The study of etiological profile in new onset seizures in Indian scenario
Keywords:Cerebral venous thrombosis, Cerebrovascular accidents, Electroencephalography (EEG), Lumbar puncture, Neurocysticercosis, Psychogenic seizures
Background: A seizure (Latin word which means “to take possession of”) is a paroxysmal event due to abnormal excessive or synchronous neuronal activity in the brain. Seizure is a medical emergency and about 1 in 10 persons will experience a seizure in their lifetime. Etiological contribution to seizures in developing countries is different from developed countries. Epilepsies related to malaria, neuroinfections, tuberculosis, HIV, meningitis, trauma and perinatal difficulties more prevalent in India and other developing countries. Neurocysticercosis is the most common cause of seizures/epilepsy in the developing countries and designated as a “biological marker” of the social and economic development of a community. In India, Single Small Enhancing CT Lesions (SSECTL) being the most common radiological finding and dying cysticercus larva in histopathological studies. Aim: To study the etiological profile in new onset seizures.
Methods: This was an observational and prospective study. The present study enrolled 100 patients above 15 years of age with new onset seizures. All the patients and their relatives were interviewed regarding history and thorough clinical examination was done. Routine blood investigations, blood urea, serum creatinine, blood sugar, liver function tests, serum electrolyte were done. Special investigations like electroencephalography (EEG), CT scan brain, MRI, and lumbar puncture were done in selected cases.
Results: Out of 100 patients included in the study, neuroinfection is leading cause of seizure in 36%, Cerebrovascular accidents (25%) and metabolic in (12%). Majority of seizures in neuroinfections were due to neurocysticercosis in 15 patients (42%) followed by meningoencephalitis in 14 patients (38%). Among Cerebrovascular accidents, stroke accounted for 84% (21) (Infarct-12, Haemorrhage-9), followed by cerebral venous thrombosis 12% (3). Out of 12 patients with metabolic seizures, hypoglycaemia and hyponatremia constituted 33% each.
Conclusions: Etiological spectrum of seizures includes neuroinfection, CVA, tumour, metabolic, poisoning and alcohol withdrawal. Neuroinfection accounted for significant number of seizures in all the age groups. Neurocysticercosis is the most common etiology among neuroinfections. Cerebrovascular accidents common in 4th & 5th decades. Limitation: Patients <15 years with new onset seizures were not included in the study.
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