Study of EEG and CT Scan in Neurologically Normal Cases of Focal Convulsions

Twenty-three neurologically normal children with focal convulsions were studied with EEG and CT scan. Thirty-five per cent had an abnormal CT scan. Lesions of potential therapeutic significance were seen in 30 per cent of all scans. Abnormalities detected on CT scans were as follows: tuberculomas, five cases; acute infarct, one case; gliosis, one case; multiple cortical cysts, one case. All the cases with intracranial tuberculomas were aged more than 5 years. A good correlation was found between the EEG and the CT scan findings. Maximum percentage (57 per cent) of CT scan abnormality was seen in cases exhibiting focal abnormality on EEG and minimum percentage in those with a normal EEG (18 per cent).     

Electroencephalographic correlation of clinical,radioisotopic brain scan,CT scan and postmortem diagnosis

Fifty three cases of different neurological disorders were studied in children and EEG correlation was done with clinical findings, RI brain scan, CT scan, carotid angiography, postmortem and operative findings. EEG was abnormal in 36/53 cases (67·92%), CT scan in 28/35 cases (80%), RI brain scan in 17/21 cases (80·95%), carotid angiography in 3/3 cases (100%) and postmortem and operative procedures were helpful in 10 cases. Out of 35 cases of CT scan, good EEG CT scan correlation was observed in 16 cases (45·71%) (including 3 cases of idiopathic epilepsy) and in 9 cases (25·71%), although the EEGs were abnormal, they did not correlate well with the abnormality revealed in CT scan. In the remaining 10 cases (28·57%), there was poor EEG CT scan correlation. Out of 21 cases of RI brain scan, good RI brain scan EEG correlation was observed in 17 cases (81%) and poor correlation in remaining 4 cases (19%). Carotid angiographic and EEG correlation in all 3 cases (100%); postmortem EEG correlation in 2/2 cases (100%) and operative procedures EEG correlation in 6/8 cases (75%). In 2 cases of infratentorial space occupying lesions EEG was normal. It is concluded that EEG is a fairly useful, noninvasive investigation in various neurological disorders in children.     

Electroencephalographic correlation of clinical, radioisotopic brain scan, CT scan and postmortem diagnosis

Fifty three cases of different neurological disorders were studied in children and EEG correlation was done with clinical findings, RI brain scan, CT scan, carotid angiography, postmortem and operative findings. EEG was abnormal in 36/53 cases (67·92%), CT scan in 28/35 cases (80%), RI brain scan in 17/21 cases (80·95%), carotid angiography in 3/3 cases (100%) and postmortem and operative procedures were helpful in 10 cases. Out of 35 cases of CT scan, good EEG CT scan correlation was observed in 16 cases (45·71%) (including 3 cases of idiopathic epilepsy) and in 9 cases (25·71%), although the EEGs were abnormal, they did not correlate well with the abnormality revealed in CT scan. In the remaining 10 cases (28·57%), there was poor EEG CT scan correlation. Out of 21 cases of RI brain scan, good RI brain scan EEG correlation was observed in 17 cases (81%) and poor correlation in remaining 4 cases (19%). Carotid angiographic and EEG correlation in all 3 cases (100%); postmortem EEG correlation in 2/2 cases (100%) and operative procedures EEG correlation in 6/8 cases (75%). In 2 cases of infratentorial space occupying lesions EEG was normal. It is concluded that EEG is a fairly useful, noninvasive investigation in various neurological disorders in children.     

小儿病毒性脑炎(偏瘫型)50例脑电图及影像学改变

本文对５０例病毒笥脑炎（偏瘫型）结合脑电图（ＥＥＧ）、头颅ＣＴ及ＭＲＩ结果分析,资料显示：ＥＥＧ检查５０例,异常４９例,头颅ＣＴ检查４２例,异常２６例,ＭＲＩ检查８例,全部异常。结果表明：ＥＥＧ确是监测脑功能变化及病理变化最敏感的指标,可作为脑内病变转归的客观依据,而ＣＴ、ＭＲＩ等影像学检查对病脑（偏瘫型）的病理解剖形态的显示则是重要的辅助诊断手段。     

One vs. two years of anti-epileptic therapy in children with single small enhancing CT lesions

