NEU/01(P) CLINICAL PROFILE OF SEIZURE DISORDER IN CHILDREN AGED BIRTH TO
12 YEARS AND USEFULNESS OF VARIOUS DIAGNOSTIC MODALITIES
Hemant Gogia, Premila Paul
VMMC & Safdarjang Hospital, Ansari Nagar, New Delhi
OBJECTIVE: to determine the etiology of seizure disorder in children (0-12 years) and usefulness of
various diagnostic modalities used in the workup of seizure disorder METHODS:259 children attending
hospital emergency room with primary complaint of seizure in the period between May 2004 to April
2005 were registered .A detailed history, clinical examination and relevant investigations like CSF
examination (including PCR& Elisa for MTB& NCC), CXR,Mx, CECT Head, EEG were done and
patient having a definite underlying cause such as suspected infective CNS pathology with abnormal
CSF examination and with developmental, structural malformation were excluded, however patients
having seizures with fever where no cause was found were included. RESULTS: out of 259 children,
144 (55.59% ) were males and 105 females (40.54% ). Maximum number of children were in the age
group of 5-10 years (126). Children presented with GTCS 112 (43.24% ), 92 (35.52%) with complex
partial seizures, 28 (10.81%) simple partial seizures ,6 (2.31%) with myoclonic seizures,3(1.15%)
atonic seizures,2(0.77%) gelastic seizures and 3(1.15) had unclassified seizures. Among these there
were 42 cases(16.21%) of febrile seizures, and 13 cases mimicked seizure activity and were
subsequently classified as pseudo seizures : of which7 (2.71%) had breath holding spell and 6(2.31%)
pseudo seizures ,so were not further investigated.112(43.24%) children presented in status epilepticus.
36 patients showed abnormal EEG. Out of which8were GTCS,24partial seizures and4 had myoclonic
seizures.CECT head showed abnormality in 61(23.55%) cases(19 GTCS,42 partial seizure) and most
common abnormality was single ring enhancing lesion (SECTL) 38(14.67%) cases. CXR and Montoux
test were performed in all of them and were positive in 16(6.17%) and 19 (7.33%) children respectively.
Out of 38 patients with SECTL, 18 had positive Elisa test for neurocysticercosis and 8 had positive
PCR for Tuberculosis. CONCLUSION: Though in majority of the children diagnostic workup was
negative and exact cause was not available. CTscan appeared to be most useful tool to find out probable
etiology which can be supplemented by specific tests for neurocysticercosis and tuberculosis.
NEU/02(O)
CLINICAL
PROFILE
AND
OUTCOME
OF
PEDIATRIC
NEUROCYSTICERCOSIS –A STUDY FROM WESTERN NEPAL
Sriparna Basu, Uma Ramchandran, Anna Thapliyal
The Department of Pediatrics, Manipal College of Medical Sciences & Manipal Teaching Hospital,
Phulbari, Pokhara, Nepal.
Introduction: Neurocysticercosis (NCC) is the commonest parasitic disease of central nervous system
and a common pediatric neurological problem in Western Nepal. Objective: To define the magnitude of
the disease in pediatric population and to determine the epidemiology, clinical features, investigations,
response to treatment and follow up of the disease Materials and methods: Medical records of 124
children with NCC were evaluated. Diagnosis was primarily based on clinical features, CT scan
features, electroimmunotransfer blot (EITB) assay and exclusion of other causes. All patients were
treated with 28 days’ course of albendazole, anti-edema drugs and anticonvulsants. Follow up period
varied from 1-3 years. Data were analyzed by mean and standard deviation Results: The commonest age
group was 10-12 years, youngest being of 11 months. Commonest clinical presentation was partial
seizures. The most frequent finding in CT scan was single ring enhancing lesion with perilesional
edema. EITB was positive in 80.72% of serum and in 96.88% of CSF samples. Ninety-eight patients
had complete clinical recovery and 87 patients had complete disappearance of lesion in CT scan at the
end of one year. Recurrence of seizures was the only residual symptom found in 6 (4.83%) patients, all
of them having calcified lesions. Conclusion: In endemic areas of NCC partial seizures in the pediatric
age group is an indicator of the disease. A good diagnostic marker is EITB while CT scan remains the
best investigation for confirmation. Recurrent partial seizure is the only residual symptom which may
occur more commonly in patients with calcified lesions.
NEU/03(O) CLINICAL EPIDEMIOLOGY OF PERVASIVE DEVELOPMENTAL DISORDERS
Sharmila Banerjee Mukherjee, Monica Juneja
Maulana Azad Medical College, Department of Pediatrics, Bahadur Shah Zafar Marg, New Delhi –
110002
Objectives: To study the clinical and neurodevelopmental profile of Pervasive Development Disorders
in Indian Children. Design: Descriptive study. Setting: Child development and early intervention clinic
of a tertiary hospital. Subjects: Children with developmental delay, speech delay, behavioural and/ or
poor school performance were screened for Pervasive Development Disorders. Methods: All patients
were reviewed with a detailed history including social and developmental history and complete
examination was done. The quality of child’s play and social interaction was directly observed. The
diagnosis was established using the criteria of Diagnostic and Statistical Manual of Mental Disorders,
Fourth edition. Childhood autism rating scale and Autism behavior checklist were also used.
Development/ Intelligence quotient and social quotient were assessed. Results: The number of children
diagnosed as having Pervasive Development Disorders was 124. Autistic disorder was diagnosed in
117, Asperger’s disorder in 3, Rett’s disorder in 2 , Childhood disintegrative disorder and Pervasive
Development Disorder Not Otherwise Specified in one patient each. The diagnosis had not been
suspected in most children at referral. The mean age at diagnosis was 57.03 ± 35.56 months. The male
female ratio was 2.02: 1. Global developmental delay/ Mental retardation was seen in 116 children.
Conclusion: Pervasive Development Disorders are not uncommon in Indian children. For early
diagnosis, developmental surveillance should be elaborate. The medical community must increase their
awareness and ability to recognize Pervasive Development Disorders for appropriate and early
intervention.
NEU/04(P) CLINICAL PROFILE OF PATIENTS WITH ACUTE FLACCID PARALYSIS IN A
TERTIARY CARE TEACHING HOSPITAL
Kalra Veena, Sharma Anita, Kamate Mahesh, Banerjee Bidisha, Chaudhry Rama, Aneja Satinder, Dua
Tarun
Department of Pediatrics, Division of Neurology, All India Institute of Medical Sciences, Ansari
Nagar, New Delhi 110 029
Aims and Objectives: To study clinical profile of patients presenting with acute flaccid paralysis.
Materials and methods:All patients less than 15 years fulfilling WHO definition of acute flaccid
paralysis presenting between August 2003 to August 2005 included. History of complaint and preceding
illnesses taken. Detailed examination & disability score at admission recorded. CSF examination and
nerve conduction done in Guillain-Barre syndrome(GBS) patients Results:Total seventy patients
enrolled, age ranging from 15 months to 13 years with 47 boys and 23 girls. Final diagnosis included
43 GBS, 6 transverse myelitis, 6 traumatic neuritis, 3 hypokalemic paralysis, others-12. No cases of
poliomyelitis identified. In GBS duration of symptoms at presentaion varied from 1-30 days with
median of 5 days. Symptoms < 7 days in 14, 7-14 days in 14, 14-28 days in 15. All GBS patients had
motor weakness, 19 had paraparesis, 24 had quadriparesis, symmetrical 38 asymmetrical 5. Cranial
nerve dysfunction in 8 and 2 required ventilatory support. Preceding illness in 14(33%), respiratory tract
infection 9, diarrhoeal illness 6 and injections in 3 patients. Functional disability grade at admission
ranged from 1-9 with median of 7 (tetraparesis). CSF analysis done in 31 patients. All had <10 cells/ul,
normal sugar, proteins ranged from 13-400 mg% being normal in 10. Nerve conduction study done in
34 cases,19 had axonal GBS, 10 patients no response, 5 had demyelinating type. Those with axonal
type showed improvement in CMAP on follow up. Out of 15 mild GBS (ambulatory) 9 were axonal.
Conclusions:GBS is important cause of AFP with the ongoing active polio eradication programme.
Unlike reports from western world we have seen greater proprtion of axonal variants with relatively
good prognosis. Presence of traumatic neuritis cases stress need for injection safety in pediatric
practice.
NEU/05(P) CEREBRAL PALSY IN CHILDREN
Puneet Jairath, Kamaljeet Kaur, Shalini Soi, K.K.Locham
Deptt. of Pediatrics, Govt. Medical College/Rajindra Hospital, Patiala – 147001
Objectives : Evaluation of clinical profile of cerebral palsy. Methods : The study included 7 children
with cerebral palsy admitted to department of Pediatrics, Govt. Medical College, Patiala. Age, sex,
residence, presenting complaints, type of seizures and prenatal, natal and postnatal risk factors were
recorded in a predesigned proforma. Cerebral palsy was classified on the basis of topographic and
physiological classification. Presence or absence of mental retardation was also recorded. Results : 7
children with cerebral palsy were admitted. 1(14.28%) child was in the age group of less than 1 year
and 6 (85.71%) children were in age group of 1-3 years. 1 (14.28%) child was female and 6 (85.71%)
were males. 1(14.28%) child was of urban and 6 (85.71%) children were of rural background.
6(85.71%) children presented with seizures while 5(71.42%) were having fever. 1(14.28%) child each
presented with feeding problems and cough with fever. 5 (71.42%) children had generalized tonic clonic
seizures and 1 (14.28%) was having focal seizures. Birth asphyxia in 3(42.85%) cases and meningitis in
2(28.57%) cases were the predisposing factors while birth asphyxia and meningitis both were the
underlying causes of cerebral palsy in 2(28.57%) cases. 3 (33.33%) cases had hemiplegia and 4
(44.44%) had quadriplegia. 5 (71.42%) children had spastic type while the 2 (28.57%) had mixed type
of cerebral palsy. All children were mentally retarded. Conclusions : Spastic type was the most common
and birth asphyxia was the predominant cause of cerebral palsy. Mental retardation was associated in all
the cases of cerebral palsy.
NEU/06(P) CYSTICERCOUS ENCEPHALITIS
Megha Consul, Sugandha Arya
Department of Paediatrics,Safdarjung Hospital and VMMC,New Delhi
A 6-year-old girl presented to us with complaints of headache, fever, vomiting and dimness of vision
since 3 months and deviation of eyes since a fortnight. Examination revealed papilledema and 6th nerve
palsy. No abnormality was found on any serological investigation including CSF. Contrast enhanced CT
scan revealed no abnormality except for generalized edema. On MRI, however, multiple
neurocysticerci(starry sky appearance) were revealed and subsequent serum analysis was positive for
NCC. Cysticercotic encephalitis is a rare disorder known to present in young children with no other
abnormality except features of raised intracranial hypertension and starry sky appearance on MRI.
Treatment involves steroids ,cysticercidal drugs and anti-edema measures .
NEU/07(P)
CHILDHOOD ISCHEMIC STROKE; CLINICAL AND RADIOLOGICAL
CORRELATION
D. L. Jain, A.S. Pilkhane.
Department of Pediatric, Government Medical College, Nagpur.
Childhood stroke is an important cause of mortality and chronic morbidity, but the studies in Asian
countries are lacking, including India. Yet very little is known about the cause, treatment and
prevention. OBJECTIVES: To study clinical presentation and probable etiology of ischemic stroke in
children. To find out correlation between clinical presentation and radiological findings. To study short
term outcome including survival and neurological sequalae. METHODOLGY: Design: It is a cross
sectional study with follow up duration of eight weeks. Setting: Department of Pediatrics, Government
Medical College and Hospital, Nagpur, a Tertiary Care Hospital in Central India. Sample: Fifty children
in age group between one month to twelve years having radiologically documented ischemic stroke
were included. Data Collection: Complete hemogram including Hb, cell count, hematocrit and
screening test for sickle cell disease was done in all cases; while CSF study, liver function test was done
in selected patients. All of them were subjected to contrast CT scan study. CT angiography was
performed in 28 out of 50 cases and carotid Doppler in twenty two children. RESULTS: More than half
of cases etiology remains unknown but anemia and hypercholestrolemia (in few cases). May be the risk
factor for ischemic stroke. On CT scan cortical infarcts were more common forty eight percent and
Middle Cerebral Artery affected in majority eighty four percent of them. Overall outcome pertaining to
mortality, neurological sequalae or recovery was not significantly affected by cortical or sub-cortical
infarction. The risk factors reported in immediate mortality were alteration in sensorium at the time of
presentation, extent of area involved by ischemic infarct, hemorrhagic transformation and underlying
etiology.
