The study of etiological profile in new onset seizures in Indian scenario

Bezwada Srinivasa Rao, Matta Sree Vani, Gedela Abhishek Ravi Varma


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.  


Cerebral venous thrombosis, Cerebrovascular accidents, Electroencephalography (EEG), Lumbar puncture, Neurocysticercosis, Psychogenic seizures

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Kasper DL, Brauwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL. Seizure and epilepsy. In: Kasper DL, Brauwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL, eds. Harrison’s Principles of Internal Medicine. 18th ed. New Delhi: McGraw Hill; 2004.

Lee Goldman, Andrew I. Schafer. Seizures. In: Lee Goldman, Andrew I. Schafer, eds. Goldman’s Cecil Medicine. 24th ed. Philadelphia: Saunders; 2011.

Sridharan R, Murthy BN. Prevalence and pattern of epilepsy in India. Epilepsia. 1999;40:631-4.

Radhakrishnan K, Pandian JD, Santoshkumar T, Thomas SV, Deetha TD, Sarma PS, et al. Prevalence, knowledge, attitude, and practice of epilepsy in Kerala, South India. Epilepsia. 2000;41:1027-35.

Khadilkar SV. Neurology: the scenario in India. J Assoc Physicians India. 2012 Jan;60:42-4.

Allan H. Ropper, Martin A. Samuels. Seizures. In: Allan H. Ropper, Martin A. Samuels, eds. Adams Principles of Neurology. 9 ed. New York: McGraw-Hill Medical; 2009: 331-365.

Jan Stam. Thrombosis of the cerebral veins and sinus. N Engl J Med. 2005;352:1791-8.

Pal DK, Carpio A, Sander JW. Neurocysticercosis and epilepsy in developingcountries. J Neurol Neurosurg Psychiatry. 2000;68:137-43.

Prasad KN, Prasad A, Verma A, Singh AK. Human cysticercosis and Indian scenario: a review; J. Biosci. 2008;33:571-82.

Wadia RS, Makhale CN, Kelkar AV. Focal epilepsy in India with special reference to lesions showing ring or disc like enhancement on contrast computed tomography. J Neurol Neurosurg Psychiatry. 1987;50:1298-301.

Maneesh KS, Ravindra KG, Gopal N, Verma DN, Surendra M. Single small enhancing computed tomographic (CT) lesions in Indian patients with new-onset seizures. A prospective follow-up in 75 patients. Seizure. 2001;10:573-8.

Bayindir C, Mete O, Bilgic B. Retrospective study of 23 pathologically proven cases of central nervous system tuberculomas. Clin Neurol Neurosurg. 2006;108(4):353-7.

Levy RM, Bredesen DE. Central nervous system dysfunction in acquired immunodeficiency syndrome. J Acquir Immune Defic Syndr. 1988;1:41-64.

Daggett P, Deanfield J, Moss F. Neurological aspects of hyponatremia. Postgrad Med J. 1982;58:737-40.

Hillbom M, Pieninkeroinen I, Leone M. Seizures in alcohol-dependent patients: epidemiology, pathophysiology and management. CNS Drugs. 2003;17(14):1013-30.

Murthy JMK, Yangala R. Acute symptomatic seizures - incidence and etiologicalspectrum: a hospital-based study from South India. Seizure. 1999;8:162-5.

Narayanan JT, Murthy J. New-onset acute symptomatic seizure in a neurological intensive care unit. Neurol India. 2007;55:136-40.

Sander JWAS, Hart YM, Johnson AL, Shorvon SD. National general practice study of epilepsy: newly diagnosed epileptic seizures in a general population. Lancet. 1990;336:1267-71.