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ISSN 2063-5346
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A STUDY ON THE CLINICO-ETIOLOGICAL SPECTRUM IN CHILDREN WITH EPILEPSY AGED 6-15 YEARS

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Dr. Amodini Arora, Dr. Shiji Chalipat, Dr. Sharad Agarkhedkar, Dr. Shailaja Mane,Dr. Nikita R Khot
» doi: 10.31838/ecb/2023.12.s2.012

Abstract

Aims & Objectives: Epilepsy was defined conceptually as a disorder of the brain characterized by an enduring predisposition to generate epileptic seizures. This definition is usually practically applied as having two unprovoked seizures >24 h apart with at least one epileptic seizure in the previous 5 years regardless of anti -epileptic drug treatment. The International League Against Epilepsy (ILAE) accepted recommendations of a task force altering the practical definition for special circumstances that do not meet the two unprovoked seizures criteria. The task force proposed that epilepsy be considered to be a disease of the brain defined by any of the following conditions: (1) At least two unprovoked (or reflex) seizures occurring >24 h apart; (2) one unprovoked (or reflex) seizure and a probability of further seizures similar to the general recurrence risk (at least 60%) after two unprovoked seizures, occurring over the next 10 years; (3) diagnosis of an epilepsy syndrome. Seizures are one of the most prevalent neurological symptoms and risk factors for hospitalisation among children. This study aims at identifying the aetiology and classification of seizures which is essential for their long-term treatment. This study assessed the clinico-etiological and developmental spectrum among paediatric patients aged 6-15 years. Furthermore, this study also examined the frequently used antiepileptic drugs. Materials and Methods: A cross-sectional study was conducted on 55 paediatric patients aged 6–15 years admitted from the outpatient department or on regular follow-up at the Neurology OPD in Paediatrics at a tertiary care centre in Western Maharashtra. The complete trial lasted from August 2020 through February 2022. These patients were diagnosed with epilepsy for a duration of at least 6 months. An informed written consent was signed and approved by the primary caregivers of the children included in the study. This transverse study comprised multi-parametric analysis of the patient’s clinical condition including seizure type, frequency, duration, and etiology. Electroencephalogram (EEG) and Magnetic Resonance Imaging (MRI) were performed to identify the lateralisation and localization of neuro-functionality. Results: The study indicated a higher prevalence of epilepsy among male children, with 71% of their corresponding population compared to 29% of female children with epilepsy. Both male and female pat ients showed their respective peaks at around 8 years of age, which cumulatively consisted of 29% of the total population. However, the developmental profile of epileptic patients demonstrated a comparable proportion of age-appropriate (47.27%) and delayed (50.09%) milestones. Magnetic Resonance Imaging (MRI) findings were not strongly conclusive, as 45.45% of patients had normal reports while 54.54% had abnormalities in their neuroimaging outcomes. Most frequently, EEG is used to diagnose epilepsy, which may generate abnormal readings for epileptic patients. Here, 76.08% of patients showed spikes and sharp waves in their final reports that represent seizure activity, while only 23.91% had normal EEG readings. Furthermore, the type of seizures was analysed, and it was observed that generalised seizures were the most prevalent among patients, accounting for around 72.72%, followed by focal seizures (23.63%) and epileptic seizures (3.63%). In majority of patients, the onset of epilepsy started before the age of two, constituting 30.61%, practically equal to or more than double of any other age group observation. On the therapeutic prevalence, sodium valproate was administered to the maximum number of patients, 31. That constituted 67.39% of the total patients subjected to any medicine. Clobazam and Levetiracetam were the other two frequently administered medicines after sodium valproate with 36.95% and 34.78%, respectively. In this study it was analysed that, multi-drug therapy was more prevalent amongst patients in this age group over monotherapy for both generalized and focal seizures. The etiological spectrum of patients confirmed that structural etiology was found in most patients, with 36.36%, while metabolic etiology constituted 14.54% of the total population. Statistical analysis revealed a statistically significant co-relation between the refractory epilepsy in children aged 6 to 15 years and NICU Admission, Eventful birth history, Developmental delay and abnormal EEG Patterns. There was no statistical co-relation between the abnormal MRI findings and refractory epilepsy. Conclusion: This study concluded that generalized seizure is the most widespread seizure type that effects the paediatric group aged 6-15 years, where male patients were at a higher risk than females. The onset of seizures was not effectively diagnosed in the early stages. Multidrug therapy was administered and prescribed among the paediatric seizure patients in this age group. EEG and MRI are the most commonly utilised diagnostic tools for Epilepsy.

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