NEU/08(O) CONGENITAL MYOPATHIES: A CLINICOPATHOLOGICAL STUDY OF 16
CASES
Sheffali Gulati, M.C. Sharma, S Epari,Chitra Sarkar, Veena Kalra,
Associate Professor, Child Neurology Division, Department of Pediatrics, All India Institute of Medical
Sciences, New Delhi
Congenital myopathies are a group of neuromuscular disorders, mostly of childhood onset, often of
slow progression, but exceptionally having more rapid course. They show disease specific structural
changes in the muscle which are detected by enzyme histochemistry, and electron microscopy but
sometimes with immunohistochemistry. We report a series of 16 cases of congenital myopathy, which
to the best of our knowledge is first largest series from India. Material & Methods: Conducted at
Myopathy Clinic, Department of Pediatrics, All India Institute of Medical Sciences. All cases between
January 2001 to December 2004 diagnosed as congenital myopathies were studied. Clinical data and
muscle biopsies were reviewed. Results: During this period 16 patients were diagnosed as congenital
myopathies: Central core disease 6; Multi mini core disease 4; Centronuclear myopathy 2; Nemaline
myopathy 1; Congenital fibre type disproportion 3. Age ranged from newborn to 12 years. All
presented in the first decade of life. The most common findings were difficulty in running and getting
up followed by generalized hypotonia in 5 (31.2%), facial dysmorphism in 4 (25%), high arched palate
in 2 (12.5%) and ptosis in one (6.2%). Family history of similar illness was present in two cases.
Creatine phosphokinase levels were either normal or mildly elevated. Electromyography was done in 12
patients, of which 8 showed myopathic changes, 3 were normal and 1 was suggestive of neurogenic
atrophy. Conclusions: We are able to categorize the various congenital myopathies with available
investigations and one should have a high index of suspicion for them.
NEU/09(P) CEREBRAL VENOUS THROMBOSIS
Prachi Gupta ,Sujata,M.S.Prasad
Department of Pediatrics, Safdarjung Hospital, New Delhi
Cerebral venous thrombosis has a wide range of age group distribution, but in children it is a rare but
significantly serious complication of a very common illness : acute gastroenteritis with dehydration.
We report a case of a 6 months old female child who presented with the above complication. A 6
months of female child developmentally normal for age presented to the hospital with the complaints of
fever,loose stools and vomiting for 3 days and abnormal jerky movements of the left side of the body
assosciated with uprolling of eyeballs for one day. There was no history of ear disease, rash, contact
with Koch’s,head trauma. On examination child was drowsy and signs of severe dehydration were
present along with left hemiparesis with no cranial nerve deficit and no signs of raised intracranial
tension. The dehydration of the patient was corrected.Blood investigations including coagulation profile
and FDP were normal except for microcytic hypochromic anemia, thus ruling out metabolic cause of
seizures.Cerebrspinal fluid analysis was normal and cultures were sterile. CECT head clinched the
diagnosis : (R) parietal cortical venous infarct along with superior sagittal thrombosis. Further
investigations like protein C,S etc to rule out hypercoagulable state were within normal limits. With
appropriate fluid and drug therapy and physiotherapy, the child recovered completely in 6 days and was
discharged with no residual defects.
NEU/10(P)
CLINICAL PROFILE OF SPEECH AND LANGUAGE DISORDERS
PRESENTING AT A TERTIARY LEVEL HOSPITAL IN INDIA.
Kashyap N, Khanna H, Sharma P
Child Development Clinic, Apollo Centre of Advanced Pediatrics, Apollo Indraprashtha Hospital,
Sarita Vihar, New Delhi 110044
Disorders of communication are the most common developmental problem in pre-school aged children
and 7 to 10 % of children are considered to be functioning below the norm in some aspect of speech or
language ability. Evaluation of speech and language delay is a challenge. Appropriate intervention is
often delayed due to improper identification and lack of systematic approach to its recognition. This
paper presents the clinical profile of speech and language disorders noted in a retrospective analysis of
715 cases seen at a tertiary level hospital in India. Material & Methods: A total of 715 cases were seen
during Jan 2002 to Aug 2005 out of which 90 cases presented with speech and language delay as a
presenting complaint. A developmental pediatrician undertook detailed clinical and developmental
examination and speech and language assessment was done in a multidisciplinary setting involving
ENT specialist and speech and language pathologist. The speech and language disorders were classified
based on DSMIV criteria. Hearing was tested by BERA or audiometry. Results: 74 of 90 (82%) were
male and 16 (18%) were females. The subjects were in the age range of 5months to 12 years. Age
distribution indicated that majority of the cases (72%) were less than 5 years of age, with 30% of the
total presented before three years of age. The diagnostic workup revealed that 47.8% were Autistic
spectrum disorders, 13.3% had mental retardation, 11% had ADHD, 10 % had developmental language
disorder, 6.7% had hearing loss, 3.3% had articulation disorder and 3.3% had associated neurological
conditions. 6.7% could not be classified and were labeled as specific language impairment.Conclusions:
Presentation of speech and language disorders can be diverse. Autistic spectrum disorders were the
largest category recognized in our series probably due to the study being conducted at a tertiary level
referral centre. A detailed clinical and developmental examination with appropriate clinical tools in a
multidisciplinary setting is required to workup these conditions.
NEU/11(P) GUILLAIN-BARRE SYNDROME WITH HERPES SIMPLEX VIRUS INFECTION
Rajiv Kumar, Nomeeta Gupta, Rajesh Sardana, Bindu Shrivastava, Gurdeep Atwal, Sandeep Patel
Department of Pediatrics, Batra Hospital & Medical Research Centre, New Delhi-110062.
Guillain-Barre Syndrome (GBS) is an acute flaccid lower motor neuron paralysis. Usually GBS occurs
a few days or weeks after the patient had respiratory or gastrointestinal viral infections. GBS caused by
Herpes simplex virus (HSV) infection is very uncommon in children. We report uncommon case of
GBS with HSV infection in a 4 year old child. Case Report: A 4 year old male child admitted in our
institution with history of fever, headache, vomiting and uprolling of eyeballs for 3 days; altered
sensorium and unable to walk for 2 days. On examination, he was afebrile, sick, and comatose with
stable vitals and blood pressure 130/90 mm Hg. No abnormality was detected on examination of
cardiovascular, respiratory and gastrointestinal systems. Central nervous system revealed power grade
1-2/5 and hypotonia in all four limbs. Deep tendon reflexes and planters were not elicitable. There was
minimal response to painful stimuli and to verbal commands. There was no focal neurological deficit.
The sensorium deteriorated gradually and power became 0/5 in all four limbs. He eventually developed
autonomic dysfunction and respiratory failure for which he was put on mechanical ventilation. The
complete blood counts, electrolytes, urinalysis, blood sugar, serum CPK, and blood culture were
normal. CSF examination showed 46 lymphocytes with protein 68 mg%, glucose 60 mg% and positive
HSV IgM. Poliomyelitis was ruled out by serological test and stool culture. CT head scan revealed
picture suggestive of Herpes simplex encephalitis. EEG was normal. Nerve conduction test revealed
severe peripheral neuropathy. He was treated with intravenous broad-spectrum antibiotics, high dose
intravenous immunoglobulin, intravenous acyclovir, intravenous mannitol and antihypertensive drugs.
He regained consciousness gradually and started responding to verbal commands. Tone and power
improved gradually in al four limbs. Nasogastric feeds were started. Physiotherapy was done and
continued even after discharge. At the time of discharge, he could sit independently and was accepting
orally but was unable to walk. After 3 weeks on follow-up, the child was walking and running.
NEU/12(O) HOME-BASED THERAPY IN CHILDREN WITH AUTISTIC DISORDER
Monica Juneja, Sharmila Banerjee Mukherjee
Child Development and Early Intervention Clinic, Department of Pediatrics, Maulana Azad Medical
College, N. Delhi - 110002.
Objectives: To evaluate the effectiveness of individualized home-based therapy in children with Autistic
disorder. Design: Retrospective. Setting: Child development and early intervention clinic of a tertiary
hospital. Subjects: Children with Autistic disorder (AD) who were exclusively attending the clinic for
Behavioral and speech therapy for at least six months. Methods: Parents are trained in a one to one
session and given written and pictorial instructions regarding therapy, which they implement at home.
During follow up the counseling is reinforced and modified according to the goals achieved and
compliance for therapy is assessed. For the purpose of this study, files of children fulfilling the
inclusion criteria were reviewed. Pre and Post treatment development quotient, social quotient,
expressive and receptive language quotients, Childhood autism rating scale and Autism behavior
checklist scores were recorded. Statistical analysis was performed using SPSS software version 11.
Results: Sixteen children were enrolled. The male: female ratio was 13: 3 and the mean age was 39.06 ±
22.05 months. According to the Kuppuswamy scale, 2 children belonged to class I, 9 to class II, 2 to
class III and 3 to Class IV. Fifteen children had severe AD. Mental retardation was present in 81.25 %.
The average duration of therapy was 19.5 ± 11.78 months. Compliance to therapy by the care givers
was less than 25% in 5, 25 - 50 % in 3, 50 to 75% in 3 and 75 - 100% in 5 children. Post therapy it was
seen that there was a statistically significant difference in the development quotient (p = 0.015), social
quotient (p = 0.004), expressive language quotient (p =0.03), Childhood autism rating scale score (p =
0.001), and Autism behavior checklist score (p = 0.014). Severity of symptoms was also reduced.
Conclusion: Home based behavioral therapy is effective, even in children with severe AD and those
belonging to low socioeconomic classes.
NEU/13(O) LACUNAE IN THE DIAGNOSIS AND APPROPRIATE TREATMENT OF WEST
SYNDROME AND ITS CORRELATION WITH LONG TERM FOLLOW UP.
Anaita Hedge, Varsha Vaidya, Shilpa Kulkarni, V.Lakshmi Kumari.
Bai Jerbai Wadia Hospital for Children, Achararya Donde Road, Parel Mumbai 400 012
Aims and objectives: To highlight the lacunae in diagnosis and appropriate treatment of West
Syndrome. To see if early and appropriate treatment changes the long- term prognosis. Materials and
methods: 1000 cases of unequivocal childhood epilepsy from a tertiary pediatric epilepsy clinic were
reviewed. Detailed history regarding birth, family, and type of seizures, EEG, MRI,
neurodevelopmental stAims and Objectives: To study clinical, electrophysiological and
neuroradiological aspects of patients with neonatal hypoglycemic insult. Materials and methods: 2000
epilepsy patients from 1998–2004 visiting our epilepsy center were studied. Those with documented
neonatal hypoglycemia on NICU discharge cards or neuroimaging suggestive of perinatal hypoglycemic
insult(parieto-occipital damage) were analysed. Detailed clinical history, perinatal risks, age of onset,
type of epilepsy and thorough neurological examination were obtained. Patients were subjected to
electroencephalography (EEG), neuroimaging. Follow-UP period was 0-84 months (average 19.93).
Results: 70/2000(3.5%)patients had neonatal hypoglycemic brain damage.59/70 (84.28%) showed
NICU records of documented hypoglycemia. 11 patients perinatal hypoglycemia was suspected on
neuroimaging during epilepsy workup. 19/59 (32.75%) had neonatal hypoglycemic seizures. Perinatal
risk factors were intrauterine growth retardation in 31/70 (44.28%)& sepsis 26/70(37.14%). 7/70 (10%)
had isolated hypoglycemia. All patients were seizure free on monotherapy at discharge from NICU.
Age of onset of repeat seizures was 19.13 months (2-108 ) Partial seizures were 30/70(42.85%),
infantile spasms 24/70(34.28%) and myoclonic in 7/70(10%). Development was delayed in
54/70(77.14%). EEG revealed focal epileptiform abnormalities in 27/70 ( 38.57%) , multifocal in 19/70
(27.14%),hypsarrythmia in 18/70 (25.71%). 6/70(8.57%) had normal EEG. 53/70 underwent
neuroimaging studies. 20/70 (28.57%) showed isolated parieto-occipital damage suggesting neonatal
hypoglycemic insult, 18/70 ( 25.71%) had combinations of parieto -occipital damage and different
perinatal insults On follow up 28/70 (40%) were seizure free.19/70 (27.14%) had poor seizure control.
Conclusions: Hypoglycemia is common, easily treatable condition in neonates. It is associated with
significant neurological damage and epilepsy. Complex partial seizures and West syndrome were the
commonest outcomes with poor prognosis in later.
NEU/14(O) EARLY PREDICTORS OF INTERACTABLE EPILEPSY
Vikas D. Bansal, B. B. Javadekar
Department of Paediatrics, M.P.Shah Medical College, Jamnagar.
