CONCLUSION:

Computerized Axial Tomography findings in children with afebrile seizures: A

hospital based study at eastern Nepal Dr. Prakash Poudel, MD1, Dr. Mohit Chitlangia, MD1, Dr. Mukesh K Gupta, MD1

1B.P. Koirala Institue of Health Sciences, Dharan, Nepal

INTRODUCTION:

Neuroimaging plays an important role in the evaluation and management of a child with epilepsy MRI is considered the imaging modality of choice CT can be performed in resource limited areas where MRI is not available

OBJECTIVES

To explore CT scan findings in children suffering from afebrile seizures To find out the yield of CT scan in evaluation of children with afebrile seizure

Sample size For estimated sensitivity of 30% with precision of ± 10.0%, a minimum of 280 seizure cases with CT scan were required for the study Patient details recorded in predesigned data collection sheet and updated at each visit CT and EEG were ordered when necessary Diagnosis and classification of seizure was made on electroclinical ground whenever possible based upon classification proposed by ILAE (1981) The analysis was done using SPSS 16.0 Yields of CT scan among total cases and among investigated cases calculated CT scan findings presented

METHODS:

Study Design: Prospective (1stJuly 2009 to 31st March 2014) Place: Pediatric Neurology Clinic at B.P. Koirala Institute of Health Sciences, Dharan, Nepal

Inclusion criteria: Age 1 month to 20 years, History of afebrile seizure

Exclusion criteria: Neonates, Febrile convulsion, Acute symptomatic seizures, Pseudoseizures

RESULTS Number of cases: 447 M:F ratio: 3:2 (276 male and 171 female) Median age at presentation: 84 (IQR 36 to 144) months Median age at onset of seizure: 46 (IQR 12 to 102) months

Figure 1: Yield of CT Scan CT scan was done in 321 (71.8%) cases. It was

abnormal in 143 cases.

Yield 32.0% Out of total cases 44.5% Out of investigated cases

Figure 2: CT Scan Findings:

0

20

9.6 8.7

3.1 2.7 2.2 1.1 0.9 0.7 0.7 2.2

13.4 12.1

4.4 3.7 3.1 1.6 1.2 0.9 0.9 3.1

% Out of total cases (447)

% Out of investigated cases (321)

Figure 3: Atrophy (n=43)

* Post Encephalitis ; # Neurocutaneous Syndromes

Table 1: Baseline characteristics

Characteristics Number (n=447) Percentage

Seizure onset below 5 years of age 282 63.1 History of status epilepticus 98 21.9 Presentation with first seizure 80 17.9 Presence of developmental delay 137 30.6 History of birth asphyxia 71 15.9 Family history of seizure 51 11.4 Abnormal neurological examination 152 34.0

Head circumference Microcephaly Macrocephaly

58 4

13.0 0.9

Presence of motor deficit 105 23.5

Tone abnormality Hypertonia Hypotonia

82 15

18.3 3.4

Electroencephalogram Normal Abnormal Not done*

108 277 62

24.2 62.0 13.9

Cerebral palsy 86 19.2

Type of seizure Generalized Focal

217 230

48.5 51.5

Diffuse atrophy, 29, 68%

Hemiatrophy, 10, 23%

Focal atrophy, 4, 9%

Figure 4: Neurocysticercosis (n=39)

Ring enhancing lesion, 25, 64%

Calcified granuloma, 13,

33%

Vesicular stage, 1, 3%

Figure 5: Tumor (n=3)

PNET, 1

Hypothalamic Hamartoma, 1

Ganglioglioma, 1

Figure 6: Neurocutaneous syndromes (n=3)

Tuberous Sclerosis, 2

Sturge Weber Syndrome, 1

Figure 7: Structural abnormality (n=14)

0

54

2 2 2

1 1 1 1

Figure 8: Stroke (n=12)

Infarction 83%

Sinus venous thrombosis

17%

Figure 9: Post-encephalitis Changes (n=10)

10, 100%

Areas of hypodenisties, atrophy and gliosis

Figure 10: Other findings (n=10) White matter hypodenisties of unknown etiology, 3

Hydrocephalus, 3 Degenerative

brain disease, 2

Multifocal hemorrhagic contusion, 1

Gliosis , 1

In a resource limited area where MRI is less practical, CT scan is a valuable alternative tool in evaluating a child with afebrile seizure because yield of CT scan is reasonably good.

Significant proportion of children in such area have seizures because of consequences of perinatal brain injury, CNS infection, neurocysticercosis, stroke and various other structural abnormalities. Underlying pathology in brain due to these conditions can be well detected by CT scan.