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\def\RunningAuthor{Suvarna Rekha P and Krishnappa J}
\firstPage{28}
\articleType{Original Article}
\receivedDate{18 Jun 2020}
\acceptedDate{04 Aug 2020}
\revisedDate{25 Jul 2020}
\journalVolume{2021, 12}
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\journalDoi{ijrps.v12i1.3908}
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\title{\textbf{Study of Clinico-Etiological profile of seizures in Kolar District of Karnataka, India}}
\author{Suvarna~Rekha~P\textsuperscript{*}, 
            Krishnappa~J~\\[5pt]{Department of Pediatrics, R L Jalappa Hospital and Research Center, Kolar, India}}

\begin{abstract}
All children between 1 month to 18 years, admitted with new on set undiagnosed febrile or a febrile convulsive seizure disorder to R.L. Jalappa Hospital and Research Centre, Kolar are included in this study. The study was conducted over a period of one year from Dec 2013 to Jan 2015 with sample size of 150.  The mean age of onset of seizure in study group was 5.19 \ensuremath{\pm} 4.37 years.The age group at which maximum onset of seizures found was between 1-5 years of life. Febrile seizure (65.9\%) was the most common cause of seizure below 5 years of age and Neurocysticercosis (50\%) in the age group 6-18 years. Females were more susceptible to seizure disorders than males. The most common clinical presentation of seizures was generalized tonic-clonic type (56.6\%). The most common etiology was infectious (66.1\%), Idiopathic generalized epilepsies (45\%) were most common type of epilepsy. Mean temperature on admission to hospital in febrile seizure patients was 101.43\ensuremath{^{0}}F. Mean age for febrile seizure was 24.05 months. Further, studies on large scale over longer duration should be carried out, to put forth the diagnostic guidelines and management plans based on clinical presentation and etiological causes in a specific age group.
\end{abstract}\def\keywordstitle{Keywords}

\begin{keywords}Epilepsy,\newline Seizure,\newline Convulsion,\newline clinical profile,\newline Neurocysticercosis
\end{keywords}
\twocolumn[ \maketitle {\printKwdAbsBox}]
\makeatletter{\raggedright\textsuperscript{*}Corresponding Author\par Name:\ Suvarna~Rekha~P~\\ Phone:\ ~\\  Email:\ suvarna.korpu@gmail.com
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\section{Introduction}
Seizure is a common problem evaluated in pediatric emergency departments which is transient occurrence of signs and symptoms due to the abnormal, excessive, or synchronous neuronal activity in the brain characterized by abrupt and involuntary skeletal muscles activity. \unskip~\citep{855782:20050003}. 

The clinical diagnosis of epilepsy usually requires the occurrence of at least two unprovoked seizures 24 hrs apart or one unprovoked seizure and enough EEG and clinical information to convincingly demonstrate an enduring predisposition to develop recurrences. 

Approximately 4-10\% of children experience at least 1 seizure (febrile or afebrile) in the 1st 16 years of life. The cumulative lifetime incidence of epilepsy is 3\%, and more than half of the cases start in childhood. The annual prevalence is 0.5-1.0\% globally. \unskip~\citep{855782:20050001}

Thus, the occurrence of a single seizure or of febrile seizures does not necessarily imply the diagnosis of epilepsy. \unskip~\citep{855782:20050001} Status epilepticus refers to continuous or recurrent seizure activity lasting longer than 30 minutes without recovery of consciousness in between. \unskip~\citep{855782:20050004}

The age and neurodevelopmental maturity status determine the clinical manifestations and the type of seizure disorders encountered. \unskip~\citep{855782:20050005} Although the outlook for most children with symptomatic seizures or those associated with epilepsy is generally good, seizures may signal a potentially serious underlying systemic or central nervous system (CNS) disorder that requires thorough investigation and management. \unskip~\citep{855782:20050001} The type of seizure, its etiology, manifestations and progression varies from age to age. 

This study was planned in rural tertiary level hospital with the aim to study the clinico-etiological profile of seizures in children among 1 month to 18 years of age of Kolar District, Karnataka. It also helps in prognostication and outcome.


