial assessment of meningitis (to rule out cerebral abscess) was made. The seizure episodes which lasted for 3 days began to reduce gradually, and completely subsided 24 hours after the removal of the antra pack. However, when the patient had a CT scan with iodine-based contrast as requested by the paediatric neurologist (to rule out cerebral abscess), the episodes went up significantly again for another 24 hours, after which it began to reduce, till none was recorded 48 hours after contrast administration. Povidone-Iodine (PVI) slowly liberates free iodine to exhibit its broad range of microbicidal activity. However, depending on the amount of iodine absorbed, there is a possibility of iodine toxicity, with different systemic manifestations including seizures, especially in children. The seizure is believed to be a result of disruption in the blood-brain barrier by free iodine from PVI and the iodine-based contrast media. Therefore caution should be taken in using PVI as an antiseptic agent in antra packs or on any mucosa surface, especially in children.&#x0D;

The impact of COVID-19 on treatment follow-up and medication adherence among patients with epilepsy at a referral hospital in Ethiopia.

The world continues to be challenged by the Coronavirus disease 2019 (COVID-19) and preventive measures like maintaining social distancing and lockdowns challenge patients to attend regular follow-ups and get a refill for medication that causes adherence problems. Hence, this study attempts to assess the impact of COVID-19 on treatment follow-up and medication adherence among patients with epilepsy. A total of 276 patients with epilepsy were enrolled in the study. Data collection was carried out through medical record reviews and patient interviews. Patients who visited Zewditu Memorial Hospital from August to September 2021 and those who had follow-up at least for two years before the outbreak of the pandemic were included. The data was analyzed using SPSS v.24. About 69.6% of patients were adherent to their treatment and 83.3% of the patients had a seizure-free period of less than 1 year. Ninety (32.6%) of the participants missed their treatment follow-up during the pandemic, mainly due to fear of being infected with COVID-19. Sixty-eight (24.6%) patients have experienced increased seizure episodes during the pandemic as compared to the previous times. Moreover, 56 (20.3%) participants were not taking their antiseizure medications (ASMs) during the pandemic because of the unavailability of medications and they discontinued hospital visits for their medication refills. Among those who missed their treatment follow-up, 20% had seizure-related physical injuries. Only educational level has a significant association with visiting health facilities during the pandemic. Thus, participants who completed college and above (OR = 2.58, 95% CI (1.32-6.38)) were more likely to attend their follow-up during the pandemics as compared to participants who can't read and write. The present study revealed that COVID-19 might have impacts on treatment follow-up and medication adherence due to fear of infection, travel restrictions and the indirect impact on the availability and affordability of medications. These might lead to poor treatment outcomes like increased seizure frequency and seizure-related physical injuries.

Diagnostic role of serum prolactin level in different kinds of seizure and seizure-like episode in children: A hospital-based study

Background: Serum prolactin level has been previously used in distinguishing epileptic seizure from non-epileptic seizure, as prolactin level usually rises following an epileptic seizure in children. Aims and Objectives: We conducted this study to determine the role of serum prolactin as a surrogate marker of seizure disorder and whether serum prolactin level varies between different types of seizure, febrile seizure, and seizure mimics. Materials and Methods: This cross-sectional comparative study was conducted for 1 year among 113 children between 6 months and 16 years of age of either sex. They were divided into 3 groups (1) epileptic seizure, (2) febrile seizure, and (3) seizure mimics. The blood sample was collected within 1 h of the occurrence of seizure for estimation of serum prolactin level. Each child was investigated and treated according to the protocol. Results: Mean post-ictal prolactin level was found significantly higher in epileptic seizure (29.94±7.97 ng/mL) compared to febrile seizure (10.21±0.94 ng/mL), and seizure mimics (8.73±0.67 ng/mL). Among group 1, serum prolactin levels significantly elevated in children with generalized tonic-clonic seizure (GTCS) (34.18±2.76 ng/mL) and complex partial seizure (CPS) (31.38±1.59 ng/mL) compared to simple partial seizure (SPS) (14.36±2.33 ng/mL). Post-ictal serum prolactin levels remain elevated for a longer duration in GTCS (54.26±5.19 min) and CPS (45.19±1.73 min) compared to children with SPS (26.76±2.33 min). Conclusion: Estimation of serum prolactin level within 1 h after a seizure can be used for screening purposes to distinguish between epileptic and non-epileptic seizures. A high prolactin level is suggestive of GTCS or CPS whereas a low level is indicative of SPS, febrile convulsion, or seizure mimics with a prolactin cutoff taken 24 ng/mL in our study.

Depression and anxiety among patients with epilepsy: A cross-sectional study from Riyadh, Saudi Arabia.