The duration of anti-epileptic drug (AED) therapy in children with seizures due to single small enhancing CT lesions (SSECTL) is controversial. We sought to determine whether there is any difference in the rate of seizure recurrence after 1 vs. 2 years of AED therapy and to identify the factors predictive of seizure recurrence. A total of 115 consecutive children with seizures and SSECTL were randomly assigned to two groups. Group A received AED(s) for 1 year and Group B for 2 years seizure-free interval. CT scan and EEG were done prior to AED withdrawal and children were followed-up for seizure recurrence for at least 1 year. Association between seizure recurrence and clinical and CT characteristics was analysed. Groups A and B consisted of 55 and 51 children, respectively (nine were lost to follow-up). There were 61 boys and 45 girls; mean age 9.33 years. Most (93 per cent) had focal seizures: 36 per cent complex partial, 22 per cent simple partial, 35 per cent partial with secondary generalization; 21 per cent had status epilepticus. The two groups were comparable in clinical, EEG and CT characteristics. CT scan and EEG prior to AED withdrawal were abnormal in 44 per cent and 33 per cent respectively. Six children, three from each group had seizure recurrence. Significant association was found between seizure recurrence and abnormal CT (persistence/calcification of lesion) and abnormal EEG prior to AED withdrawal (p < 0.01). The relative risk of seizure recurrence in a child with abnormal CT and EEG prior to AED withdrawal was 26.2 (95 per cent confidence interval 3.3-210.2, p = 0.0003). No association was found between seizure recurrence and any of the other variables. There was no difference in seizure recurrence after 1 vs. 2 years of AED therapy. Combination of persistent/calcified CT lesion and abnormal EEG prior to AED withdrawal was the best predictor of seizure recurrence.     

脑性瘫痪患儿150例血清TORCH抗体检测的意义

目的分析150例脑性瘫痪(脑瘫)患儿的TORCH抗体检测结果,为防治提供依据。方法对150例1个月~3岁脑瘫患儿采用间接酶联免疫吸附方法进行TORCH-IgG检测,1~6个月患儿同时检测TORCH-IgM。分析比较阳性与阴性患儿间的高危因素、脑瘫分型、并发症、头颅CT、脑干听觉诱发电位、眼底检查、脑电图等情况。结果共检测出TORCH-IgG阳性患儿58例(阳性率38.58%);阳性中以巨细胞病毒(CMV)为最常见,其次为弓形体(TOX);母子TORCH阳性符合率达85.71%。高危因素中阳性患儿以窒息、早产、黄疸、低体质量为多见,阴性患儿以窒息、早产、颅内出血为主。脑瘫分型在阳性患儿以痉挛型四肢瘫和偏瘫多见,而阴性患儿以痉挛性双瘫和偏瘫为多见。阳性患儿并发症较阴性患儿多,尤以智力低下为最明显。阳性患儿的头颅CT、脑干听觉诱发电位、眼底检查、脑电图异常率明显较阴性患儿高。结论TORCH感染是婴幼儿脑瘫的重要病因之一,对孕妇、新生儿及婴幼儿常规进行TORCH抗体检测是防治脑瘫发生的重要措施之一。     

Tuberculous meningitis in children

Summary Ninety cases of tuberculous meningitis have been analysed with special reference to some prognostic factors such as the age of the patient, duration of symptoms before treatment, C.S.F. picture and type of treatment. 78·8 per cent. of cases were males and 84·4 per cent. below the age of 5 years. The peak incidence was below 3 years, 21·1 per cent. of cases occurring below the age of 1 year, the youngest patient being 4 months old. History of contact could be obtained in 27·78 per cent. of cases. X-Ray chest showed evidence of intrathoracic tuberculous foci in 74·4 per cent. of cases, with miliary lesions in 15·5 per cent., hilar lymphadenopathy in 33·3 per cent., bronchopneumonic infiltration in 21·1 per cent., fibrosis in 3·3 per cent. and thickened pleura in 1·1 per cent. of cases. Out of 90 cases, 35 expired, another 35 left the hospital in an unsatisfactory state, and only 20 cases recovered, giving a satisfactory response in 22·2 per cent. of cases. The combined figures for mortality and unsatisfactory results were 82·9 per cent., 77·2 per cent. and 64·3 per cent. between the age groups 0 to 2, 2 to 5 and above 5 years respectively. 84·2 per cent. of cases with coma and/or fits either proved fatal or had severe neurological sequelae. Low cerebrospinal fluid sugar and chlorides and raised proteins affected the prognosis adversely. Treatment under “Category I, II and III” showed satisfactory response in 29·3, 50 and 11·65 per cent. of cases respectively. Steroid therapy did not seem to favourably influence the results in cases picked up at random. From the Department of Pediatrics, Medical College, Amritsar     