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\caption{\boldmath {Age distribution of patients}}
\label{f-064ec110cef9}
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\caption{\boldmath {Gender distribution of patients}}
\label{f-1573128d9185}
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\caption{\boldmath {Type of Seizures}}
\label{f-d353ae8e3018}
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\caption{\boldmath {Number of patients who had seizure associated with fever}}
\label{f-698a03e07c78}
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\caption{\boldmath {Risk factors for Seizures}}
\label{f-cdfbbaec67af}
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\caption{\boldmath {CT scan findings in patients}}
\label{f-2e9d065edce2}
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\caption{\boldmath {MRI Diagnosis of patients with Seizures}}
\label{f-14c531604be6}
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\caption{\boldmath {EEG Findings in patients with Seizures}}
\label{f-2f5d211b8b23}
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\caption{\boldmath {Gender distribution of febrile seizure patients}}
\label{f-aca06b6d3476}
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\egroup

\begin{table*}[!htbp]
\caption{\boldmath {Distribution of patients born to consanguineously married parents} }
\label{tw-cdc8d5c84def}
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\tbltoprule \rowcolor{kwdboxcolor}\cellcolor[HTML]{E5E5E5}{} & \cellcolor[HTML]{E5E5E5}{} & \cellcolor[HTML]{E5E5E5}{Cases } & \cellcolor[HTML]{E5E5E5}{Percent }\\
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\multicolumn{1}{p{\dimexpr(.16419999999999998\linewidth-2\tabcolsep)}}{\multirow{3}{\linewidth}{Parents }} &
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  16  &
  10.7 \\
 &
  Non-Consanguineous  &
  134  &
  89.3 \\
 &
  Total  &
  150  &
  100.0 \\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Motor Manifestations of Seizures in the patients studied} }
\label{tw-f694a3d8b926}
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\tbltoprule \rowcolor{kwdboxcolor}\cellcolor[HTML]{E5E5E5}{} & \cellcolor[HTML]{E5E5E5}{} & \cellcolor[HTML]{E5E5E5}{Number } & \cellcolor[HTML]{E5E5E5}{Percent }\\
\tblmidrule 
\multicolumn{1}{p{\dimexpr(.25\linewidth-2\tabcolsep)}}{\multirow{4}{\linewidth}{Motor Manifestations of Seizures }} &
  Tonic-clonic  &
  85  &
  56.6 \\
 &
  Tonic  &
  41  &
  27.3 \\
 &
  Clonic  &
  24  &
  16 \\
 &
  Total  &
  150  &
  100.0 \\
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\caption{\boldmath {Events during Seizure episode} }
\label{tw-8d053e215d34}
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\tbltoprule \rowcolor{kwdboxcolor}\cellcolor[HTML]{E5E5E5}{} & \cellcolor[HTML]{E5E5E5}{} & \cellcolor[HTML]{E5E5E5}{Cases } & \cellcolor[HTML]{E5E5E5}{Percent }\\
\tblmidrule 
\multicolumn{1}{p{\dimexpr(.2748\linewidth-2\tabcolsep)}}{\multirow{2}{\linewidth}{Loss of Consciousness during seizure episode }} &
  No (Conscious)  &
  12  &
  8.0\% \\
 &
  Yes (Unconscious)  &
  138  &
  92.0\% \\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Post ictalphenomenon in seizure subjects } }
\label{tw-5e1ee6422104}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.3346\linewidth-2\tabcolsep}p{\dimexpr.33269999999999996\linewidth-2\tabcolsep}p{\dimexpr.33269999999999996\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}\multicolumn{3}{p{\dimexpr(.9999999999999999\linewidth-2\tabcolsep)}}{\cAlignHack \cellcolor[HTML]{E5E5E5}{Level of Consciousness at admission}}\\
\tblmidrule 
Awake  &
  88  &
  58.7\% \\
Response to verbal stimulus  &
  50  &
  33.3\% \\
Response to painful stimulus  &
  6  &
  4.0\% \\
Unresponsive  &
  6  &
  4.0\% \\\cline{1-1}\cline{2-2}\cline{3-3}
\multicolumn{3}{p{\dimexpr(.9999999999999999\linewidth-2\tabcolsep)}}{\cellcolor[HTML]{E5E5E5}\cAlignHack {Neurological deficits }}\\\cline{1-3}
Absent(No)  &
  144  &
  96.0\% \\
Present(Yes)  &
  6  &