It is well established that epileptic disorders are associated with a wide range of psychosocial issues that overburden the affected individuals and limit their lifestyle. This study aimed to determine the commonalities between depression and anxiety symptoms among patients with epilepsy (PWE). In addition, we assessed whether depression and anxiety rates varied depending on factors related to the disease. A cross-sectional study was conducted between October 2021 and March 2022 among all PWE at Prince Mohammed bin Abdulaziz Hospital, and 147 patients who responded to the questionnaires were included for analysis (65.6% response rate). Depression was measured using the Patient Health Questionnaire depression scale (PHQ-9), while anxiety levels were measured using the Generalized Anxiety Disorder scale (GAD-7). Demographic variables such as sex, age, marital status, and factors related to epilepsy were also recorded. The results showed that 39.5% and 27.9% of participants had major depressive disorder (MDD) and generalized anxiety disorder (GAD), respectively. The presence of factors that increased susceptibility to seizures was associated with a greater expression of depression (P = 0.035) and anxiety (P = 0.002) symptoms. The presence of symptoms/signs that precede seizures was associated with a higher risk of moderate and severe depression (P = 0.001) and moderate and severe anxiety (P < 0.001). Irregular use of medications was associated with a higher risk of moderate and severe depression (P = 0.037); however, lamotrigine was associated with lower rates of depression among the participants (P = 0.023). This study found that PWE had a higher prevalence of MDD and GAD than the general population. However, this accepted paradigm has yet to reflect a meaningful change in constructing condition-specific recommendations for PWE. Our study revealed that the presence of subjectively recognized signs of an impending ictal episode was significantly associated with a higher risk of moderate and severe depression and anxiety. Furthermore, factors that increase the susceptibility to seizures were associated with a higher risk of depression and anxiety. Irregular medication use was associated with a higher risk of moderate and severe depression. However, lamotrigine was associated with lower rates of depression among participants.

Global developmental delay in a child with asphyxia neonatorum: Why search for an additional explanation?

Children presenting neurological problems and a history of “not cried immediately at birth” are labeled to have cerebral palsy due to birth asphyxia. Although this may be true in many situations, the presence of some additional features may help determine an alternate diagnosis. We present such a case with an alternate diagnosis. A child with a history of birth asphyxia was labeled as a case of global developmental delay or a case of cerebral palsy by the treating doctors. However, the child had certain dysmorphic features such as bulbous nose, depressed nasal bridge, low-set ears, high-arched palate, squint, and flat feet. The child was initially treated in the Neonatal Intensive Care Unit after birth. Later, she developed various neurological features, with frequent episodes of aspiration pneumonia and seizures which were managed with anticonvulsant drugs and antimicrobial agents. She also had some additional non-specific features. On detailed evaluation, the child was diagnosed to have 1q43q44 microdeletion. Search for an alternate or additional diagnosis should be carried out if a child presenting with global developmental delay has some additional syndromic features. This will help in the prognostication of child and help parents in future pregnancy.

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.

Idiopathic Hypoparathyroidism Presenting with Erythrodermic Psoriasis and Fahr’s Syndrome: A Case Report

Idiopathic hypoparathyroidism may remain asymptomatic or present with hypocalcaemic neuromuscular manifestations. Dermatological manifestations like exfoliative dermatitis, pustular psoriasis and symmetrical brain calcification known as Fahr’s syndrome are uncommon in clinical practice. Even in absence of neuromuscular symptoms, hypocalcaemia associated with exfoliative skin lesions and symmetrical brain calcification should prompt investigation for hypoparathyroidism. A 40-year-old male presented with diffuse erythematous pruritic plaques and fever of 10 days duration. Auspitz sign was positive on examination. Investigations showed leucocytosis with neutrophilic predominance. He was admitted with a diagnosis of erythrodermic psoriasis with secondary infection. On the second day of admission he developed an episode of generalised tonic clonic seizure for the first time. Investigations into the cause of seizure revealed low serum calcium while computerised tomography of head revealed symmetrical calcification of bilateral basal ganglia. Further, he was found to have a low level of intact Parathyroid Hormone (PTH) level and hyperphosphataemia. Based on clinical, biochemical and radiological findings, a diagnosis of idiopathic hypoparathyroidism, psoriasis and Fahr’s syndrome was made. Serum calcium was corrected with infusions of calcium gluconate followed by oral calcium carbonate. The patient was kept under observation for seizure recurrence. Calcium and vitamin D supplements and hydrochlorothiazide were started and psoriasis treatment was continued. His skin lesions resolved over the next two weeks, serum calcium levels returned to normal level and no seizure episodes were reported over three months of follow-up.

Knowledge and Attitude of School Teachers toward Epilepsy in Al-Baha City, Saudi Arabia- A Cross-sectional Study

Introduction: Epilepsy is a neurological disorder characterised by recurrent unprovoked episodes of seizures. A seizure is a frightening event, especially when it lasts more than five minutes, known as status epilepticus, which, if not treated promptly, can lead to brain injury. Understanding first aid for a seizure is crucial and may save the patient’s life. Aim: To assess school teachers’ knowledge about epilepsy, their attitudes toward epileptic patients, and the factors that affect teachers’ knowledge in Al-Baha City. Materials and Methods: This cross-sectional study was conducted in Al-Baha City, Saudi Arabia, from November 2021 to May 2022. A total of 305 teachers working in various randomly selected schools, equally distributed between male and female schools, were enrolled. Data were collected through an electronic questionnaire to evaluate teachers’ knowledge and attitudes toward epilepsy. Statistical analysis was performed using the Chi-square test, with data considered statistically significant when the p-value was less than 0.05. Results: In the present study, out of 305 subjects, 167 (54.8%) were male, and the majority, 137 (44.9%), were aged between 35-44 years. Of the participants, 214 (70.2%) were found to have poor knowledge about epilepsy, particularly regarding its etiology, impact on learning, and treatment options. There was a positive attitude among 211 (69.2%) participants toward hiring epileptic patients in their businesses and 240 (78.7%) responded positively to allowing their children to play with epileptic patients. However, 125 (41%) participants had a negative attitude toward allowing their offspring to marry an epileptic patient. Conclusion: The school teachers’ knowledge about epilepsy was poor. While their attitudes were positive regarding hiring epileptic patients and allowing their children to play with them, their attitude was negative regarding allowing their offspring to marry an epileptic patient.