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Year : 2022  |  Volume : 9  |  Issue : 1  |  Page : 49-53

Clinico etiological profile of “first seizure” in children. Experience from an armed forces tertiary care hospital in eastern India

Department of Pediatrics, Command Hospital, Kolkata, West Bengal, India

Correspondence Address:
Dr. Aparajita Gupta
Command Hospital, Alipore, Kolkata, West Bengal
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/amit.amit_1_22

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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.

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