  4.0\% \\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Neurological manifestations in patients} }
\label{tw-0d79dc6c14e2}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.3321\linewidth-2\tabcolsep}p{\dimexpr.28049999999999997\linewidth-2\tabcolsep}p{\dimexpr.2042\linewidth-2\tabcolsep}p{\dimexpr.1832\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}\cellcolor[HTML]{E5E5E5}{} & \cellcolor[HTML]{E5E5E5}{} & \cellcolor[HTML]{E5E5E5}{Cases } & \cellcolor[HTML]{E5E5E5}{Percent }\\
\tblmidrule 
\multicolumn{1}{p{\dimexpr(.3321\linewidth-2\tabcolsep)}}{\multirow{2}{\linewidth}{Head Circumference }} &
  Microcephaly  &
  6  &
  4\% \\
 &
  Normal  &
  144  &
  96.0\% \\
\multicolumn{1}{p{\dimexpr(.3321\linewidth-2\tabcolsep)}}{\multirow{2}{\linewidth}{Signs of upper motor neuron type of leison }} &
  Absent  &
  144  &
  96.0\% \\
 &
  Present  &
  6  &
  4.0\% \\
\multicolumn{1}{p{\dimexpr(.3321\linewidth-2\tabcolsep)}}{\multirow{2}{\linewidth}{Clinical signs of meningitis }} &
  Absent  &
  143  &
  94.0\% \\
 &
  Present  &
  9  &
  6.0\% \\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Laboratory findings in patients} }
\label{tw-883d543a579b}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.3396\linewidth-2\tabcolsep}p{\dimexpr.3303000000000001\linewidth-2\tabcolsep}p{\dimexpr.1603\linewidth-2\tabcolsep}p{\dimexpr.1698\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}\cellcolor[HTML]{E5E5E5}{} & \cellcolor[HTML]{E5E5E5}{} & \cellcolor[HTML]{E5E5E5}{Cases } & \cellcolor[HTML]{E5E5E5}{Percent }\\
\tblmidrule 
\multicolumn{1}{p{\dimexpr(.3396\linewidth-2\tabcolsep)}}{\multirow{2}{\linewidth}{Malaria Parasite in Peripheral Smear/Rapid diagnostic test }} &
  Negative  &
  145  &
  96.7\% \\
 &
  Positive  &
  5  &
  3.3\% \\
\multicolumn{1}{p{\dimexpr(.3396\linewidth-2\tabcolsep)}}{\multirow{2}{\linewidth}{Hyponatremia }} &
  Absent  &
  149  &
  99.3\% \\
 &
  Present  &
  1  &
  0.7\% \\
\multicolumn{1}{p{\dimexpr(.3396\linewidth-2\tabcolsep)}}{\multirow{2}{\linewidth}{Hypocalcemia }} &
  Absent  &
  144  &
  96.0\% \\
 &
  Present  &
  6  &
  4.0\% \\
\multicolumn{1}{p{\dimexpr(.3396\linewidth-2\tabcolsep)}}{\multirow{2}{\linewidth}{Widal Test Positive }} &
  No  &
  148  &
  98.7\% \\
 &
  Yes  &
  2  &
  1.3\% \\
\multicolumn{1}{p{\dimexpr(.3396\linewidth-2\tabcolsep)}}{\multirow{2}{\linewidth}{Abnormal CBC }} &
  No  &
  127  &
  84.6\% \\
 &
  Yes  &
  33  &
  15.4\% \\
\multicolumn{1}{p{\dimexpr(.3396\linewidth-2\tabcolsep)}}{\multirow{3}{\linewidth}{Urine culture Report }} &
  Candida  &
  1  &
  0.7\% \\
 &
  E.coli  &
  7  &
  4.7\% \\
 &
  Normal  &
  142  &
  94.7\% \\
\multicolumn{1}{p{\dimexpr(.3396\linewidth-2\tabcolsep)}}{\multirow{4}{\linewidth}{Tests for tuberculosis }} &
  Normal  &
  146  &
  97.3\% \\
 &
  Hilar nodes present in chest X ray   &
  2  &
  1.3\% \\
 &
  Mantoux Positive  &
  3  &
  2\% \\
 &
  Sputum for AFB  &
  1  &
  0.7\% \\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Age distribution of febrile seizure patients} }
\label{tw-3545bed77952}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.2087\linewidth-2\tabcolsep}p{\dimexpr.0713\linewidth-2\tabcolsep}p{\dimexpr.14\linewidth-2\tabcolsep}p{\dimexpr.14\linewidth-2\tabcolsep}p{\dimexpr.14\linewidth-2\tabcolsep}p{\dimexpr.14\linewidth-2\tabcolsep}p{\dimexpr.16\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}\cellcolor[HTML]{E5E5E5}{Age in Month } & \cellcolor[HTML]{E5E5E5}{N} & \cellcolor[HTML]{E5E5E5}{Mean } & \cellcolor[HTML]{E5E5E5}{SD } & \cellcolor[HTML]{E5E5E5}{Min } & \cellcolor[HTML]{E5E5E5}{Max } & \cellcolor[HTML]{E5E5E5}{Range }\\
\tblmidrule 
Febrile seizures  &
   &
   &
   &
   &
   &
  \\
Simple Febrile Seizures  &
  46  &
  25.17  &
  15.53  &
  6.10  &
  59.1  &
  53.00 \\
Complex Febrile Seizures  &
  12  &
  19.77  &
  10.01  &
  8.13  &
  36.50  &
  28.37 \\
Total  &
  58  &
  24.05  &
  14.65  &
  6.10  &
  60.83  &
  54.73 \\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Temperature at admission in febrile seizure patient} }
\label{tw-68765044e994}
\centering 
\begin{threeparttable}