Ventriculitis complicating pyogenic meningitis in neonates

Ventriculitis, was diagnosed in 17 cases of neonatal bacterial meningitis by positive culture and/or leucocytosis of ventricular fluid. Majority of the patients were female (14) and 13 were preterm. Maternal and/or obstetric complications were present in 82 per cent. Mean age of diagnosis of meningitis was 7·7±5·1 days. In all patients blood and CSF cultures were identical: E. coli (11), group B streptococcus (3), citrobacter-enterobacter (2) and pseudomonas (1). Six received systemic therapy and 11 were administered combined systemic and intraventricular therapy. Overall mortality rate was 23·5 per cent and eight of the 13 survivors were abnormal on follow up. Outcome was related to the duration to render the CSF sterile and to the interval between the diagnosis of meningitis and ventriculitis. The mortality was significantly lower in patients treated with combined systemic and intraventricular therapy.     

Acute respiratory tract infections in Indian children with special reference to Mycoplasma pneumoniae

A total of 70 Indian children of either sex and under 5 years of age who were admitted to the All India Institute of Medical Sciences, New Delhi during a 1-year period (January 1994-December 1994) with complaints suggestive of acute respiratory tract infections (ARTI), were investigated for bacterial aetiology of infection with special reference to Mycoplasma pneumoniae. Microbial aetiology could be established in 44/70 (62.8 per cent) of cases of ARTI. Mycoplasma pneumoniae infection was seen in 21/70 (30 per cent), aerobic bacteria in 14/70 (20 per cent), Chlamydia pneumoniae in 2/70 (2.8 per cent), and mixed infection with mycoplasma either with bacteria and/or chlamydia in 7/70 (10 per cent). However, in 26/70 (37.1 per cent) cases no cause could be detected. Diagnosis of infection with M.pneumoniae was based on culture in 2/20 (10 per cent) cases, antigen detection in throat swab by indirect immunofluorescence assay using specific antibody in 16/70 (22.8 per cent) cases, and demonstration of IgM antibody in serum by serodia Myco II particle agglutination test in 17/70 (24.2 per cent). Streptococcus pneumoniae (9/70, 12.8 per cent) and Staphylococcus aureus (5/70, 7.1 per cent) were the aerobic isolates from blood in these patients. Results of this study indicate that M.pneumoniae plays a significant role in respiratory tract infection in an Indian paediatric population. Rapid diagnostic procedures, such as antigen detection and IgM antibody demonstration, should be used more widely to determine the infective aetiology early in the course of illness. The study also highlights the mixed aetiology in ARTI in children, which has important therapeutic implications.     

Foreign bodies in the tracheo-broncheal tree in children: diagnostic problems and management

Over a 7 year period 296 children with foreign body aspiration into tracheo broncheal tree were studied. Seventy seven per cent of them were in the age group of one to five years. In 80·8% of the children, the onset of clinical symptoms were strongly suggestive of foreign body aspiration, although the history of foreign body ingestion was forthcoming only in 33·8% cases. Associated complications like bronchiectasis, segmental atelectasis with or without consolidation, pneumonitis and surgical emphysema were seen in 18·9% of them. Bronchoscopy was successful in all the cases. Post bronchoscopic complication was negligible. Three children needed segmental resection in view of the persistence of bronchiectatic changes in the affected segment of the lung.     