Epilepsy is affecting approximately 50 million people worldwide. Prognosis for majority of patients is
good but upto 30% suffer from intractable epilepsy. Because interactability of epilepsy is said to
develop early in the course of the disease and early aggressive management can prevent intractability, it
is essential to identify children destined to develop intractable epilepsy early in their course. AIMS : To
identify early predictors of intractable epilepsy. MATERIAL AND METHODS : A case control study
of 67 patients following the epilepsy clinics, Department of Paediatrics G.G.H. Jamnagar comparing 32
cases and 35 controls. Cases were patients who averaged atleast 1 unprovoked seizure per month during
an observational period of atleast 2 years. Controls were subjects having achieved remission for at least
1 year on current therapy. Both cases and controls were analysed for the factors which have been
reported to have unfavourable prognosis like age of onset of seizures, type of seizures, number of
seizures before starting treatment, episodes of status epilepticus, predisposing factor for epilepsy, types
of epilepsy (idiopathic / probable symptomatic and symptomatic), developmental delay, abnormal
neurological status, EEG findings and site of epileptic focus on EEG and CT scan. Strong assocaition
were noted between intractability and general factors with early onset of seizures, focal type of seizures,
more than 10 episodes of seizures before starting treatment, history of status epilepticus particularly
more than 2 episodes, symptomatic epilepsy, presence of developmental delay, presence of abnormal
neurology and microcephaly. Cases were significantly younger than controls at onset (0.87 Vs. 3.74
years) this was not solely to cases with onset during the first year of life but was an association apparent
throughout the age range studied with P value < 0.01, focal seizures P < 0.01, multiple seizures episodes
(> 10 episodes) P < 0.01, more than 2 episodes of status epilepticus, P < 0.05, symptomatic epilepsy P <
0.01, developmental delay P <0.01, abnormal neurology P<0.01 and microcephaly P< 0.001.
CONCLUSION : Our study suggested that the risk of developing intractable epilepsy may be predicted
at the time of initial diagnosis in children with early age of onset of symptomatic epilepsy with high
seizure propensity with frequent episodes of status epilepticus, developmental delay with abnormal
neurology especially microcephaly.
NEU/15(P) EPILEPSY FOLLOWING NEONATAL HYPOGLYCEMIA
Varsha Vaidya, Shilpa Kulkarni, V.Lakshmi Kumari, Anaita Hedge.
Bai Jerbai Wadia Hospital for Children, Achararya Donde Road, Parel Mumbai 400 012
Aims and Objectives: To study clinical, electrophysiological and neuroradiological aspects of patients
with neonatal hypoglycemic insult. Materials and methods: 2000 epilepsy patients from 1998–2004
visiting our epilepsy center were studied. Those with documented neonatal hypoglycemia on NICU
discharge cards or neuroimaging suggestive of perinatal hypoglycemic insult(parieto-occipital damage)
were analysed. Detailed clinical history, perinatal risks, age of onset, type of epilepsy and thorough
neurological examination were obtained. Patients were subjected to electroencephalography (EEG),
neuroimaging. Follow-UP period was 0-84 months (average 19.93). Results: 70/2000(3.5%)patients
had neonatal hypoglycemic brain damage.59/70 (84.28%) showed NICU records of documented
hypoglycemia. 11 patients perinatal hypoglycemia was suspected on neuroimaging during epilepsy
workup. 19/59 (32.75%) had neonatal hypoglycemic seizures. Perinatal risk factors were intrauterine
growth retardation in 31/70 (44.28%)& sepsis 26/70(37.14%). 7/70 (10%) had isolated hypoglycemia.
All patients were seizure free on monotherapy at discharge from NICU. Age of onset of repeat seizures
was 19.13 months (2-108 ) Partial seizures were 30/70(42.85%), infantile spasms 24/70(34.28%) and
myoclonic in 7/70(10%). Development was delayed in 54/70(77.14%). EEG revealed focal epileptiform
abnormalities in 27/70 ( 38.57%) , multifocal in 19/70 (27.14%),hypsarrythmia in 18/70 (25.71%).
6/70(8.57%) had normal EEG. 53/70 underwent neuroimaging studies. 20/70 (28.57%) showed isolated
parieto-occipital damage suggesting neonatal hypoglycemic insult, 18/70 ( 25.71%) had combinations
of parieto -occipital damage and different perinatal insults On follow up 28/70 (40%) were seizure
free.19/70 (27.14%) had poor seizure control. Conclusions: Hypoglycemia is common, easily treatable
condition in neonates. It is associated with significant neurological damage and epilepsy. Complex
partial seizures and West syndrome were the commonest outcomes with poor prognosis in later.
NEU/16(P) EFFICACY AND SAFETY PROFILE OF CLOBAZAM IN INDIAN CHILDREN
Rachna Seth, Veena Kalra , Devender Mishra, Anita Sharma, N C Saha,
Department of Pediatrics, All India Institute of Medical sciences, New Delhi, India
Background. Clobazam, is a newer 1, 5-benzodiazepine used for the treatment of epilepsy. Most studies
on adults and few on children have shown clobazam to be a useful oral adjunctive therapy in refractory
epilepsy. It is reported to be better tolerated and less sedating than other benzodiazepines. Asian data
on use of clobazam is limited being particularly scarce in children. Our aim was to evaluate the efficacy
of clobazam in childhood refractory epilepsy and to characterize the adverse drug reaction profile in the
Indian children. Methods: A cohort of 88 children (9 months to 12 years) with ‘refractory’ epilepsy was
started on clobazam as add-on therapy. Diagnosis was established and seizure type recorded. Patients
were followed at the Pediatric Neurology Clinic at All India Institute of Medical Sciences. Therapeutic
response was recorded as ‘complete’, ‘good’, ‘fair’ and ‘no response’. Observed side effects were
classified as ‘mild’, ‘moderate’ and ‘severe’. Results: Most children were on at least two antiepileptics.
Seizures most identified were either partial (36.3%) or generalized tonic clonic (15.9%). Clobazam was
effective against all seizure types. The dose ranged from 0.3-2 mg/kg/day (average 1 + 0.2 mg/kg/day).
Complete seizure control was seen in 62.2% patients. Tolerance was seen in 5 (5.6%) patients. Side
effects were seen in 23 (26%) patients and were ‘mild’ in 20/23 patients. Clobazam was stopped in three
patients who developed ataxia, which resolved on stopping the drug. Conclusions: Clobazam is well
tolerated and has a broad spectrum of antiepileptic activity. It is a safe add on antiepileptic with mild
adverse drug reactions . The drug was well tolerated . Single daily dose and low cost of the drug were
responsible for good compliance. Clobazam is recommended as a safe add on drug with low rate of
undesired side effects in children with refractory epilepsy.
NEU/17(P) DEVIC’S DISEASE - CASE REPORT
Karuna Thapar, Abha Midha, Sandeep Aggarwal, Gaurav Dhawan
Department of Pediatrics, Govt. Medical College, Amritsar-143001
Introduction: Neuromyelitis optica (devic’s disease) is an uncommon clinical syndrome comprising of
unilateral/ bilateral optic neuritis and transverse myelitis within 8 weeks. Case Report: An 8 year female
presented with cough, abdominal pain, backache and dysuria for 5-6 days. Pain in legs, inability to
stand and walk, urinary retention and dribbling of urine for 3 days. History of fever of short duration 1
month back. Development of child was normal and child was immunized. On examination, vitals were
stable, GPE was normal. Neurological findings included grade 1 power and hypotonia of lower limbs.
All reflexes of lower limbs were absent. Sensory loss was present up to the level of umbilicus. There
was no sensory and motor loss in upper limbs, cranial nerves were normal, so child was then diagnosed
as a case of transverse myelitis. Child had a sudden loss of vision on 7 th day. This led to the possibility
of devic’s disease. Fundus examination was normal. Routine investigations were normal. CSF
examination showed 4 cells/cmm, predominant lymphocytes, proteins 34 mg%, globulin negative, sugar
45.5 mg%, and chloride 125.2 mg% with no microorganism. MRI spine showed myelitis at dorsal cord
D8- D12 level, child was put on intravenous dexamethasone within 4 hours of loss of vision. Vision
showed improvement in 24 hours and full vision was restored within 72 hours. Sensory loss of lower
limbs progressively decreased and child was able to stand. On 15th day child was able to walk without
support. There was no residual neurological deficit.
NEU/18(P)
BECKER MUSCULAR DYSTROPHY: PREVALENCE AND PATTERNS OF
CARDIAC INVOLVEMENT
Sheffali Gulati, Anita Saxena, Vani Wazir, M.C. Sharma, Chitra Sarkar, Madhulika Kabra, Monica
Tiwari, Veena Kalra,
Associate Professor, Child Neurology Division, Department of Pediatrics, All India Institute of Medical
Sciences, New Delhi
Duchenne muscular dystrophy (DMD) is a severe X-linked genetic disease affecting one in 3500 boys.
It is due to a lack of dystrophin, a submembrane protein of the cytoskeleton, which leads to the
progressive degeneration of skeletal, cardiac, and smooth muscle tissue. A milder form of the disease,
Becker muscular dystrophy (BMD), is characterized by the presence of a semifunctional truncated
dystrophin, or reduced levels of full-length dystrophin. Cardiac disease is not as common or as severe as
in DMD Objective: To assess cardiac involvement in BMD patients by clinical, radiographic,
electrocardiographic and echocardiographic monitoring. Materials and methods: Thirty four patients
diagnosed to have BMD amongst those attending the Myopathy Clinic, Department of Pediatrics, All
India Institute of Medical Sciences were enrolled. A detailed clinical evaluation, CPK levels and gene
deletion studies were carried out. Cardiac investigations included Chest X ray, 12 lead ECG and
echocardiography. Results: Age at onset was between 4 to 18 years (mean 11.4  3.8 years). Clinical
features included: calf hypertrophy in 73.5%, developmental delay in 14.7%, myopathic facies in
17.6%, gower’s sign in over 90% and a positive family history in 38.2 %. The CPK levels had a mean
of 8009 IU/L  10482.9. The cardio-thoracic ratios were between 0.40 to 0.52 (mean 0.46 0.03).
Ejection fraction was between 41 to 64 (mean 54.6 6.1). ECG showed a V1R> 4mm, q waves in
lateral and inferior leads in 47.1%, 2.9% and 2.9% respectively. Gene deletion studies will be discussed.
Conclusions: Cardiac dysfunction is less common in BMD than in DMD but early recognition is
necessary to institute appropriate treatment thus reducing morbidity.
NEU/19(P) BRAIN STEM AUDITORY EVOKED RESPONSE AUDIOMETRY (BERA) IN
HYPERBILIRUBINEMIC NEONATES
Pramod Sharma, N.P. Chhangani,Keshram Meena,B.D. Gupta,Rakesh Jora ,Ravi Bhatia
Umaid hospital,Dr SN Medical College, Jodhpur
Neonatal hyperbilirubinema places the affected neonate at increased risk for hearing impairment. Brain
Stem Auditory Evoked Responses (BAER) is an effective, objective method of assessing auditory
functions and abnormalities correlate with serum bilirubin levels. Further therapeutic interventions have
been shown to improve BAER record. OBJECT: -To record BAER in icteric term neonates & derive
values for various latency period & interwave distances. Methodology : A prospective case controlled
study in which 30 icteric term neonates delivered at Umaid Hospital Jodhpur without any obstetrical
complications were enrolled.Babies with abnormal events like severe birth asphyxia, pyogenic
meningitis, septicemia, congenital craniofacial malformations or babies on mechanical ventilator were
excluded. BERA recordings were made as per the technique described by Taylor et al.The records were
obtained at the time of peak hyperbilirubinema, after therapy & on follow up at the age of 2-4 months.
Results: Mean birth weight, mean gestational age & mean age at enrolment were 3.31+0.41 kg;
38.38+1.26 weeks and 4.16+0.77 days respectively. Mean serum bilirubin levels were 25.91+7.28mg%
with 5 babies having Rh incompatibility. Mean latency of all waves was prolonged at all decibel levels
before treatment & after phototherapy and /or exchange transfusion the latency showed a statistically
significant decrease. Similarly interwave period was prolonged in all segments, which too showed
significant reversion after therapy. Changes in BAER were significant at serum bilirubin above 25mg%.
Abnormal BAER responses were seen in 73.3% babies with 20% patients showing absence of wave V
at 30 db in both ears though it persisted in only 7 cases (23.3%) after treatment. On follow up tracings
16% continued to show abnormality at 3 months of age. Conclusion: Hyperbilirubinema is significant
high risk factor causing hearing impairment. BAER can detect bilirubin encephalopathy relatively early
and correlates well with serum bilirubin levels.
NEU/20(O) ANOMALIES OF CRANIAL VAULT IN PEDIATRIC AGE GROUP
Niranjan K. Singh, Sushma Malik, Sushma Save, Surekha Joshi.
Pediatric Neurology Clinic, Department of Pediatrics, T.N. Medical College & B.Y.L. Nair Hospital,
Mumbai.
INTRODUCTION: Abnormal shape and size of the skull are frequently observed in early childhood.