\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.3271\linewidth-2\tabcolsep}p{\dimexpr.06549999999999997\linewidth-2\tabcolsep}p{\dimexpr.0724\linewidth-2\tabcolsep}p{\dimexpr.1028\linewidth-2\tabcolsep}p{\dimexpr.08570000000000002\linewidth-2\tabcolsep}p{\dimexpr.09129999999999999\linewidth-2\tabcolsep}p{\dimexpr.0818\linewidth-2\tabcolsep}p{\dimexpr.1734\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}\cellcolor[HTML]{E5E5E5}{Temperature in degree of Fahrenheit} & \cellcolor[HTML]{E5E5E5}{N} & \cellcolor[HTML]{E5E5E5}{Mean } & \cellcolor[HTML]{E5E5E5}{SD } & \cellcolor[HTML]{E5E5E5}{Min } & \cellcolor[HTML]{E5E5E5}{Max } & \cellcolor[HTML]{E5E5E5}{Range } & \cellcolor[HTML]{E5E5E5}{Quartile Range }\\
\tblmidrule 
Febrile seizures  &
   &
   &
   &
   &
   &
   &
  \\
Simple Febrile Seizures  &
  46  &
  101.65  &
  1.015  &
  100.00  &
  105.00  &
  5.00  &
  1 \\
Complex Febrile Seizures  &
  12  &
  100.58  &
  0.514  &
  100.00  &
  101.00  &
  1.00  &
  1 \\
Total  &
  58  &
  101.43  &
  1.027  &
  100.00  &
  105.00  &
  5.00  &
  1 \\
\tblbottomrule 
\end{tabulary}\par 
\begin{tablenotes}\footnotesize 
    
\item{Mean temperature on admission to hospital in febrile seizure patients was 101.43\ensuremath{^{0}}F.}
\end{tablenotes}
\end{threeparttable}