Paralytic poliomyelitis in slums of Bombay

Under six children (15,165) in a slum population of 98,453 were surveyed for lameness due to paralytic poliomyelitis. Higher incidence of paralysis was found in girls (male to female ratio 1∶1·48). Peak age of onset of paralysis was between 6 months to 11/2 years. About 2/3rd 65·9 per cent children with paralysis did not receive any vaccination before the development of paralysis, 14·6 per cent received all three doses of OPV, 11 per cent had received 2 doses and 8·5 per cent received one dose; 9·8 per cent developed provocative paralysis following DPT amd 78·2 per cent had received injections for symptoms of prodromal period; 37·8 per cent paralytic children were not hospitalized. Immunization coverage of child population was good though not 100 per cent. Yearwise immunization coverage and incidence of paralysis and impact of migrating population are discussed.     

Enteropathogenic E. coli in infantile diarrhea in a rural area

A total of 54 (27·55 per cent) enteropathogenic E. coli (EPEC) were isolated from 260 cases of infantile diarrhea with preponderance of serotype 055 (27 strains), followed by 0127 (13 strains), 0124 (11 strains) and 020 (three strains). Other EPEC serotypes were not isolated.     

EnteropathogenicE. coli in infantile diarrhea in a rural area

A total of 54 (27·55 per cent) enteropathogenic E. coli (EPEC) were isolated from 260 cases of infantile diarrhea with preponderance of serotype 055 (27 strains), followed by 0127 (13 strains), 0124 (11 strains) and 020 (three strains). Other EPEC serotypes were not isolated.     

Late Electroencephalographic Findings after Recovery from Tuberculous Meningitis

Eighty five children and young persons cured of tuberculous meningitis were reexamined by EEG 6—12 1/2 years after the onset of the disease.
Moderate or severe EEG changes were seen in 50 cases, i.e. 59 per cent. The most frequent abnormality found was general dysrhythmia (29 cases) combined with focal abnormalities in 9 cases. Focal abnormalities were seen in the records of altogether 14 former patients. Of these, 9 had convulsions. Repeated EEG examinations were made in 15 cases. Seven of these showed improvement and 1 progression of the disturbances. Abnormal EEGs were seen most frequently among the youngest patients (0—3 years), among patients with severe symptoms on admission and among patients treated with cortisone.
Correlation was also found between EEG changes and other sequelae: convulsions, neurological disorders, mental sub-normality, behaviour disturbances and intracranial calcifications. There were no correlations between EEG abnormalities and late ophthalmological and otological sequelae.     

Morbidity and mortality in diarrhea in rural Haryana

Five thousand children under 6 years of age from 69 villages in Haryana were followed up for 2 years to assess the extent and severity of acute diarrheal disease. Almost 70–75 per cent of children suffered from diarrhea every year. The annual attack rate was 1·92/child during the first year and 2·16/child in the second year. Thirty four per cent suffered from 3 or more episodes. Maximum attack rate of 2·69/child/year was seen in children 1–2 years of age. No severe dehydration was seen and one or more signs of dehydration were reported in 3013 (12·2%) cases. Diarrhea accounted for 23·1 per cent (27) of total deaths (117) during the study period. The case fatality rate in 7424 episodes of diarrhea was 3·63/1000 episodes. The findings of this prospective study have operational and logistic implications in national diarrheal disease control programme and may strengthen the monitoring of the desease.     

Morbidity and mortality in diarrhea in rural Haryana

Five thousand children under 6 years of age from 69 villages in Haryana were followed up for 2 years to assess the extent and severity of acute diarrheal disease. Almost 70–75 per cent of children suffered from diarrhea every year. The annual attack rate was 1·92/child during the first year and 2·16/child in the second year. Thirty four per cent suffered from 3 or more episodes. Maximum attack rate of 2·69/child/year was seen in children 1–2 years of age. No severe dehydration was seen and one or more signs of dehydration were reported in 3013 (12·2%) cases. Diarrhea accounted for 23·1 per cent (27) of total deaths (117) during the study period. The case fatality rate in 7424 episodes of diarrhea was 3·63/1000 episodes. The findings of this prospective study have operational and logistic implications in national diarrheal disease control programme and may strengthen the monitoring of the desease.     