These are a major concern to both parents and pediatricians. AIMS & OBJECTIVES: To estimate the
prevalence, spectrum & etiology of cranial vault anomaly (CVA). To study the correlation of clinicodemographic factors to morbidity. MATERIAL & METHODS: Detailed history, thorough physical and
neurological examination including anthropometry was taken in all cases. Relevant investigations were
done to ascertain the underlying etiology. All data were analysed statistically using Chi Square Test and
Z-test with SPS software package. RESULTS: Of the 137 subjects enrolled, CVA was encountered
most commonly in 0-2 years age group with slight female preponderance (Male: Female – 0.87: 1).
Based on skull size anomalies microcephaly was seen in nearly 81% and macrocephaly in 19%.
Microcephaly was either primary (53%) or secondary in nature (47%). The spectrum of shape
anomalies ranged from plagiocephaly to brachycephaly, scaphocephaly and acrocephaly. Amongst these
positional plagiocephaly was the predominant form noted. The etiology of various CVA was either –
idiopathic (44.47%) or symptomatic. Clinical presentation in 20% of our cases was primarily related to
the shape / size of the skull, whereas in 80% the symptomatology was related to their underlying illness.
In 8% of our subjects, recognisable syndromes like Down, Crouzon, Aicardi, etc. were detected.
CONCLUSION: Early detection, management and intervention of children presenting with CVA will
ensure optimum brain growth and decrease the morbidity significantly. In cases of craiosynostosis,
careful search for syndromic association and early neurosurgical intervention would prove very
beneficial.
NEU/21(P) ACUTE DISSEMINATED ENCEPHALOMYELITIS (ADEM)- CASE REPORT
Karuna Thapar, Abha Midha, Gaurav Dhawan
Department of Pediatrics, Govt. Medical College, Amritsar-143001
Introduction: ADEM is immunologically mediated inflammatory demyelinating disease of CNS.
Highest prevalence is seen in prepubertal boys. Clinical manifestations include abrupt development of
irritability and neurological signs in children recovering from a viral prodrome. Changes in long tract
signs and mental status are commonly observed. Case Report: A 7 years old male child presented with
intermittent fever for 25 days, headache for 15 days, irritability, excessive crying, vomiting, and pain
abdomen. On examination vitals were normal, neck rigidity was present, pupils were bilaterally
reacting, tone was normal and reflexes were present. CSF studies were normal. MRI revealed few small
hyper intense lesions in the sub cortical white matter of cerebral hemispheres, left caudate nucleus and
rostrum of corpus callosum on right side suggestive of acute disseminated encephalomyelitis. He was
treated with intravenous methyl prednisolone with which he showed slight improvement and was
discharged on oral steroids. The child was readmitted within three months again with complaints of
decreased vision for 15 days, headache for 10 days, difficulty in micturation for 4 days and irrelevant
talks for 1day. MRI brain revealed that the previous lesions had increased in number and size with
involvement of the basal ganglia and the brainstem. The child was given intravenous methyl
prednisolone (30mg/kg/day) for three days and then started on oral methyl prednisolone. The child
showed dramatic improvement to this therapy and led to resolution of all his neurological deficits.
Follow up for 5 months revealed no neurological deterioration.
NEU/22(P) ACUTE ENCEPHALITIC SYNDROME IN CENTRAL INDIA – AN OVERVIEW
Mahendra Jain, Navaneetha S., Piyush Chandel., Ankur Vikas Bopche, Jyotsna Shrivastava, G.S. Patel,
Rashmi Dwivedi.
Department of Paediatrics, Kamla Nehru Hospital, Gandhi Medical College, Bhopal.
Encephalitis is a common cause of morbidity and mortality. Objectives: To study the epidemiology,
etiology and magnitude of acute encephalitis. Setting and Methods: A retrospective study was
conducted including the period from Aug. 2003 to Aug. 2005. All children admitted with the acute
encephalitic syndrome defined as acute onset of fever with seizures and altered consciousness excluding
meningitis and cerebral malaria were included in the study. Data regarding history, clinical findings,
investigations and outcome were collected and analysed as to the etiology and cause of death. Results:
A total of 174 children were admitted (2% of in patients) 68 (39%) of them expired (5% of total
mortality). An etiological diagnosis could be made in only 11 (6.32%) cases (no serological support) 5
(2.87%) were rabies (100% mortality); 3 (1.72%) were measles (0% mortality), 2 (1.15%) were
varicella (0% mortality) and 2 (1.15%) were mumps encephalitis (50% mortality) of the 163 cases with
unknown etiology; the majority 54 (33.12%) had a short history <24 hours; 92 (56.44%), 24-72 hours
and 17 (10.43%) >72 hours. Associated gastrointestinal, respiratory symptoms were present in 42
(25.77%) and 32 (19.63%) cases, rash in 7 (4.29%); conjunctivitis in 23 (14.11%) focal seizures in 8
(4.91%); pyramidal tract signs in 123 (75.46%) extra pyramidal signs in 2 (1.23%). 12 (17.64%) of the
68 expires presented with status epilepticus; 17 (25%) with fluid and inotrope resistant shock and 19
(27.94%) with signs of raised ICT. CSF pleocytosis could be documented in 51 (31.29%) of the cases
including post mortem LP. Maximum no. of cases and expiries were recorded during the months of
May to August. Conclusion: Encephalitis is a major cause of morbidity and mortality, but the problem
is under addressed. Facilities for serodiagnosis and intensive care should be made available atleast at the
tertiary care level.
NEU/23(O) AN OUTBREAK INVESTIGATION OF ENCEPHALITIS IN GORAKHPUR, UP:
2004
Neeru Gupta , Kunal Chatterjee , Shah Hossain, Bina Pani Das, S.Venkatesh and Shiv Lal
Assistant Director General, Division of RHN, ICMR, New Delhi
Introduction: Japanese encephalitis is an acute disease (caused by an arbovirus) of major public health
importance, which primarily attacks children and has a high case fatality rate of 20 percent or much
more and in large number of instances sequelae occur among survivors. This viral encephalitis has
reservoirs in pigs and water frequenting birds, is transmitted by Culex mosquitoes and has a potential
for outbreaks. Gorakhpur is reporting outbreaks of Japanese encephalitis regularly for many years. In
the year 2004 there was an outbreak too. National Institute of Communicable Diseases (NICD)
constituted a team of four including epidemiologists, entomologists and clinicians to undertake
epidemiological investigations. Objectives: The outbreak was investigated with the objectives to
confirm the existence of an epidemic, to identify the source of the outbreak and to understand the
circumstances due to which the epidemic was taking place. Methods: The team visited Gorakhpur from
14th to 17th Sept, 2004. The team interviewed the key persons and analyzed the records. They also did
clinical examination of patients, eco-entomological survey and collection of blood samples of patients
for serological survey methodology to confirm the outbreak and understand the epidemiological reasons
behind the outbreak in order to suggest control measures and future prevention. Results: There were
cases of encephalitis occurring in the district of Gorakhpur as well as in the adjoining districts in the
region. The diagnosis was also established as IgM positive for Japanese Encephalitis at the NICD
laboratory. Total number of cases in the district of Gorakhpur were117 and deaths were 24 from 12 th
July, 2004 to 13th September, 2004. Cases were still continuing to come. All the PHC areas and blocks
in the district were affected. Entomological investigations revealed C tritaeniorhynchus at outbreak
level density in the affected villages. The density was indoor 8 per man-hour and outdoor 60 per ten
sweeps of 'mosquito catching net'. Amplifier host of Pigs and ardeid birds were common in the area.
Conclusions: Gorakhpur is one of the districts with highest number of cases and deaths due to
encephalitis and a programme is also launched to immunize 1-3 year old children in the district with 2
doses of killed JE vaccine in the same year. The age band may be increased as well as community
compliance should also be ensured for sustainable results. Vector control measures in the district needed
be intensified including focused IEC for source reduction (pigs segregation). Personal protection
measures may be emphasized in a tailored campaign to protect the children from mosquito bite.
Physical medicine unit, paediatric neurology and resuscitation teams may be organized in a dedicated
unit for better case management and reduction in death and disability.
NEU/24(P) AN INTERESTING CASE REPORT OF HEMIPLEGIA IN CHILDHOOD
Dilip Mukherjee, Asha Mukherjee, Arpan Agarwal, Saradindu Sarkar,
Ramakrishna Mission Seva Pratishthan-Vivekananda Institute Of Medical Sciences, 99, Sarat Bose
Street. Kolkata-700026
This communication deals with a case of hemiplegia in a child and its investigations. Raja Doloi,a
previously healthy 21/2 yr old Hindu male residing in 24 Pgs district of West Bengal presents to the ED
12 hrs after developing sudden onset weakness followed by inability to move left upper and lower limbs
and deviation of angle of mouth to right side. Mother informed that while playing with friends the
previous afternoon, Raja suddenly fell on ground after which he was unable to get up and stand of his
own. He remained irritable for whole night until next morning when parents observed facial
asymmetry, aphasia,unable to move left limbs.No h/o blood transfusion,diarrhea, bleeding
manifestation,prolonged fever, cong. cyanotic heart disease, joint pains, sore throat, TIA. Birth and
Development history;Normal
O/E: Healthy, alert,no malnutrition, no distress. Vitals:
T=98.6;P=100/min, regular,equally palpable in 4 limbs; R=26; BP=148/92 mm Hg (severe
hypertension) CVS & Resp Sys: NAD CNS: Cranial Nvs; Left sided UMN Facial Nv palsy. No other
CN deficiet.; TONE:Increased in left upper and lower limbs; POWER: Left Upper 2/5; Left Lower 3/5;
Right Upper and Lower limbs: 5/5 Plantar: Extensor on left side; DTR: All Brisk on left side. No
sensory deficiet, involuntary movements,cerebellar or meningeal signs. Fundoscopy-normal CT Scan
done urgently shows hemiatrophy of right hemisphere with focal infarcts on both right and left side
corresponding to ACA & MCA territory.. We proceed to evaluate for ischemic stroke. Hematological
tests(CBC; Electrolytes etc) reveled only moderate anemia ; ECG,ECHO: NAD; Collagen Vascular
screen : Normal; Protien C & S and Antithrombin III- Not Deficient VDRL, HIV , Lactate, Pyruvate
levels- normal Urinary VMA, USG Abd, Renal Artery Doppler: all normal (for hypertension
evaluation) MRI and MR Angiography done: Reveals narrowing of distal portions of both lt. and rt.
Internal carotid artery and basilar artery with non visualisation of proximal portions of lt. Aand rt. ACA,
MCA, and PCA. Collateral vessels noted on the left side. This confirms the diagnosis of Moya Moya
Disease as evidenced by MR Angio in a case of left sided hemiplegia with ipsilateral facial nerve palsy
anh aphasia associated with severe hypertension.
NEU/25(P) A STUDY OF HYDROCEPHALUS BETWEEN AGE GROUP 0-10YRS WITH
SPECIAL REFERENCE TO AEITOLOGY AND CLINICAL FEATURE.
Joydeep Das, Swapan Mukherjee, Jayanti Chakraborty, Rajoo Thapa, Shantoo Pramanik
Institute of child health,Park circus.Kolkata-17
Objective: Hydrocephalus is a major cause of childhood disability and it is one of the common cause of
chronic illness of childhood.This study analyses clinical profile,pattern and spectrum of disease and
aeitological diagnosis of patients presented with hydrocephalus between age group0-10 yrs.
Method:This is a cross sectional randomised study of 48 pts.under 10 yrs. of age at a urban tertiary
referal center over a span of one year from September2004 to September2005. Results and analysis:Out
of 48 cases heading the list is congenital acqueductal stenosis with 12 pts(24%) followed by pyogenic ,
tubercular meningitis and hydrocephalus ex vacuo were 20%,18% & 12% respectively.5pts(10%) were
diagnosed as ICSOL & 3pts(6%) were labelled as viral meningitis.Lastly, there were 4% cases of
acqueductal stenosis with arrested hydrocephalus and one case of normal pressure hydrocephalus.
Conclusion: As this study analyses the spectrum of clinical presentation alongwith aeitological
diagnosis so it will help pediatrician and neurologist to plan a therapeutic approach and avoid further
damage to the neural tissue as well as developing brain.
NEU/26(P) A STUDY OF MUSCULAR WEAKNESS IN CHILDREN IN NORTHERN INDIA
Rahul Jain, Bibek Talukdar, Vinod Puri, Medha Tatke
Department of Pediatrics, Neurology and Pathology, Maulana Azad Medial College and Associated
G.B.Pant Hospital, New Delhi-110002
Introduction: Muscular weakness is an important pediatric problem but has not been studied well in
India. Objective: A study was planned to find the disorders causing muscular weakness in children.