\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Etiological Diagnosis of patients with Seizures } }
\label{tw-dafec5a9d8ce}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.17860000000000003\linewidth-2\tabcolsep}p{\dimexpr.1802\linewidth-2\tabcolsep}p{\dimexpr.3587\linewidth-2\tabcolsep}p{\dimexpr.1314\linewidth-2\tabcolsep}p{\dimexpr.1511\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}\cellcolor[HTML]{E5E5E5}{} & \cellcolor[HTML]{E5E5E5}{} & \cellcolor[HTML]{E5E5E5}{} & \multicolumn{2}{p{\dimexpr(.2825\linewidth-2\tabcolsep)}}{\cAlignHack \cellcolor[HTML]{E5E5E5}{Total }}\\
\rowcolor{kwdboxcolor}\cellcolor[HTML]{E5E5E5}{} & \cellcolor[HTML]{E5E5E5}{} & \cellcolor[HTML]{E5E5E5}{} & \cellcolor[HTML]{E5E5E5}{Cases } & \cellcolor[HTML]{E5E5E5}{Percent }\\
\tblmidrule 
\multicolumn{1}{p{\dimexpr(.17860000000000003\linewidth-2\tabcolsep)}}{\multirow{14}{\linewidth}{Etiological Diagnosis }} &
  \multicolumn{1}{p{\dimexpr(.1802\linewidth-2\tabcolsep)}}{\multirow{2}{\linewidth}{Febrile Seizures }} &
  Simple febrile seizure  &
  46  &
  30.7\% \\
 &
   &
  Complex febrile seizure  &
  12  &
  8.0\% \\
 &
  \multicolumn{1}{p{\dimexpr(.1802\linewidth-2\tabcolsep)}}{\multirow{6}{\linewidth}{Infectious Causes }} &
  Neurocysticercosis  &
  34  &
  22.7\% \\
 &
   &
  Encephalitis  &
  19  &
  12.7\% \\
 &
   &
  Pyogenic meningitis  &
  7  &
  4.7\% \\
 &
   &
  Tuberculoma  &
  2  &
  1.3\% \\
 &
   &
  Tuberculous meningitis  &
  2  &
  1.3\% \\
 &
   &
  Cerebral Malaria  &
  1  &
  0.7\% \\
 &
  \multicolumn{1}{p{\dimexpr(.1802\linewidth-2\tabcolsep)}}{\multirow{3}{\linewidth}{Metabolic Causes  }} &
  Hypo Calcemic seizure  &
  6  &
  4.0\% \\
 &
   &
  Hypoglycemic seizures  &
  1  &
  0.7\% \\
 &
   &
  Hyponatremic seizures  &
  1  &
  0.7\% \\
 &
  \multicolumn{2}{p{\dimexpr(.5389\linewidth-2\tabcolsep)}}{Cerebral palsy } &
  4  &
  2.6\% \\
 &
  \multicolumn{2}{p{\dimexpr(.5389\linewidth-2\tabcolsep)}}{Congenital anomalies } &
  2  &
  1.3\% \\
 &
  \multicolumn{2}{p{\dimexpr(.5389\linewidth-2\tabcolsep)}}{Not found } &
  13  &
  8.7\% \\
\multicolumn{3}{p{\dimexpr(.7175\linewidth-2\tabcolsep)}}{Total } &
  150  &
  \\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {ILAE Classification of seizure types in patients} }
\label{tw-8979f92fedb5}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.25\linewidth-2\tabcolsep}p{\dimexpr.4218\linewidth-2\tabcolsep}p{\dimexpr.14309999999999995\linewidth-2\tabcolsep}p{\dimexpr.18509999999999998\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}\cellcolor[HTML]{E5E5E5}{} & \cellcolor[HTML]{E5E5E5}{} & \cellcolor[HTML]{E5E5E5}{Cases } & \cellcolor[HTML]{E5E5E5}{Percent }\\
\tblmidrule 
\multicolumn{1}{p{\dimexpr(.25\linewidth-2\tabcolsep)}}{\multirow{4}{\linewidth}{IIAE Classification of seizure types }} &
  Generalized Tonic-clonic  &
  85  &
  56.6\% \\
 &
  Generalized Tonic  &
  25  &
  16.6\% \\
 &
  Simple Partial Seizure  &
  12  &
  8.0\% \\
 &
  Complex Partial Seizure  &
  28  &
  18.6\% \\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Showing ILAE Classification of epilepsies and epileptic syndromes} }
\label{tw-4acd800835db}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.4923\linewidth-2\tabcolsep}p{\dimexpr.14879999999999999\linewidth-2\tabcolsep}p{\dimexpr.12989999999999998\linewidth-2\tabcolsep}p{\dimexpr.229\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}\cellcolor[HTML]{E5E5E5}{Epilepsies and Epileptic syndromes} & \cellcolor[HTML]{E5E5E5}{Cases } & \cellcolor[HTML]{E5E5E5}{\% } & \cellcolor[HTML]{E5E5E5}{Total }\\
\tblmidrule 
Situation-related seizures 
  ~\newline 1.~1. ~\newline 2.~2. ~\newline 3.~3. ~\newline  &
  58  \mbox{}\protect\newline 67  \mbox{}\protect\newline 05  &
  44.6  \mbox{}\protect\newline 51.6  \mbox{}\protect\newline 3.8  &
  130(86.6\%) \\
Generalised epilepsy 
  ~\newline 1.~1. ~\newline 2.~2. ~\newline 3.~3. ~\newline  &
  09  \mbox{}\protect\newline 06  \mbox{}\protect\newline 00  &
   60  \mbox{}\protect\newline  40  &
  15(10\%) \\
Localisation related epilepsy (LRE) 
  ~\newline 1.~1. ~\newline 2.~2. ~\newline  &
  03  \mbox{}\protect\newline 02  &
   60  \mbox{}\protect\newline  40  &
  5(3.4\%) \\
Total  &
  150  &
   &
  150 \\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Association between Etiological Diagnosis and Types of seizures} }
\label{tw-2224e097372f}
\centering 
\begin{threeparttable}