Etiological spectrum of localization-related epilepsies in childhood and the need for CT scan in children with partial seizures with no obvious causation--a study from south India

The etiological spectrum of 558 children (< 16 years) with partial seizures seen in a university hospital in south India, was analysed using syndromic classification proposed by the International League Against Epilepsy (ILAE). Partial seizures accounted for 57 per cent of childhood epilepsies. Idiopathic localization-related epilepsies accounted for 3 per cent, symptomatic localization-related epilepsies for 48 per cent and cryptogenic localization-related epilepsies for 49 per cent. Single CT enhancing lesion (SCTEL; solitary cysticercal granuloma), single small cerebral calcific CT lesion (SSCCCTL), and multiple small cerebral calcific CT lesions together accounted for 51 per cent of patients categorized under symptomatic localization-related epilepsies. Of the 138 patients with these CT lesions, only four patients with SCTEL had focal signs to suggest symptomatic etiology and in the remaining the putative etiology was established only after CT scan was obtained. A CT scan was carried out in 247 children with localization-related epilepsies with no obvious causation, and the proportion of CT scans showing one of these three etiologies was 0.54 [95 per cent confidence intervals (CI), 49-60]. Our observations suggest that in India a child with partial seizures with no obvious causation has a high probability of harboring one of these three lesions. In these patients, a CT scan should be the initial structural imaging investigation and will be cost effective.     

偏侧惊厥-偏瘫-癫(间)综合征的临床特点及诊断

目的探讨偏侧惊厥-偏瘫-癫癎(HHE)综合征的临床特点及诊断。方法对5例HHE综合征患儿的临床资料进行回顾性分析,总结临床特征及其发病的危险因素,进行必要的辅助检查,包括头颅CT和(或)MRI、脑电图及诊断性智力测定或精神运动发育评价。结果4例4岁内起病,3例伴热性惊厥,最长惊厥时间均在2 h以上,并惊厥侧肢体偏瘫。5例均在偏瘫后2年内出现癫癎反复发作。4例为局限性运动发作,1例为精神运动性发作。5例均存在智力障碍或精神发育迟滞。头颅MRI检查4例发现左侧海马硬化,1例CT示右半球萎缩。脑电图均异常,4例见异常放电,1例示明显不对称。5例均予卡马西平为主的药物治疗,癫癎发作得到控制或部分控制。结论HHE综合征是持续偏侧惊厥导致的偏瘫-癫癎综合征,海马硬化可能是反复癫癎所致海马的继发性损伤,而非癫癎的起源灶。应提高对该病的认识,早期正确处理惊厥持续状态将减少HHE综合征发生。     

Etiology of maternal and early childhood deficiency anemia

One hundred mothers from the urban slum and rural areas of Varanasi and their 109 children between 3 months and 3 years of age were studied. The prevalence of anemia in the mothers (Hb<12·0 g%) and their children (Hb<11·0 g%) was 57·0 and 55·0 and 55·0 per cent respectively. The mean age of anemic children (18·4±9·2 months) was higher than that of nonanemic children (15·1±11·3 months). The prevalence of anemia in the children of anemic mothers was 63·5 per cent as compared to 43·5 per cent in the children of non-anemic mothers (p<0·05). This difference could be due to poor maternal iron stores, prolonged breast feeding and higher prevalence of intestinal parasites in the anemic mothers and children (73·8 and 59·9% respectivelty) compared to (19·4 and 2·6%) in their non-anemic counterparts.     

Herpes simplex virus encephalitis in children

Herpes simplex encephalitis (HSE) is an uncommon disease, yet 25 to 30 per cent of cases involve children. The initial clinical findings are nonspecific (fever, altered mental status), but most cases evolve to demonstrate focal neurologic signs and symptoms. The CSF is abnormal in over 90 per cent of cases. The EEG, CT, and MRI will further help in detecting focal encephalitis. The clinician caring for a child with focal encephalitis should institute broad-spectrum antimicrobial therapy plus acyclovir, pending definitive diagnosis by ancillary tests or brain biopsy, which is positive for HSE 33 to 55 per cent of the time and is diagnostic for other treatable conditions 10 to 20 per cent of the time. Acyclovir is the drug of choice for HSE and substantially reduces mortality and morbidity. The management of HSE in a child requires an experienced team of specialists and laboratory support in a tertiary intensive care setting.