Methods: Consecutive cases presenting with primary complaints of weakness of muscles of any part of
the body, within a year (between march 2004 and February 2005) were enrolled for the study. Weakness
associated with upper motor neuron diseases were excluded. All the cases were admitted and worked
up. Besides clinical evaluation, the cases were subjected to investigations that included, besides others,
estimation of serum creatine phosphokinase, serum glutamate pyruvate transaminase, serum glutamate
oxalate transaminase, electromyographic studies, nerve conduction studies and histopathological studies
of muscle biopsy specimens, as required, to confirm the diagnosis. Results: Most of the cases hailed
from Delhi and the neighboring states. 41 Cases, who met the case selection criteria, were investigated.
The etiologies found were acute flaccid paralysis 15 (36.5%), Duchenne muscular dystrophy 12
(29.26%), Becker muscular dystrophy 1 (2.44%), congenital muscular dystrophy 1 (2.44%), spinal
muscular atrophy 5 (12.19%), hereditary motor and sensory neuropathy 2 (4.87%), myasthenia gravis 1
(2.44%), glycogen storage disorder type II 1 (2.44%), congenital Bell palsy 1 (2.44%), and congenital
Erb’s palsy 1 (2.44%) and unclassified 1 (2.44%). Amongst the patients with acute flaccid paralysis, 13
(31.71%) had Guillain-Barré syndrome and 2 (4.87%) had diphtheritic polyneuropathy. Conclusion:
The study shows that Guillain-Barré syndrome dominates the acute disorders while Duchenne muscular
dystrophy the chronic disorders causing muscular weakness in children in North India.
NEU/27(O)
INCIDENCE OF CSF ELISA POSITIVITY FOR NCC IN PATIENTS
PRESENTING WITH FOCAL SEIZURES AND HAVING RING ENHANCING LESION IN
BRAIN
Suman Lata,Jacob Puliyel,Nirmal Kumar,Sona Chowdhary,Vikas Bhambhani
Department of Pediatrics,St. Stephen's Hospital,Tis Hazari, Delhi-54
BACKGROUND AND OBJECTIVES: This study is to look at the incidence of CSF-ELISA for
neurocysticercosis positivity in those who have ring – enhancing lesion on CT scan .The study was
conducted among twenty two consecutive children presenting with focal seizures to our pediatric ward.
MATERIALS AND METHODS: Twenty three patients were enrolled in the study in the age group 6
months to 12 years who presented with focal seizures. Analysis was done to look at the incidence of
ring – enhancing lesions in patients with focal seizures and to look at what percentage of patients have
CSF ELISA positivity for neurocysticercosis among patients with focal seizures and ring – enhancing
lesions. ELISA positivity was also co-related with red meat intake, literacy of parents and socioeconomic status RESULTS: In our study 60.9% children who presented with focal seizures had ring –
enhancing lesions in the brain. 38.5% of the patients who had focal seizures and ring –enhancing
lesions in the brain had CSF ELISA positivity for neurocysticercosis. CONCLUSION: CSF ELISA for
neurocysticercosis would be a helpful investigation in all children who present with focal seizures and
have ring – enhancing lesions in CT SCAN as it will help in determining the etiology and further
management of these cases.
NEU/28(P) INTERMITENT PROPHYLAXIS WITH ORAL DIAZEPAM IN FEBRILE
SEIZURE
Ajoy Kumar Sarma
Oil India Hospital, Duliajan, Assam
Aim and objective : To evaluate the effects of oral diazepam as a intermitent prophylaxis in febrile
seizure. Settings : Oil India Hospital, Duliajan, Assam Material and Methods: All children with febrile
seizure presenting at the hospital from 01/04/2003 to 31/03/2005 were considered. Diagnosis is done
by taking detail history, clinical examination, heamatological and biochemical studies and CSF analysis
(when indicated). On discharge oral diazepam was advised 0.3mg / kg /day tid for 2 days for
subsequent febrile episidoe, along with antipyretics. Results: We treated 82 patients aged between 6
months to 6 years. They have had simple or complex febrile seizures. Recurrence occurred in 22
patients (26%), none had a long lusting febrile convulsion. Transient side effects occurred in 21.95% of
the cases.Conclusion : We conclude that oral diazepam is safe and effective drug for prophylaxis of
febrile seizures when used as soon as any signs of illness appears.
NEU/29(P) IN ACHIEVING GOALS OF EARLY IDENTIFICATION AND INTERVENTION
OF CHILDREN WITH HEARING IMPAIRMENT
Mohd. Shamim Ansari, Ashok kumar Sinha
Ali yavar Jung National Institute for the hearing handicapped, K.C. Marg, Bandra (w), Mumbai400050.
Early detection and intervention of hearing loss of any degree is critical to the linguistic, social and
educational development of children with auditory deficits. The present study was conducted to
determine the ages of suspicion in children with hearing loss. The survey revealed that the average ages
of detection of hearing loss by parents is about 11.45 months, which unexpectedly lower than the
reported ages of Identification of hearing loss in Indian literature. The present study also found delay in
suspicion of hearing loss, initiation of diagnosis and fitting of amplification essential to initiate and
institute early remedial programs to facilitate development of speech and language skills in children
with hearing impairment. Surprisingly these delays are found to be attributable to the professional
failure to detect the presence of hearing loss at young age. Thus the study emphasizes that parents are at
best position to detect the hearing problem in their children, hence they can be effectively utilized as
manpower/ equal partners in achieving the goals of early identification of hearing loss. It also advocates
for imparting the sufficient training to those who are involved in the Rehabilitation of children with
hearing impairment.
NEU/30(P) INTERESTING CASES OF ATAXIA
Sharma Anita, Kalra Veena, Banerjee Bidisha, Kamate Mahesh, Kabra Madhulika
Department of Pediatrics, Division of Neurology, All India Institute of Medical Sciences, Ansari Nagar,
New Delhi 110 029
Background-Chronic or recurrent ataxia are of diverse etiologies – post infectious, paraneoplastic,
degenerative, metabolic or structural. Identification of cause is based on identifying pointers in clinical
phenotype. Three interesting prototypes cases of chronic ataxia are described. 15 Y/F Progressively
increasing difficulty in walking, frequent falls, writing, numbness feet, truncal incurving, for 2 yrs. No
cognitive decline or headache. Examination-Muscle mass & bulk normal except Wasting of small
muscles of hands & feet. Tone and Power normal. All DTRs absent, Planter B/L mute. Pain & touch
normal. Impaired position sense and vibration both LL. Romberg Sign Positive, MRI spine -spinal
atrophy. Possibility Friedrich’s Ataxia 12- year-boy presented during third episode of acute intermittent
ataxia. Present episode started two months back& was longest one. Examintion- FTT, no nystagmus or
telengectasia. Power 4/5. DTR normal upper limbs, absent lower limbs. Plantar flexor. Pain and touch
normal. Vibratory & joint position sensation impaired all limbs more in lower limbs. Romberg sign
positive. MRI normal. Recurrent Intermittent ataxia with complete recovery suggested neurometabolic
disorder. No response on motor and sensory nerve conduction.Urinary organic acids normal. Lactate /
Pyruvate (L/P) ratio was normal. Oral glucose challenge test for dysmetabolic state done. Two fold
rise in. blood lactate & pyruvate noticed. Urinary alanine by semiquantitative test positive. Reversible
metabolic cause of intermittent ataxia demonstrated. Diagnosis –Pyruvate Dehydrogenase Complex
deficiency considered. Patient put on thiamine and showed improvement within a week. 7 yr boy, one
yr h/o ataxia, falls, dropping of objects. Static symptoms. No cognitive decline, skeletal abnormality or
family history. Examination- Ambulatory with support, DTR sluggish, Sensory system normal,
Cerebellar sign +. On MRI cerebellar atrophy, lactate, ammonia, organic acid, serum cholesterol,
triglycerides normal. LDL & Apolipoprotein B low with normal Apolipoprotein A. Possibile diagnosis
Hypobetalipoproteinemia. Conclusion- Paraneoplastic related to neuroblastomas and postinfectious
were commonest.
NEU/31(O) IN VIVO EVALUATION OF NEURONAL DENSITY AND MYELINATION
CHANGES IN THE CEREBELLUM IN MALNUTRITION.
Rachna Seth, Veena Kalra , Uma Sharma, N R Jagannathan
Department of Pediatrics and NMR, All India Institute of Medical sciences,New Delhi, India
Background. Animal studies and autopsy data have shown that malnutrition is associated with
reduction in number of neurons and diminished myelination . These changes are most pronounced in the
cerebellum. We attempted to assess Cerebellar neuronal density and myelination in children with
malnutrition using magnetic resonance spectroscopy (MRS). Methodology. Children with PEM and
normal age matched healthy controls underwent Proton MRS of the cerebellum. MRS was performed
by 1.5 Tesla (Sonata, Siemens) using a CP array head coil. MRS was repeated after 3-6 months of
nutritional rehabilitation and compared with baseline spectra. Vitamin E level estimation was also done
and correlated with the level of neurometabolites IQ assessment was also done. Results. All the
patients had late onset malnutrition with onset after 2 years in majority (85%). Two patients were low
birth weight babies. The proton MRS spectra showed three major resonance peaks arising from N-acetyl
aspartate (NAA) at 2.02 ppm representing neuron density, Creatine ( Cr) and Phospho creatine (PCr) at
3.04 ppm representing energy metabolism and from Choline (Cho) and Phosphoryl choline at 3.20 ppm
representing myelination. . 72% PEM subjects had normal IQ while 22% had dull normal IQ. Head
size and development was normal in all PEM subjects. The ratios of neuromatabolites (NAA/Cr &
Cho/Cr) were comparable between the controls and PEM subjects. These ratios did not change after
nutritional rehabilitation. Conclusion: This pilot study establishes similar baseline spectra of proton
MRS in PEM subjects and age matched controls. Brain maturation occurs mostly during the first two
years of life, and proton MRS is shown to reflect this development The metabolite ratios were similar
in PEM subjects before and after nutritional rehabilitation thus reinforcing the concept of ‘brain sparing’
and proving it at the molecular level. Our data establishes that neuronal density and myelination were
not affected in PEM acquired after two years of age. This proves that brain metabolites are spared in
late onset chronic malnutrition.
NEU/32(P)
INTRAVENOUS IMMUNOGLOBULINS (IVIG) IN SEVERE GUILLIAN BARRE SYNDROME(GBS)
S.S. Dhanawade V.K. Patki , B.B.Shah
vkp31073@rediffmail.com
Aims and objective - To evaluate whether early use of IVIG can reduce need of mechanical ventilation
and mortality in patients with GBS. Material and methods -This is a retrospective analysis of 21
children with severe GBS admitted to PICU of Wanless Hospital, Miraj from Aug.2000 to Aug.2005.
All children received IVIG infusion in total dose of 2g/kg over 2 -5 days (unless death supervened). The
need for mechanical ventilation, mortality and period between maximum disability to full ambulation
were compared between the patients who were electively admitted and those who were referred late by
using Student t-test for unpaired data. Results -The age of the patients ranged from 10 months to 15 yrs
with mean of 4.5 yrs. Male to female ratio was 2.5. The children were admitted to PICU after a median
of 2 days onset of weakness (range 1-4days ). The disease progression from onset to maximum
disability was seen over a median duration of 2 days (range 1-4 days).13 children were electively
admitted whereas 8 children were transferred from other hospitals in late stages. Fourteen children
required mechanical ventilation. There was one death in children who admitted electively whereas 6
deaths in children who had been transferred late (p<0.01).Median duration of ventilation, median
duration of PICU stay and median period from maximum disability to full ambulation were (11 days ,
15 days & 60 days respectively) much higher as compared to that of elective admissions( 7 days , 9
days & 33days respectively).There was no side effect of IVIG therapy. Conclusion - Early use of IVIG
could reduce the mortality and the need of intubation and mechanical ventilation.
NEU/33(P) MYASTHENIA GRAVIS- CASE REPORT
Karuna Thapar, Abha Midha, Gaurav Dhawan
Department of Pediatrics, Govt. Medical College, Amritsar-143001
Introduction: Myasthenia gravis is a disease caused by an immune-mediated neuromuscular blockade.
There is decrease in number of available Acetyl choline receptors due to circulating receptor antibodies.
Disease is generally nonhereditary and is an autoimmune disorder. Case Report: 3 year old female child
complained of drooping of left upper eyelid, difficulty in swallowing, slight difficulty in walking for 1
year. Patient took treatment from various local practioners, took steroids, and developed hirsutism so
drugs were stopped. Patient reported in outdoor with drooping of left upper eyelid and mild dysphagia.
On examination child was healthy with normal anthropometric measurements with drooping of left
upper eyelid. Vitals were normal. Systemic examination including neurological examination was
normal. No family history. No history of diplopia. Examination of eye revealed normal visual acuity,
normal fundus examination, and normal sized pupil reacting to light. T-3, T-4 and TSH were normal.