\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.13449999999999996\linewidth-2\tabcolsep}p{\dimexpr.16400000000000002\linewidth-2\tabcolsep}p{\dimexpr.0801\linewidth-2\tabcolsep}p{\dimexpr.2468\linewidth-2\tabcolsep}p{\dimexpr.11599999999999998\linewidth-2\tabcolsep}p{\dimexpr.1302\linewidth-2\tabcolsep}p{\dimexpr.1284\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}\cellcolor[HTML]{E5E5E5}{} & \cellcolor[HTML]{E5E5E5}{} & \cellcolor[HTML]{E5E5E5}{} & \cellcolor[HTML]{E5E5E5}{} & \multicolumn{2}{p{\dimexpr(.24619999999999997\linewidth-2\tabcolsep)}}{\cAlignHack \cellcolor[HTML]{E5E5E5}{Types of Seizure }} & {\multirow{2}{*}{\cellcolor[HTML]{E5E5E5}{\cAlignHack Total }}}\\
\rowcolor{kwdboxcolor}\cellcolor[HTML]{E5E5E5}{} & \cellcolor[HTML]{E5E5E5}{} & \cellcolor[HTML]{E5E5E5}{} & \cellcolor[HTML]{E5E5E5}{} & \cellcolor[HTML]{E5E5E5}{Partial } & \cellcolor[HTML]{E5E5E5}{Generalized } & \\
\tblmidrule 
\multicolumn{1}{p{\dimexpr(.13449999999999996\linewidth-2\tabcolsep)}}{\multirow{14}{\linewidth}{Etiological Diagnosis }} &
  \multicolumn{2}{p{\dimexpr(.24410000000000004\linewidth-2\tabcolsep)}}{\multirow{2}{\linewidth}{Febrile Seizures }} &
  Simple febrile seizure  &
  0  &
  46  &
  46 \\
 &
   &
   &
  Complex febrile seizure  &
  0  &
  12  &
  12 \\
 &
  \multicolumn{2}{p{\dimexpr(.24410000000000004\linewidth-2\tabcolsep)}}{\multirow{6}{\linewidth}{Infectious Causes }} &
  Neurocysticercosis  &
  34  &
  0  &
  34 \\
 &
   &
   &
  Encephalitis  &
  0  &
  19  &
  19 \\
 &
   &
   &
  Pyogenic meningitis  &
  0  &
  7  &
  7 \\
 &
   &
   &
  Tuberculoma  &
  2  &
  0  &
  2 \\
 &
   &
   &
  Tuberculous meningitis  &
  0  &
  2  &
  2 \\
 &
   &
   &
  Cerebral Malaria  &
  0  &
  1  &
  1 \\
 &
  \multicolumn{2}{p{\dimexpr(.24410000000000004\linewidth-2\tabcolsep)}}{\multirow{3}{\linewidth}{Metabolic Causes }} &
  Hypo calcemic seizure  &
  0  &
  6  &
  6 \\
 &
   &
   &
  Hypoglycemic seizures  &
  0  &
  1  &
  1 \\
 &
   &
   &
  Hyponatremic seizures  &
  0  &
  1  &
  1 \\
 &
  \multicolumn{3}{p{\dimexpr(.4909\linewidth-2\tabcolsep)}}{Cerebral palsy } &
  0  &
  4  &
  4 \\
 &
  \multicolumn{3}{p{\dimexpr(.4909\linewidth-2\tabcolsep)}}{Congenital anomalies } &
  0  &
  2  &
  2 \\
 &
  \multicolumn{3}{p{\dimexpr(.4909\linewidth-2\tabcolsep)}}{Not found } &
  4  &
  9  &
  13 \\
\multicolumn{2}{p{\dimexpr(.29849999999999998\linewidth-2\tabcolsep)}}{} &
  \multicolumn{2}{p{\dimexpr(.3269\linewidth-2\tabcolsep)}}{Total } &
  40  &
  110  &
  150 \\
\tblbottomrule 
\end{tabulary}\par 
\begin{tablenotes}\footnotesize 
    
