A STUDY ON CLINICO-ETIOLOGICAL PROFILE OF INFANTS PRESENTING WITH FIRST EPISODE OF SEIZURE IN TERTIARY CARE HOSPITAL

BACKGROUND Seizure is "a transient occurrence of signs and/or symptoms due to abnormal excessive or synchronous neuronal activity in the brain. The risk of seizures is the highest in the first year of life. Neonatal seizures have different causes and different risk factors depending on maturity, weight and underlying conditions. Children after the first four weeks of life are susceptible to metabolic derangements with mild illnesses, at an increased susceptibility for CNS infections and also at risk of seizures due to various agerelated syndromes e.g. febrile seizures, infantile spasm, Dravet syndrome etc. After the studies of Cheverie & Acardi et al. not much work has been done on aetiology of seizures in this age group. There is a paucity of Indian data regarding the aetiology and outcome of seizures in infants after the neonatal period. Therefore, in this case control study with longitudinal design, we analysed the prevalence of various aetiologies, the clinical spectrum of seizure disorders and the primary outcome of infants aged 4 weeks to 12 months admitted with the first attack of acute seizure disorder. We wanted to determine the common aetiologies of the first episode of seizures among infants aged 4 weeks to 12 months admitted in North Bengal Medical College & Hospital. We also wanted to determine the clinical sub-types of seizures and short-term (6 months) outcomes of the first episode of seizure among the study subjects. METHODS This is a hospital based observational study with longitudinal design, carried out (total 57 subjects) among infants admitted with first seizure, in the Dept. of Paediatrics, North Bengal Medical College & Hospital, Darjeeling, West Bengal. RESULTS The study was conducted among 57 infants (Male-57.9% and 42.1% females) to determine the common aetiologies and clinical sub types of first episode of seizure as well as the short-term (6 Months) outcome of first seizure in infants aged 4 weeks to 12 months. Among 57 study subjects, 29.8% belonged to <6 months age group followed by 70.2% in >= 6 months age group and mean was 7.1 (+/- 2.7) months. Present study revealed majority (54.4 %) of infants had provoked seizure, among them CNS infection (acute pyogenic bacterial meningitis, 21%. Acute viral encephalitis and meningoencephalitis (79%) are the most common (33.3%) cause of seizure, followed by febrile seizure (14%). Unprovoked seizure constituted 45.6 % of cases in our study population. The most common seizure subcategories were generalized tonic (52.6%) followed by generalized tonic clonic (14%), focal clonic (14%), generalized clonic (8.7%), tonic clonic (7%), and focal to bilateral tonic clonic (3.5%). Current study has also shown 18 patients (32.1%) developed subsequent seizure after first episode of seizure; among them 61.1 % had developed within 24 hours of first seizure and 38.9 % developed after 24 hours after first seizure. CONCLUSIONS CNS infection is most common cause of first seizure in this study, and also associated with high mortality rate. Early detection, timely referral to higher center, appropriate and timely management of these infants can prevent further progression of disease.