A Study of 50 cases of Focal Seizures with CT Scan Correlation

Sivakumar, D K (2011) A Study of 50 cases of Focal Seizures with CT Scan Correlation. Masters thesis, Coimbatore Medical College, Coimbatore.

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Abstract

INTRODUCTION : Epilepsy has been important medical problem of Mankind since ancient times. About 3000 years ago a secondarily generalized major seizure was fully described in Akkadian, the oldest written language, written in Mesopatomia. Epileptic seizures continue to cause significant morbidity even in this computer age and our understanding of its etiology, pathophysiology and management is still in its infancy. Hippocrates first extensively studied epilepsy. His monograph “On the sacred diseases” stated a basic fact about epilepsy- that it originates in the brain. Unfortunately for many centers superstition and ignorance prevailed over rational inquiry. In fact in India, Epilepsy is still considered a mental disorder and legislation continues to reflect this view. Julius Caesar, Alexander the Great and Napoleon Bonaparte are a few of the famous personalities who are said to have suffered from this disorder. From the patient’s point of view, the diagnosis of epilepsy has farreaching implications in his personal as well as social life. If even leads to unemployment. Hughling Jackson was the first to classify seizures into generalized and focal (partial) in the year 1870. This classification still holds its place in the clinical description of epilepsy and in its management. International league against epilepsy, classifies epileptic seizures broadly into I - Partial ( focal, local) seizures, II - Generalized seizures, III - Unclassified seizure. With sub division under each categories Partial seizures are those in which in general the first clinical and Electroencephalographic changes indicate initial activation of a system of Neurons limited to part of one cerebral hemisphere. AIM OF THE STUDY : 1. To study the age and sex distribution of Focal seizures. 2. To study the etiological factors responsible for Focal seizures 3. To study the value of CT Scan of the brain in the diagnosis of the etiology of Focal seizures. 4. To study the correlation between clinical features and CT Scan findings. MATERIALS AND METHODS : This study was carried out in the Department of Medicine and Department of Neurology, Coimbatore Medical College Hospital, Coimbatore Inclusion Criteria: Total of 50 patients who were admitted with history of focal seizure or attending Neurology OPD were included in this study. Exclusion Criteria: Patients with a history of recent head injury and those who were admitted in the surgical ward of the hospital were excluded. Study Period: From April 2009 to September 2010. Type of Study: Descriptive Study. Detailed history was elicited (Both from the patient and his/her intelligent attender) and clinical examination was carried out to ensure the organic nature of epilepsy. A proforma formulated by the Post graduate and accepted by the Professor of Medicine was used to collect the data –Proforma enclosed. All the EEGs were critically analyzed for the presence of focal, localized or generalized changes by montage wise analysis.Individual abnormalities were recorded in the proforma . CT scan brain plain and contrast axial section with routine slice thickness was performed in all cases. Radiologist opinion obtained. Abnormalities noted. Finally the data was analyzed combining the clinical EEG and CT scan brain findings and conclusion arrived. SUMMARY : 1. Sex Incidence of Partial seizures are nearly equal with slight male preponderance. 2. The highest incidence in the age group of 10-19 years(26%) 3. 74% of patients with partial seizures showed lesions on CT scan. 4. Patients with postictal deficit have more chance of structural lesion.This study has shown 20 out of 23 patients who has postictal clinical signs or deficit had abnormal CT brain (87%). 5. Incidence of structural lesion in CT brain is more in patients who has an abnormal EEG, more so if EEG has lateralizing abnormality (82.35%). 6. Contrast enhancings granuloma was the most common cause for partial seizure (40%),particularly Tuberculoma of the brain was the most commonest cause, present in 34 %of patient, followed by CVA (12%).The most common age group in which tuberculoma was detected is 10-19 years. 7. Contrast enhancing granuloma were predominantly situated In the parietal lobe. Parietal lobe lesions were the most common cause of partial seizure. 8. EEG was most often abnormal in patients with contrast Enhancing granuloma (55%) when compared to other lesions(45%). In 2 patients physical examination, CT Scan, EEG and other investigations did not reveal a causative factor. These should be further evaluated with MRI to rule out significant brain abnormalities and detect treatable causes if any. CONCLUSIONS : It can be concluded that the probability of detecting a structural brain abnormality, treatable or otherwise, is very high .In patients with partial seizures, CT scan is indicated in all cases of partial seizures. Though newer imaging modalities like MRI may be more specific and sensitive, given the socioeconomic setup of our country ,CT scan still remains the most valuable tool in making etiological diagnosis of partial seizures.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Focal Seizures ; CT Scan Correlation ; 50 cases.
Subjects: MEDICAL > General Medicine
Depositing User: Subramani R
Date Deposited: 17 Feb 2018 21:37
Last Modified: 17 Feb 2018 21:37
URI: http://repository-tnmgrmu.ac.in/id/eprint/5856

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