\item{   \ensuremath{\chi } 2 = 51.72, df = 3 ,p {\textless}0.001* }
\end{tablenotes}
\end{threeparttable}

\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Age-wise distribution of etiology of seizures} }
\label{tw-cd7b568f0a52}
\centering 
\begin{threeparttable}

\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.27630000000000003\linewidth-2\tabcolsep}p{\dimexpr.1149\linewidth-2\tabcolsep}p{\dimexpr.13899999999999999\linewidth-2\tabcolsep}p{\dimexpr.12690000000000001\linewidth-2\tabcolsep}p{\dimexpr.13119999999999997\linewidth-2\tabcolsep}p{\dimexpr.1117\linewidth-2\tabcolsep}p{\dimexpr.10\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}\cellcolor[HTML]{E5E5E5}{Etiological Diagnosis } & \multicolumn{2}{p{\dimexpr(.2539\linewidth-2\tabcolsep)}}{\cAlignHack \cellcolor[HTML]{E5E5E5}{Age Infants (\textless\ 1 year) }} & \multicolumn{2}{p{\dimexpr(.2581\linewidth-2\tabcolsep)}}{\cAlignHack \cellcolor[HTML]{E5E5E5}{1 to 5 years }} & \multicolumn{2}{p{\dimexpr(.2117\linewidth-2\tabcolsep)}}{\cAlignHack \cellcolor[HTML]{E5E5E5}{6 to 18 years }}\\
\rowcolor{kwdboxcolor}\cellcolor[HTML]{E5E5E5}{} & \cellcolor[HTML]{E5E5E5}{Count } & \cellcolor[HTML]{E5E5E5}{\% }\cellcolor[HTML]{E5E5E5}{Count } & \cellcolor[HTML]{E5E5E5}{\% } & \cellcolor[HTML]{E5E5E5}{Count } & \cellcolor[HTML]{E5E5E5}{\% }\\
\tblmidrule 
Cerebral Malaria  &
  0  &
  0.0\%  &
  1  &
  1.5\%  &
  0  &
  0.0\% \\
Cerebral palsy  &
  1  &
  4.5\%  &
  3  &
  6.2\%  &
  0  &
  0.0\% \\
Complex febrile seizure  &
  2  &
  9.0\%  &
  10  &
  15.4\%  &
  0  &
  0.0\% \\
Encephalitis  &
  0  &
  0.0\%  &
  3  &
  4.6\%  &
  16  &
  26.6\% \\
Hypo calcemic seizure  &
  4  &
  18.2\%  &
  2  &
  3.1\%  &
  0  &
  0.0\% \\
Hypoglycemic seizures  &
  0  &
  0.0\%  &
  1  &
  1.5\%  &
  0  &
  0.0\% \\
Hyponatremic seizures  &
  0  &
  0.0\%  &
  0  &
  0.0\%  &
  1  &
  1.6\% \\
Neurocysticercosis  &
  0  &
  0.0\%  &
  4  &
  6.2\%  &
  30  &
  50.0\% \\
Not found  &
  0  &
  0.0\%  &
  4  &
  6.2\%  &
  9  &
  15.0\% \\
Pyogenic meningitis  &
  4  &
  18.2\%  &
  1  &
  1.5\%  &
  2  &
  3.3\% \\
Simple febrile seizure  &
  10  &
  45.4\%  &
  36  &
  54.5\%  &
  0  &
  0.0\% \\
Tuberculoma  &
  0  &
  0.0\%  &
  0  &
  0.0\%  &
  2  &
  3.3\% \\
Congenital anomalies  &
  1  &
  4.5\%  &
  1  &
  1.6\%  &
  0  &
  0.0\% \\
Tuberculous meningitis  &
  0  &
  0.0\%  &
  0  &
  0.0\%  &
  2  &
  3.2\% \\
\tblbottomrule 
\end{tabulary}\par 
\begin{tablenotes}\footnotesize 
    