Anti acetylcholine esterase test could not be performed due to cost factor. ANA was negative. Serum
CPK was normal. ECG was normal. Child responded to edrophonium chloride (1mg/kg). Child was
then diagnosed as a case of myasthenia gravis and put on neostigmine methylsulphate (0.4mg/kg) orally
every 4-6 hours.
NEU/34(P)
MAGNETIC RESONANCE IMAGING IN PEDIATRIC NEUROLOGICAL
DISORDERS
Mukti Sharma, Pl Prasad, Ss Nawre
Command Hospital (CC), Lucknow Cantt – 226 002
Background MRI of the brain and spinal chord is done for all kinds of neurological symptoms. We
undertook a retrospective analysis of the records of all children who underwent a MRI of the CNS at
our hospital and correlated the outcome to evaluate its utility in pediatric neurological disorders.
Patients & Methods Seventy four children underwent MRI of the brain and spinal cord between Jan 04
to Aug 05, of which half were males and mean age was 6.4 (range 1 month to 10) years. Children with
febrile seizures and trauma were excluded from the study. The clinical features, biochemical
parameters and outcome of MRI were correlated. Results Of the 28 children evaluated for seizure
disorders, nine (32%) had inflammatory granuloma, two (7%) had cerebral atrophy. Of 18 children with
congenital anomalies; meningo-myelocoele (n=4), tethered cord (n=2), spinal diastometomyelia (n=1),
sacrococcygeal mass (n=2), occipital encephalocele (n=4), hydrocephalus (n=4), congenital AV
malformation (n=1) the abnormality could be delineated well in all. Of the 12 with developmental
delay, 3 (25%) revealed effects of HIE and the rest were normal as were all 5 scans of children with
cerebral palsy. Of the five paralytic children, one with infantile hemiplegia revealed gliosis in the brain
scan, the rest were normal. All six children non-specific headache had normal brain scans Conclusions
MRI scan is a useful diagnostic tool in seizure disorders and congenital anomalies of the CNS, however
its role in children with developmental delay, cerebral palsy, paralysis and non-specific headaches is
limited.
NEU/35(O) NEURODEVLOPMENTAL OUTCOME OF NEONATAL SEIZURE IN TERM
NEONATES -9 MONTHS FOLLOW -UP STUDY
Satheesh.C.T, Rathika Shenoy, Kamalakshi Bhat, Nutan Kamath.
Kasturba Medical College, Mangalore, Karnataka – 575001
Aim: To analyze the neurodevelopmental outcome of Neonatal intensive care unit [NICU] term
graduates with seizures at 9months. Methods: Prospective study on term neonates with seizure over
period of 20months.The neurodevelopmental assessment using bayley scales of infant development
(BSID) was scheduled at every 3months. Sequelae of seizures analyzed were mortality, motor and
mental quotient<70% on BSID, microcephaly, seizure recurrence, visual and hearing impairment. EEG
was done. Results: cohort of 61term neonates with seizures were enrolled. 62.29% of cases were
followed up for 9months, there was male predominance and 28.9% were small for gestational age
(SGA) in this series. Common seizure pattern observed were Subtle and multifocal .76.3% of cases had
seizure onset in first 3days. Birth asphyxia was noted in50% of cases. Out come at 9 months: Seizures
recurrence in[31.5%] of cases, Microcephaly[ 27%], Motor delay[43.25%], Psychomotor delay[37.8%],
Visual impairment[ 27%], Hearing impairment[8.1%]. 72.7% of SGA babies had abnormal outcome.
Seizures due to hypoxic ischemic encephalopathy (HIE) stage III, inborn error of metabolism (IEM),
persistent hypoglycemia and CNS malformation had significant abnormal outcome. Majority of
neonates with poor neurological status had abnormal outcome. Other factors associated with abnormal
outcome were Myoclonic seizures, generalized tonic and presence of background EEG abnormality.
Conclusion: 1. Seizure etiology and neonatal neurological status significantly determined long term
neurodevelopmental outcome. 2. Neonates with seizures and associated co-morbid conditions require
long term follow up.
NEU/36(P) NEONATAL SEIZURES: TOWARDS A MORE PRECISE DIAGNOSIS AND ITS
IMMEDIATE OUTCOME
Maninder S. Dhaliwal, Anuj Bansal, Arun S., Raghuveera K.
Kasturba Medical College, Mangalore, Karnataka – 575001
Neonatal seizures continue to be a motive for multiple controversies: the diagnosis only by clinical
approaches, the necessity to confirm with EEG record and their treatment and control. Objective: To
establish the incidence of type of clinical neonatal seizures and their relation to the
electroencephalogram(EEG), the underlying etiology with emphasis on immediate outcome. Design: A
prospective hospital based study. Methods: All neonates with seizures admitted in Neonatal special care
unit, to the constituent hospitals of Kasturba Medical College, Mangalore were studied from Aug. 2002
to Nov. 2004. Necessary investigation including EEG were carried out and analyzed. Immediate
outcome was determined by global neonatal neurological assessment as proposed by Agustin Legido et
al. Results: 111 neonates with seizures were studied wherein majority (71%) of seizures occurred in first
two days of life. Hypoxic ischemic encephalopathy [HIE](38%), followed by infection and
hypoglycemia were the common causes. Multifocal clonic seizure type (38%) was the commonest
seizure pattern observed. Good immediate outcome was seen for focal seizures (p<.012) and
hypocalcemia while poor outcome was seen for tonic seizures (p<0.0005), interventricular hemorrhage
and HIE. Out of 111 cases, 66 EEG were recorded, 30 came abnormal. Maximum correlations between
seizure type and EEG abnormality were found for mixed type (62.5%) and multifocal clonic(59%)
seizures. Background abnormality in EEG was more common in cases of HIE (35%) and hypoglycemia
(28%). Conclusion: Thorough clinical examination with appropriate laboratory investigations which
includes EEG is essential in all cases of neonatal seizures for diagnosis, effective treatment and to
prognosticate outcome.
NEU/37(P)
NEUROCYSTICERCOSIS IN CHILDREN: CLINICAL CHARACTERISTICS
AND OUTCOME. A STUDY FROM EASTERN INDIA.
Abhijit Dutta, A.Mallick, J.K.De, D.P.Banerjee
Calcutta National Medical Collage & Hospital,Gora Chand Road, Kolkata-700014
INTRODUCTION & OBJECTIVE : Neurocysticercosis is the most common parasitic infection of the
central nervous system. Majority of patients presents with seizure. Objective of this prospective study
was to determine clinical characteristic and outcome of neurocysticercosis over a period of three years.
METHODS: We studied 58 children under 15 years with neurocysticercosis. Diagnosis based mainly on
CT scan and MRI of brain. Detailed history, seizure activity, neurological finding and respond to
therapy were noted and they were prospectively reviewed with repeat CT scan of brain at 3-month
interval over 3years. RESULTS:Among 58 childrens included in the study, 25 were male and 33 were
female. Average age of presentation was 8.5 years. Focal seizure with or without secondary
generalization was common mode of presentation. Headache was associated in 13(22.4%) children.
Ring enhancing CT scan of brain was common radiological finding and 72.4% showed perilesional
edema. Al the lesions were parenchymal and most (83%) were single and locating in the following
order: parietal-30 (51.7%), fronto-parietal-15 (25.8%), frontal-9 (15.5%) and occipitel-4 (6.8%).
Albendazole therapy given to some patients did not have any beneficial effect on seizure control. On
follow up, 72.4% of lesions disappeared, 26% get calcified and 2.3% of lesions persisted at the end of
one year. CONCLUSION: Neurocysticercosis is an important cause of convulsion in children specially
between 6-9 years and it should be considered as differential diagnosis of childhood convulsion. In the
majority of the patients the lesions disappeared spontaneously and the prognosis is good.
NEU/38(P) PAEDIATRIC CNS TUMOURS IN MADURAI
J. Balaji, D. Meikandan, P. Amutha rajeswari, M.L. Vasanthakumari, R.A. Sankarasubramanian
N. Ragavan, V.Inbasekaran
Institute of Child Health and, Research Centre And Neurosurgery, Department, Govt Rajaji Hospital,
Madurai Medical College, Madurai.
INTRODUCTION :Brain tumours are the most common solid tumours in children. It is the second
most common neoplasm of childhood. AIMS & OBJECTIVES : To find out the prevalence of
paediatric CNS tumours, to analyze clinical profile and various types. MATERIAL & METHODS : A
prospective observational study was done for suspected cases of CNS tumours admitted in our hospital
in one year (1st September 2004 to 31st August 2005) after institutional ethical clearance and with
informed consent. Post operative cases were followed up. The clinical profile and types of CNS
tumours were analysed by using simple descriptive statistics. RESULTS :Out of 6601 inpatients, 16 had
CNS tumours by clinical and Radiological diagnosis. Out of which 11 cases were operated and biopsy
proved. There is no gender variation (M:F = 8:8). Age group less than 3 years 50%, from 4 to 10 years
18.75% and above 10 years 31.25%. Clinical profile showed that head ache was present in 44%,
vomiting 63%, seizures 25%, papilledema 81%, hydrocephalus 37.5%, Motor deficit 19 %,
cerebellor signs
37.5%, cranial nerve palsy 18.75%, Meningitis like picture in 2 cases,
Neurodegenarative disorder like picture 1 and Diabetes Inspidus in 1 children. Types of CNS tumours
were medulloblastoma or PNET 43.75%, Astrocytoma 25%, craniopharyngioma18.75% and
Ependymoma 6.25%. CONCLUSIONS :Infratentorial tumours were more common. Vomiting,
Headache, papilledema were more common presenting features. The rise in incidence of paediatric
brain tumours is due to high level of suspicion and better radiological diagnostic methods.
NEU/39(O) PAROXYSMAL NON EPILEPTIC EVENTS IN CHILDHOOD
Sushma Malik, Pravin Jawale, Surekha Joshi, Sushma Save
Pediatric Neurology Clinic, Department of Pediatrics, T.N. Medical College & B.Y.L. Nair Hospital,
Mumbai.
Introduction:-Paroxysmal nonepileptic events (PNE) are frequently encountered in children and
adolescents. These episodes of movement, sensation or behavior closely mimic epileptic seizures but do
not have a neurologic origin and therefore need to be differentiated from true seizures for appropriate
management. Aims :-To determine the prevalence, demographic profile and spectrum of PNE in
childhood. Setting :–Pediatric Neurology Clinic and wards. Design:- Prospective study. Methodology:61 cases of paroxysmal nonepileptic events (PNE) were enrolled in the study over one year. Diagnosis
was primarily based on history, clinical evaluation, psychological assessment and investigations like
CBC, 2D ECHO, IQ/DQ, Tilt test, and BERA. EEG, Video EEG and neuroimaging were done to rule
out seizure disorder. All were analyzed using Chi Square test and standard error of proportion. Results:The spectrum of PNEs observed in our study were breath holding spells (BHS) (45.9%),
syncope(9.8%), pseudoseizures(6.6%), night terrors to tic disorders. On reviewing the demographic
profile, a male preponderance (1.9:1) was noted and 82 % children were below 10 years. BHS was
encountered below three years of age and 75% of pseudoseizures and 83.3% of syncope were found in
children above 10 years. Amongst all cases of PNE, 7 subjects had associated epilepsy and nearly 1/3 rd
of the cases had behavioral problems. The latter encompassed cases of aggressive behavior, temper
tantrums, stubbornness, anxiety etc. Conclusions:- In a substantial proportion, a careful history and
examination elucidates the nature of PNE. EEG &Video EEG monitoring is the key to successful and
accurate diagnosis of PNE. Differentiation from true seizures is essential to provide appropriate
psychological and psychiatric assistance.
NEU/40(O) PREDICTION OF MYOCARDIAL DYSFUNCTION IN DUCHENNE MUSCULAR
DYSTROPHY
Rachna Seth, Veena Kalra, Sandeep Seth*, Mahesh Kamte, Bidisha Banerjee.
Department of Pediatrics and *Cardiology, All India Institute of Medical Sciences, New Delhi, India
Background: Cardiac involvement occurs in 90% of DMD patients. Early detection of cardiac
involvement may permit timely therapeutic intervention with vasodilators and beta blockers. Autopsy
data has shown that the fibrosis starts in the posterior and lateral walls. Tissue Doppler imaging (TDI), a
new echocardiographic imaging technique, picks early changes in regional systolic and diastolic
function much before conventional echocardiography. Methods: Patients with DMD were evaluated
using conventional echocardiography and tissue Doppler imaging to assess left ventricular systolic and
diastolic function. The left ventricular lateral wall was specifically examined by both techniques to pick
up regional myocardial dysfunction. The tissue Doppler and echocardiographic findings were compared
with age matched controls. Results: None of the patients with muscular dystrophy had any cardiac
symptoms. 80% of the non-ambulatory patients had left ventricular dysfunction by both conventional
echocardiography and tissue Doppler imaging. Tissue Doppler evaluation of the lateral wall revealed
reduced systolic velocities (mean ± SD: 7.8 ± 1.8 cm/sec vs controls 8.6 ± 1.8cm/sec) . 45% of
ambulatory DMD patients had normal conventional echocardiographic evaluation of the lateral wall but
tissue doppler revealed latent abnormalities of systolic function (systolic velocities <8 cm/sec ,p<0.05).
