Role of neuroimaging in children with first unprovoked seizure: A prospective observational study

OBJECTIVE

To evaluate the incidence and type of neuroimaging abnormalities in first unprovoked seizure (FUS) in children. To investigate the association of neuroimaging abnormalities with clinical variables.

METHODS

A prospective observational study enrolled children aged 6 months-14 years with FUS over one year at a tertiary-care teaching hospital, Northern India and subjected them to neuroimaging. Factors associated with abnormal neuroimaging were assessed using Chi square/Fischer Exact test.

RESULTS

Out of 115 cases, 40 (34.8%) had abnormal neuroimaging. Frequent findings were inflammatory granuloma (70%) including Neurocysticercosis (NCC) (40%), ill-defined granuloma, calcified nodule and tuberculoma followed by white matter signal alterations. Inflammatory granuloma was significantly associated with age >2 years and focal seizures. Calcified nodule was more common in children >10 years. Other neuro-abnormalities like cerebral atrophy, gliosis, infarcts, and white matter changes were significantly prevalent with generalized seizures, perinatal asphyxia, and developmental delay.

CONCLUSION

High prevalence of abnormalities in FUS, especially focal seizures, due to NCC warrants neuroimaging in all children with FUS in India.

Clinical Profile and Predictors of Mechanical Ventilation in Guillain-Barre Syndrome in North Indian Children

OBJECTIVE

To describe the clinical-laboratory profile of pediatric Guillain-Barre syndrome and delineate features associated with need of mechanical ventilation.

METHODS

In a prospective observational study at tertiary care hospital, clinical-laboratory assessment and nerve conduction studies were documented in consecutive children hospitalized with Guillain-Barre syndrome according to Brighton criteria. Clinical-laboratory features were compared between ventilated and nonventilated patients using univariate and multivariate analysis.

RESULTS

Forty-six children (27 boys) with a mean age of 69.1±35.2 months were enrolled. History of preceding infection was present in 47.8%, bulbar palsy in 43.5%, feeble voice in 41.3%, sensory involvement in 13%, and autonomic involvement in 39.5%. Tetraparesis was noted in 87% of cases. Hughes disability scale >3 was noted in 44 children at admission and 39 (84.7%) at discharge. The most common electrophysiological type was acute motor axonal neuropathy (46.5%) followed by acute motor sensory axonal neuropathy (39.5%), acute inflammatory demyelinating polyneuropathy (7%), and inexcitable nerves (7%). Nine (19.7%) children were ventilated, 3 (6.5%) died or were lost, and 43 were discharged. Factors associated with need of mechanical ventilation on univariate analysis were older age, hypertension, bulbar palsy, feeble voice, lower Medical Research Council (MRC) sum, raised total leucocyte count, and history of preceding infection. Logistic regression revealed older age, history of predisposing illness, lower MRC sum at presentation, and bulbar palsy as independent predictors of mechanical ventilation.

CONCLUSIONS

The most common electrophysiological subtype in northern Indian children is acute motor axonal neuropathy. Older age, preceding infection, low MRC sum, and bulbar palsy are predictors of mechanical ventilation in pediatric Guillain-Barre syndrome.

Epidemiology and outcome of pediatric in-hospital cardiopulmonary resuscitation in Northern India

Data regarding in-hospital pediatric cardiopulmonary resuscitation (CPR) are limited because of retrospective study designs and inconsistent definitions. There are no Indian studies on pediatric CPR. Accordingly, we conducted this retrospective study to determine the outcome of in-hospital CPR and assess which variables predict outcome. Consecutive in-hospital CPR events in children aged 1-mo to 14-yr during a 1 yr period were described prospectively using Utstein guidelines. Variables affecting outcome were evaluated by univariate and multivariate analysis. A total of 427 patients were enrolled and received CPR. The indication for CPR was primary respiratory failure in 213 (50%) and clinical cardiac arrest in 191 (44%). The most common underlying etiology was neurological illness (26%). Sustained return of spontaneous circulation was attained in 112 (26%). Fifty-three (12%) patients were alive at 24 h, of which only 8 (1.87%) were alive at discharge. Of those patients who survived to discharge, all were alive after 6 mo. Multivariate logistic regression analysis showed that CPR during night hours (adjusted odds ratio [aOR]: 3.73), CPR of more than 10 min duration (aOR: 27.04) and cardiac arrest as an indication of CPR (aOR: 2.56) were independently associated with poor immediate outcome. Factors associated with death within 24 h were CPR during night hours (aOR: 3.17), age > 1 yr (aOR: 5.52) and cardiac arrest (aOR: 4.93). Good neurological outcome was found in seven out of eight (87.5%) patients at follow up. We conclude that pediatric cardiac arrest in a tertiary hospital in India has a poor outcome even after survival beyond 24 h; however, neurological outcome is generally good among survivors.