Background: Seizure is the most common pediatric neurological disorder, occurring in 3-4% of children. The incidence is highest in children younger than 3 years of age, with a decreasing frequency in older children. Epidemiological studies reveal that approximately 150, 000 children will sustain a first-time, unprovoked seizure each year, and of those, 30, 000 will develop epilepsy. Studies focusing on the identification of associated etiological factors for seizures, their incidence, and outcomes are likely to improve management and referral strategies and subsequently reduce mortality and morbidity.
Aim of the Study: To determine the proportion of childhood seizures among all admitted pediatric patients and to identify the underlying etiologies responsible for seizure presentations in this population.
Methods: This cross-sectional study was conducted in a tertiary care hospital in Dhaka from July 2012 to December 2012. Children aged 1 month to 15 years admitted with a history of seizures were included. Data were collected through structured questionnaires covering history, physical examination, and relevant laboratory tests. The proportion of seizure cases was determined by identifying all admitted patients with seizures during the study period. A total of 100 patients were randomly enrolled. Detailed history included seizure type, duration, associated conditions, family history, birth history, and developmental milestones. Physical examinations were performed for all patients. Investigations such as CBC, MP, serum electrolytes, calcium, Blood sugar, CSF analysis, EEG, CT scan, MRI, and cranial ultrasonography were performed when indicated.
Results: During the study period, 2, 273 patients were admitted, and seizures were found in 165 cases, giving a proportion of 72 per thousand or 7.26%. Among seizure cases, 59% were male and 41% female. The highest number of cases was recorded in August (37 cases) and the lowest in December (20 cases). Generalized seizures occurred in 90% and focal seizures in 10%. Among generalized seizures, 57.8% were male, while among focal seizures, 70% were male. Signs of CNS infection were present in 26.06% and absent in 73.94%. Febrile seizure was the most common cause (46%), followed by pyogenic meningitis (8%), epilepsy (6%), viral meningitis (3%), and tubercular meningitis (3%). Most febrile seizures occurred at 13-24 months (39.19%) and were mainly due to respiratory tract infection (60.86%). Overall, the highest seizure frequency was at 13-24 months (28%), followed by 7-12 months (27%). A history of perinatal asphyxia was associated with 80% generalized and 20% focal seizures. Family history of febrile seizure was positive in 21.15% of febrile cases. Single seizures occurred in 57% and multiple in 43%. Convulsion duration was <5 minutes in 41 cases, 5-30 minutes in 41, and >30 minutes in 18. Fever was present in 75 patients, among whom 61.33% had febrile seizures. Seizures stopped spontaneously in 36 cases; 59 required single-drug therapy and 5 required multidrug therapy. And CSF analysis was done in 30 cases, normal in 60% and abnormal in 40%.
Conclusion: The study “Etiology and Incidence of Childhood Seizures in the Department of Pediatrics of a Tertiary Care Hospital” was conducted at Ad-Din Women’s Medical College Hospital over six months. Seizure disorder was found in 7.2% of all hospital-admitted patients aged 1 month to 15 years. The leading causes of childhood seizures were febrile seizure (46%), meningitis (8%), and epilepsy (6%). Most seizure patients were under 24 months of age. Many causes of seizures are preventable through measures such as vaccination (for pyogenic and TB meningitis) and public health awareness. Cerebral palsy and seizure disorders can be prevented by proper hospital delivery. Recurrence of febrile convulsions can be reduced by lowering body temperature with antipyretics and by using benzodiazepines to lower the seizure threshold during subsequent episodes of fever.
International Journal of Paediatrics and Geriatrics