In contrast, the left ventricular septum did not show any abnormalities by either conventional or tissue
dopper echocardiographic abnormalities. All the patients with abnormal tissue Doppler findings were
put on vasodilators and followed up with no worsening of cardiac function over the next one year.
Conclusions: Almost half the patients with DMD had asymptomatic cardiac involvement (lateral wall)
despite normal ejection fraction. TDI is a more sensitive tool to pick early myocardial dysfunction in
DMD and enabled initiation of drugs like Angiotensin converting enzyme inhibitors which prevented
overt LV dysfunction.
NEU/41(O) THE ROLE OF NEUROIMAGING IN EVALUATING CHILDREN WITH FIRST
AFEBRILE SEIZURES
Mritunjay Pao, Vineet Bhushan Gupta, Anil Kumar, Amita Mahajan, Praveen Khilnani, Atul Chopra
Apollo Centre for Advanced Pediatrics, Indraprastha Apollo Hospital, New Delhi
Neuroimaging is an expensive modality. Its place in the workup of child presenting with new onset
afebrile seizure is unclear. Aims & Objectives: To determine the diagnostic utility of neuroimaging in
children 1 months to 16 years of age with no prior neuropathy, presenting with the first episode of
afebrile seizures. Methods: Retrospective study. Study period: 1/01/2004 to 31/08/2005. Inclusion
criteria: 1) all children aged 1 months to 16 years presenting with first episode of afebrile seizure.
Exclusion criteria: 1) all febrile seizures, 2) recurrent seizures, 3) primary diagnosis other than seizures
e.g., trauma/meningitis etc., 4) nonseizure diagnoses, such as GER, breath-holding spells, and syncope.
Results: A total of 1214 children aged 1 month to 16 years attended the emergency and neurology OPD
of this hospital. Of these 356(29.32%) children presented with seizures, 138(38.76%) had first onset
afebrile seizures and 104(75.36%) underwent neuroimaging. Sixty four were males and 40 females. Of
these 104 children 38(36.5%) had a positive finding on neuroimaging. Thirty five (33.7%) had
inflammatory granuloma. Three children had lesions, which required intervention including a giant
aneurysm, fibrillary astrocytoma and aneurysm of the internal carotid artery. Thirty one children had
NCC (neurocysticercosis) and 4 children had tuberculoma diagnosed by neuroimaging criteria and
supported by serology. Patients with NCC presented with simple partial seizure (n=15), versive seizure
(n=4), complex partial seizure (n=3), generalized tonic clonic seizure (n=3), simple partial seizure with
secondary generalization (n=4), atonic seizure (n=2). Of the four children with tuberculoma 2 had
simple partial seizure, (1), generalized tonic clonic seizure and 1 focal with secondary generalization.
Conclusion: In comparison to published western data a significantly higher proportion of patients had
positive neuroimaging in this study. Neuroimaging should be considered in children presenting with the
first afebrile seizure in a country like India where tuberculosis and neurocysticercosis are endemic.
NEU/42(P) TOPIRAMATE AS AN ADJUNCT IN LENNOX - GASTAUT SYNDROME: A
CASE REPORT
V V Tewari, P L Prasad
Dept of Pediatrics, Military Hospital Namkum, Ranchi, Jharkhand – 834010
A 5 year old girl, presented with early childhood onset refractory seizures. She was diagnosed as
Idiopathic Lennox - Gastaut syndrome and managed with Topiramate and conventional anti epileptic
drugs. This report highlights beneficial effects of this drug combination. KEY WORDS: epileptic
encephalopathy, spike and slow waves INTRODUCTION: Lennox-Gastaut syndrome is an epileptic
encephalopathy in which the epileptiform abnormalities by themselves contribute to the progressive
disturbance in cerebral function. CASE REPORT: A 5 year old girl child presented with intractable
generalized tonic clonic and myoclonic seizures. In addition, there appeared atypical absences, loss of
previously acquired language and fine motor skills. She was managed with Sodium Valproate and
Clonazepam without much relief. Her MRI brain is normal and EEG showed recurrent bursts of spike
and slow waves. The benzodiazepine was alternated between Clonazepam and Clobazam. Topiramate
was added as an adjunct. DISCUSSION: This syndrome is considered as a prototype of a heterogenous
group of disorders referred to as the ‘epileptic encephalopathies’. The EEG characteristically shows
bursts of slow spike wave discharges (2.5 Hz or less). Sodium Valproate is the drug of choice.
Benzodiazepines are also effective. Drowsiness is associated with more seizures, as happens with
benzodiazepine usage. A combination of Sodium Valproate with benzodiazepines produces better
results than either one used alone. Topiramate has been found to be effective as an adjunct and is a safer
option. Topiramate was used intermittently with Sodium Valproate and Clonazepam or Clobazam. It
was used at a starting dose of 2 mg/kg/day and slowly increased to 6 mg/kg/day. Once there was greater
than 50% reduction in the seizure frequency, the benzodiazepine was discontinued and the child
continued on two AED’s in order to reduce benzodiazepine tolerance. Currently available data suggest
that Topiramate may have safety that is better than Lamotrigine.
NEU/43(O) SENSORY INTEGRATION THERAPY – A CENTRAL ROLE IN THE HOLISTIC
MANAGEMENT OF CHILDREN WITH CEREBRAL PALSY
Parul Valia, Vijal Oza, Spoorthy Prabhu , Unnati Desai
Krishna Developmental Centre , Baroda.
Introduction:- Children with CP have multiple sensory integration (S.I.) problems which hinder their
overall development. Aims & Objectives:- To study the extent of problems of S.I in patients with CP To
study the benefits of S.I therapy. Material & Methods:- 17 children of CP were studied over a period of
3 years (May 02 –05) for their SI problems. They were tested using the SIPT (sensory integration and
praxis tests). A questioner was also filled in by the parents & S.I. therapy was offered accordingly in
conjunction with Physio Therapy, Neuro Development Techniques, Speech Therapy & Cognitive
Stimulation SI therapy was given in the form of visual, auditory, oral, tactile stimulations & vestibular
activity. Results:- Main problems were - (children affected / improved) Distractibility (10 / 3),
Abnormal arousal (10 / 8), Altered sleep patterns (4 /0), Altered suck, swallow (6/ 4), Altered tactile
defensiveness, discrimination & localization (14/10), Altered visual response (12 / 10), Altered oral
response (6/ 4), Altered auditory response (13/ 10) Altered coordination (6/ 3), Altered proprioception
(14/ 8), Poor praxis , motar planning (9/ 7), Affected bilateral motor skills (8 / 4), Imbalance in
vestibular system , equilibrium (13/10 ) Conclusions:-1. Children with CP benefited from S.I therapy
and there was a significant decrease in their sensory problems. 2. The level of achievement in their
milestones was significantly better after giving all forms of therapy along with SI than that seen with
giving physio, cognitive, speech therapy alone. 3. Their behavioral problems were tackled in a more
efficient manner after giving SI therapy.4. They could handle their ADL (activities of daily living)
more confidently.
NEU/44(P) SPECTRUM OF CORPUS CALLOSUM DYSGENESIS
Anju Aggarwal, S.K Sethi, M.M.A Faridi .
Department of Pediatrics, University College of Medical Sciences and Guru Tegh Bahadur Hospital,
Delhi –95
Introduction: Corpus callosum dysgenesis (CCD) refers to spectrum of callosal anomalies, which range
from partial to complete absence of corpus callosum (Corpus Callosum Agenesis CCA) with an
incidence of 2-3 per 100 developmentally disabled populations. It can occur either as an isolated
malformation (isolated CCA) (49% of cases), or in association with another genetic syndrome or as a
part of telencephalic dysgenesis. We are presenting a prototype of each. Case Series: An 8-month male
child presented with features of Apert Syndrome and had corpus callosal dysgenesis that has incidence
of 27% in Apert syndrome. A 4-month male child who was initially being treated as hypocalcaemia
seizures presented with repeated seizures. On examination child had a head circumference (HC) of 38
cms (< 3rd centile) and slight developmental delay. Computed tomography revealed non lissencephalic
cortical dysplasia with CCD . Third child was a 11 month old male child who presented with repeated
right focal seizures, had a normal HC and normal development. Magnetic resonance imaging revealed
isolated corpus callosal dysgenesis. Isolated CCA appears to be related with a good prognosis ( 80%
normal outcome) .Genetic associations and prognostic factors that have implications on genetic
counseling will be discussed. Conclusion- Corpus callosal dysgenesis, a radiological diagnosis has a
wide spectrum of presentation and associations which should be considered for genetic counseling and
management.
NEU/45(P) STATUS EPILEPTICUS – A CLINICO AETIOLOGICAL PROFILE
Shalini Soi, Puneet Jairath, Kamaljeet Kaur, Baljinder Kaur, K.K.Locham
Deptt. of Pediatrics, Govt. Medical College/Rajindra Hospital, Patiala – 147001
Objectives : To assess the clinical and aetiological profile of children presenting with status epilepticus.
Methods : Period of study was 6 months from February to July 2005. Seventeen children ranging from
1-15 years of age admitted in the department of Pediatrics, Govt. Medical College, Rajindra Hospital,
Patiala were the subjects of study. Age, sex, presenting complaints, detailed history, clinical
examination and laboratory parameters were recorded in a pretested proforma. Children were
categorized into various age groups for the purpose of study. Results : Out of 17 children, 11 (64.8%)
were males and 6 (35.2%) were females. Number of children presenting in the age group of 1-5 years,
5-10 years and 10-15 years were 10 (58.85%), 5 (29.4%) and 2 (11.8%) respectively. Children
presenting with generalised seizures were 14 (82.3%), complex partial seizures 2 (17.7%) and simple
partial seizures 1 (5.9%). Number of children suffering from meningo-encephalitis were 9 (52.9%),
epilepsy 4 (23.5%), febrile seizures 1 (5.9%), neurocysticercosis 1 (5.9%), cerebral palsy 1 (5.9%) and
cerebral hemiatrophy with arachnoid cyst 1 (5.9%). 6 (35.2%) had neurological deficit, 4 (23.5%) had
features of raised intracranial tension. CSF was positive for meningitis in 8 (47.1%) of cases and 5
(29.4%) had abnormal CT scan/2-DMRI findings. 12 (76.5%) children responded to single drug therapy
while 5 (23.5%) required multiple drugs for control of seizures. Conclusions : Generalised tonic clonic
seizures are the most common type of seizures presenting with status epilepticus and the predominant
aetiology is meningoencephalitis.
NEU/46(O) SPECTRUM OF NONEPILEPTIC EVENTS IN A PEDIATRIC NEUROLOGY
CENTRE
Rekha Mittal
Command Hospital (WC)Chandimandir
Objectives: To study the spectrum of Nonepileptic events (NEEs) detected over a one year period in a
Pediatric Neurology Centre. Material and Methods: All cases diagnosed as having NEEs were included
in the study. Those children in whom the event had occurred only once were excluded from the study.
A detailed history of the events and treatment history was recorded, , clinical exam carried out and
EEGs was performed. Attempt was made to observe the event by precipitating the event by suggestion
, suggestion with injection of normal saline as being an epiletogenic agent, or by creating situations
which precipitated the events in the particular patient. Video EEG was recorded in those children where
there was a doubt about the diagnosis of NEE despite history and clinical observation of the patient.
Results: 34 cases were diagnosed to have Non epileptic events over a one year period. Of these 4 had
reported directly to the Neurology OPD, while others were referred either by Pediatricians or General
Doctors. The referred cases were given a referral diagnosis of suspected seizures in 6, seizures in 15
and uncontrolled seizures in 9 cases. 27 children (79%) were on anticonvulsants at the time of reporting.
Two neonates had benign neonatal sleep myoclonus. In the 1 month – 5 years group, breath holding
spells were commonest (8) cases followed by sleep myoclonus, while in the 5 – 12 years age group
functional seizures (4), syncopal attacks (4) and motor tics (3) were seen. Diagnosis of the nonepileptic
nature of the events could be made on the basis of history alone in 11 cases ( 32%), on clinical
observation of the event in 12 cases (35%), and on video EEG in 11 (32%). Conclusion: Breath
holding spells, sleep myoclonus, syncopal attacks and functional seizures are the common non epileptic
events that may be mistaken for seizures. Two third of the cases could be diagnosed on the basis of
history and observation of the event itself. Video EEG was useful in the remaining one third of cases.
