Abstract

DEMOGRAPHIC, ETIOLOGICAL AND NEURO-IMAGING PROFILE OF NEW ONSET SEIZURE AT TEACHING INSTITUTE

Virendra C. Patil*

ABSTRACT

Context: Etiological spectrum of acute symptomatic seizures in developing countries is different from developed countries. Seizures occur in association with an acute systemic, metabolic, or toxic insult or in association with an acute central nervous system (CNS) insult. Aims and Objectives: To study the demographic, etiological and neuro-imaging profile of new onset seizure at tertiary care teaching hospital in western Maharashtra, India. Settings and Design: This is retrospective, observational non-interventional study conducted over a period of one year (January 2013 to December 2013). Patients with new onset seizures aged ≥18 years were included in this study. Methods and Material: New onset seizure was defined as the first seizure (or the first cluster of seizures with in 24 hour period) ever experienced by the patient. Clinical history, examination (from medical records), necessary investigations were entered in data sheet and was analysed. Statistical analysis was done by computer software SSPE‑11 trial version. Categorical data were analyzed by mean, SD, percentage and Chi-square test. The level of significance was set at ‘p’ < 0.05. Results: A total 1279 patiens were admitted with CNS disease during study period of them 297 (23.22%) patiens were fulfilling criteria of new onset seiure included in present study. Total 229 (77.10%) [47.2(±13.9) years] male and 68 (22.89%) [41(±9.8) years] were female patients. Total 31 (10.43%) patients were labelled as Idiopathic/primary seizure. Total 55(24.01%) had alcohol withdrawal syndrome and 16(6.98%) male patients had alcohol intoxication with new onset seizures. Twenty four (8.08%) patient had hypoglycaemia and 26 (8.75%) had hyponatremia. Total 8 (2.89%) patients had pyogenic meningitis, 10 (3.36%) had encephalitis, 11 (3.7%) patients had cerebral malaria, 4 (1.34%) patients had Cryptoccocal meningitis, 4 (1.34%) patients had TB meningitis, 3 (1.01%) had Tuberculoma and 2(0.67%) patients had Neurocystecercosis. Total 22 (7.4%) patients had Ischemic stroke, 27 (9.09%) had hemorrhagic stroke, 7 (2.35%) patients had subarachnoid hemorrhege and 17 (5.72%) patients had CVST. Female were significantly affected with CVST with young age group compared to male with seizure [‘p’=0.002392]. Total 10 (3.36%) patients had hepatic encephalopathy, 8 (2.69%) had CKD and 2 (0.67%) had drug induced seizure. Total 4 (1.34%) patients had SOL. Total 3 (1.01%) patients had Tuberculoma. Total 3 (1.01%) patients had subdural hematoma (SDH) and 2(0.67%) had EDH. One (0.33%) patient had endosulphan induced seizure. Total 71(31%) patients had seizures related to alcohol consumption. Total 24.57% patients had seizures related to cerebrovascular accident, 22.89% had metabolic cause and 14.14% had infectious etiology. Total 54.54% patients had generalised tonic clonic seizure (GTCS) and 20.20% had focal seizure with secondary generalisation (‘p’=0.0702). Total 12.45% patients had complex partial seizure 8.75% had simple partial seizures and 4.04% had myoclonic seizures. Conclusions: The alcohol consumption, cerebrovascular accident and metabolic etiology related new onset seizures were most frequent in present study. Alcohol related seizures were common at 3rd and 4th decade, while CVA and metabolic related seizures were more common at 5th and 6th decade. The GTCS was the most common type of new onset seizure compared to all other types. We suggest to take preventive measures for alcohol, infection and metabolic related new onset seizure to reduce almost half of the overall burden of the disease.

Keywords: New onset seizures, complex partial seizure, cerebrovascular accident, hemorrhagic stroke, Ischemic stroke