79% were taking anticonvulsant drugs for NEEs at the time of reporting.
NEU/47(P) RADIOIMAGING IN CHILDHOOD SEIZRUES
K.K.Locham, Seema Rai, Rahul Gandhi, Ravneet Kaur, Puneet Jairath, Kamaljeet Kaur
Deptt. of Pediatrics, Govt. Medical College/Rajindra Hospital, Patiala - 147001
Objectives : To study clinico-radiological profile in childhood seizures. Methods : 50 children admitted
to the department of Pediatrics, Govt. Medical College, Rajindra Hospital, Patiala, were the subjects of
study. The age ranged from 1 to 15 years. Detailed history, physical examination and laboratory
investigations in the form of CSF examination, ESR, mantoux test, x-ray chest and CT scan findings
were recorded in the pretested proforma. Results : Out of the 50 cases, 30 (60%) were males and 20
(40%) were females. 30 (60%), 8 (16%) and 12 (24%) were in the age group 1-5, 5-10 and 10-15 years
respectively. 32 (64%) children presented with generalized seizures while 18 (36%) with partial
seizures. 20 (40%) children had meningitis. Out of 20 cases of meningitis, 7 (35%) had tubercular
meningitis and 13 (65%) had pyogenic meningitis. Neurocysticercosis was seen in 11 (22%) children.
Of the 11 cases of neurocysticercosis, 2, 4 and 5 were of age group 1-5, 5-10 and 10-15 years
respectively. All cases of neurocysticercosis presented with partial seizures. CT scan revealed
inflammatory granuloma (neurocysticercosis) in 11 (22%) cases, subdural effusion in 1 case and
infarction in 6 (12%) cases. Neurocysticercosis was seen in parietal lobe in 7 cases , one each in frontal,
temporal and occipital lobe while one case had multiple neurocysticercosis. Conclusions : Meningitis
was the predominant cause of seizures. Generalized seizures were the most common.
Neurocysticercosis was the most common CT scan finding.
NEU/48(P) RECURRENT GUILLAIN BARRE SYNDROME
Prachi Gupta ,Sujata, D.K. Taneja
Department of Pediatrics, Safdarjung Hospital, New Delhi
Recurrent G.B.S IS A RARE CONDITION and there is paucity of clinical and neurophysiological
studies.We report a case of recurrent episode of G.B.S.in a 11 year old boy.Though the history and
physical examination was similar to the initial attack,the severity of illness was much more this time. A
11 year old boy , diagnosed 3months back as a case of Acute Inflammatory Demyelinating Neuropathy
on the basis of electrophysiological studies and cerebrospinal fluid analysis, given I.V.Immunoglobulin
for 5 days and discharged with complete recovery presented again with similar complaints of sudden
onset ,bilaterally equal , symmetrical , ascending and progressively increasing weakness involving the
lower limbs, trunk and upper limbs,with no features suggestive of bladder,bowel, respiratory, cranial
nerve,autonomic or sensory involvement. On examination child was conscious ,oriented with stable
vitals. Motor examinatin revealed decreased power in both upper and lower limbs(3/5) , with
generalized hypotonia and areflexia, with no sensory involvement and no meningeal signs. The routine
investigations were within normal limits.CSF analysis revealed albuminocytological
dissosciaton.Electrophysiological studies were suggestive of severe demyelination with axonal
neuropathy. The patient was started on I.V.Immunoglobulin again.However the power continued to
worsen,and the patient developed sensory and respiratory involvement by the 10th day of illness.He was
put on ventilator.As the recovery began , he was weaned off in 7days.The patient improved gradually
such that by the beginning of 3rd week he had power of 4/5 with sluggish reflexes and stepping gait.The
patient was discharged with complete motor recovery.
NEU/49(O) USE OF CLOBAZAM FOR THE TREATMENT OF REFRACTORY EPILEPSY
IN CHILDREN
Sheffali Gulati, Lokesh Guglani, Mahesh Maheshwari, Amandeep Salhotra, Veena Kalra
Associate Professor, Child Neurology Division, Department of Pediatrics, All India Institute of Medical
Sciences, New Delhi
Clobazam is a 1,5 benzodiazepine whose anti-epileptic properties have been shown to be more potent
than the “conventional” AEDs. The present study was conducted to evaluate the seizure control with
Clobazam being used as an add-on drug for refractory epilepsy in children and to assess the safety
profile. Materials and methods: Conducted at Pediatric Neurology Clinic, All India Institute of Medical
Sciences, New Delhi. Children with refractory epilepsy, which was uncontrolled with two standard antiepileptic drugs at maximum doses were enrolled. Ninety two children with refractory epilepsy were
started on Clobazam and followed up to 1 year with assessment of seizure control, development of
tolerance or side-effects. Results: A total of 92 children (64 males, 28 females), with ages ranging from
2 months to 22 years, with a mean age at onset of seizures being 23.6 months (range 0-143 months)
were enrolled. The average dose of Clobazam was 0.7mg/kg (range: 0.2-2.0mg/kg) and mean duration
of administration was 15.3 months (median 12 months). The drug had to be withdrawn in 4 (4.3%) due
to severe side effects. Side effects were observed in 23 children (25% cases), with majority
experiencing sedation and lethargy (20.7%), headache and stuttering (2.2%), behavioral problems,
unsteadiness and speech disturbances (1.1% each). Tolerance was noted in 6 cases (6.5%). The overall
response to the drug showed no seizures in 39 (42.4%) cases, partially controlled in 30 (32.6%),
uncontrolled in 20 (21.7%) cases. Conclusions: Thus Clobazam is effective as an add-on drug for
refractory epilepsy in children.
NEU/50(P) INFECTIVE VASCULITIS – THE MAJOR CAUSE OF STROKE IN CHILDREN.
Navaneetha S., Piyush Chandel., Ankur Vikas Bopche, Mahendra Jain, Jyotsna Shrivastava, G.S. Patel,
Rashmi Dwivedi.
Department of Paediatrics, Kamla Nehru Hospital, Gandhi Medical College, Bhopal.
Pediatric stroke has a different etiological and epidemiological profile compared to adults. Objective :
To study the epidemiology and etiology of pediatric stroke in a tertiary care center in Central India.
Material and Methods : All children presenting to the emergency room, Kamla Nehru Hospital, Gandhi
Medical College, Bhopal over a period of 2 years from August 2003 to August 2005 with sudden onset
of neurologic deficit were included in the study and evaluated as to the cause. After a thorough history
and clinical examination, they were subjected to a CT Scan Head and/or lumbar puncture and further
work up as necessary. Result : Of the total 57 cases, multiple infarcts including micro infarcts from
vasculitis associated with meningitis, mainly tubercular 37 (65%) and pyogenic 11 (19%) turned out to
be the major etiologies. Other causes included tuberculoma 4 (7%) Arteriovenous malformation 2 (4%);
Thrombocytopenia causing intracerebral haemorrhage 2 (4%) (1 Aplastic Anemia; 1 ALL) sickle cell
anemia 1 (2%) and SLE 1 (2%). 28% (16) of the cases were <1 year old; 20 (46%) 1-5 year old, and 15
were >5 year old (26%). Majority of the pyogenic meningitis cases 6 (55%) belonged to the 1 month – 1
year age group; 3 (27%) to the 1-5 year age group and 2 (18%) belonged to >5 year age group. Majority
of TB meningitis cases 20 (54%) belonged to the 1-5 year age group; 9 (24%) belonged to the 1 month1 year age group and 8 (22%) belonged to the >5 year age group. The mortality rates were 9% in
pyogenic meningitis 11% in TB meningitis; 50% in brain abscess and 100% in intracranial
haemorrhage. Conclusions : The bulk of neurologic morbidity and mortality are due to infective causes
and hence early and prompt institution of therapy can prevent mortality and long term morbidity.
NEU/51(O)
CLINICAL STUDY ON USEFULLNESS OF CYCLICAL SEDATION IN
CHILDHOOD TETANUS
M.Veera Shankar, Gopala Krishna Shanbhag.B.V, Yatheesha B.L, Srinivas.V, Champakamalini.S
Dept. of Pediatrics, VIMS, Bellary.
INTRODUCTION: Tetanus is an important endemic disease in India. It is an acute disease induced by
exotoxin of CI. tetani, which is ubiquitous organism, so it can contaminate wounds easily. Clinically it
is characterized by muscular rigidity which persists throughout the illness, punctuated by painful
paroxysmal spasms of voluntary muscles. Mortality tends to be very high from 40 to 80 percent.
OBJECTIVE: To study the clinical profile and outcome of tetanus with respect to cyclical sedation
management. DESIGN: Prospective hospital based study of tetanus from August – 2002 to July – 2005.
SETTING: DISTRICT HOSPITAL, DEPARTMENT OF PEDIATRICS, VIMS, BELLARY.
METHODS: Children with clinical diagnosis of Tetanus admitted during study period are isolated and
clinical profile including age, sex, residence, vaccine status. Source of infection, onset of symptoms,
duration of cyclical sedation required and duration of hospital stay are noted. Cyclical sedation included
appropriate doses of IV injections of Phenobarbitone, Promethazine, Chlorpromazine and Diazepam.
RESULTS: Total number of Children during study period were 41 cases. 39 (95.12%) children were
below 10 years of age. Male to Female ratio was 1.05:1. Rural to Urban ratio was 3.1:1 (31:10). Source
of infection was traumatic in 46.34% (19 cases), otogenic in 17.7% (7 cases), unknown in 36.58% (15
cases). Unimmunized or incomplete immunization was present in all cases. Common presenting
symptom was lock jaw; with mean duration of symptoms of 4 days. Mean duration of cyclical sedation
was 16 days with mortality of 31.70% (13 cases), maximum mortality was noticed during 48-72 hours;
common cause of death was aspiration pneumonia due to uncontrolled spasms. CONCLUSION:
Mortality in our hospital was 31.70% (13 cases). Cyclical sedation is effective in preventing death from
tetanus to the extent of 68.3% (27 cases) children in our hospital. Since tetanus is a vaccine preventable
disease, immunization and health education has to be taken up in a massive scale to reduce the case
incidence.
NEU/52(P)
RAPIDLY PROGRESSIVE ATYPICAL NEUROCYTOMA OF THE SPINAL
CORD
Neeraj Awasthy, Avninder Singh, Karam Chand, Premila Paul
Department of pediatrics, neurosurgery (safdarjung Hospital). Department of pathology(institute of
pathology , ICMR)
Extraventricular neurocytomas are a well established entity. non-classical sites like cerebellum, pons
and spinal cord parenchyma have been occasionally reported. we report a case of intramedullary
neurocytoma at D2-D8 levels of the thoracic cord in an 8 yr -old boy who presented with Para paresis
and paraesthesia. The pt underwent subtotal resection. the case is noteworthy not only for its rare site
but also for atypical histopathological features like vascular endothelial proliferation mitosis and focal
necrosis and high nuclear proliferation index MIB-1.the case highlights the significance of atypical
histology , high MIB-1 and the importance of gross total resection and post op radiotherapy
NEU/53 (P) PROFILE OF ACUTE BACTERIAL MENINGITIS IN NEONATES AND YOUNG
INFANTS
Bakulesh Chauhan, Ruby Chander, Niranjan Shendurnikar, Charu Agarwal, Bithika Duttaroy
Departments of Pediatrics & Microbiology, Govt. Medical College, Baroda - 390001
Introduction: Acute Bacterial Meningitis (ABM) is one of the serious infections associated with acute
complications, mortality and risk of neurological sequelae. Objectives: The aims of present study were
to evaluate the etiology and outcome of ABM and to study the antibiotic sensitivity of organisms
responsible for ABM. Methods: The prospective study was conducted in children aged 0 to 3 months of
age admitted with a clinical diagnosis of ABM. The diagnosis of ABM was established by suggestive
CSF microscopy, biochemistry, Gram Stain and CSF culture. All the babies were treated with
intravenous antibiotics for a minimum period of fourteen days. Results: The study included 75 neonates
and young infants admitted to NICU/PICU with a clinical diagnosis of ABM. The most commonly
observed symptoms were fever, seizures and refusal to feed. CSF culture grew organisms in 28 out of
75 cases and these included Klebsiella, S.pneumoniae, E.coli, S.aureus, Coagulase Negative S.aureus
and acinetobacter. Positive and Negative Predictive Values of CSF-CRP was 45.4 % and 74.2 %
respectively. Antibiotic sensitivity showed that 50 % of the organisms were resistant to commonly used
antibiotics and none were sensitive to ampicillin. The mortality was 33.3%. Conclusions: ABM remains
a common illness in developing countries contributing to high mortality. The microorganisms show
high resistance to commonly used antibiotics used in the treatment of ABM.