\item{  Pearson Chi-square value = 132.2, df = 26, p = {\textless}0.00001}
\end{tablenotes}
\end{threeparttable}

\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Anticonvulsants used in treatment of patients with Seizures } }
\label{tw-50f2f0415dcb}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.17550000000000004\linewidth-2\tabcolsep}p{\dimexpr.18019999999999996\linewidth-2\tabcolsep}p{\dimexpr.371\linewidth-2\tabcolsep}p{\dimexpr.1313\linewidth-2\tabcolsep}p{\dimexpr.142\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}\cellcolor[HTML]{E5E5E5}{} & \cellcolor[HTML]{E5E5E5}{} & \cellcolor[HTML]{E5E5E5}{} & \multicolumn{2}{p{\dimexpr(.2733\linewidth-2\tabcolsep)}}{\cAlignHack \cellcolor[HTML]{E5E5E5}{Total }}\\
\rowcolor{kwdboxcolor}\cellcolor[HTML]{E5E5E5}{} & \cellcolor[HTML]{E5E5E5}{} & \cellcolor[HTML]{E5E5E5}{} & \cellcolor[HTML]{E5E5E5}{Cases } & \cellcolor[HTML]{E5E5E5}{Percent }\\
\tblmidrule 
\multicolumn{1}{p{\dimexpr(.17550000000000004\linewidth-2\tabcolsep)}}{\multirow{10}{\linewidth}{Anti {\textendash} Convulsant used }} &
  \multicolumn{2}{p{\dimexpr(.5512\linewidth-2\tabcolsep)}}{None } &
  5  &
  3.3\% \\
 &
  \multicolumn{2}{p{\dimexpr(.5512\linewidth-2\tabcolsep)}}{Calcium } &
  6  &
  4.0\% \\
 &
  \multicolumn{2}{p{\dimexpr(.5512\linewidth-2\tabcolsep)}}{Clobazam prophylaxis } &
  58  &
  38.6\% \\
 &
  \multicolumn{1}{p{\dimexpr(.18019999999999996\linewidth-2\tabcolsep)}}{\multirow{5}{\linewidth}{Monotherapy }} &
  Carbamazepine  &
  33  &
  22.0\% \\
 &
   &
  Valproate  &
  22  &
  14.7\% \\
 &
   &
  Levitiracetam  &
  1  &
  0.7\% \\
 &
   &
  Phenytoin  &
  12  &
  8.0\% \\
 &
   &
  Phenobarbitone  &
  9  &
  6.0\% \\
 &
  \multicolumn{1}{p{\dimexpr(.18019999999999996\linewidth-2\tabcolsep)}}{\multirow{2}{\linewidth}{Polytherapy }} &
  Phenytoin and phenobarbitone  &
  3  &
  2\% \\
 &
   &
  Multiple anticonvulsants  \mbox{}\protect\newline (phenytoin,phenobarbitone and valproate)  &
  1  &
  0.7\% \\
 &
  \multicolumn{2}{p{\dimexpr(.5512\linewidth-2\tabcolsep)}}{Total } &
  150  &
  \\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

    
\section{Materials and Methods}
\textbf{Sample size estimation}

R.L. Jalappa Hospital and Research Centre is being a tertiary care center and total number of admissions for year 2012-13 were 3242 of which, 324 cases were admitted with seizures, among them 216 were new onset seizures. Based on this value, sample size was estimated at 6.66\% expected proportion with 5\% absolute error. At 95\% confidence interval a minimum sample size of 96 was obtained. Considering 10\% non- response rate sample size required was 96+10=106.

In the study duration i.e from December 2013 to January 2015 total of 150 cases with new onset seizures were admitted and were included to the study. 

\textbf{Method of data collection}

\textbf{Method}

Patient's detailed history was obtained from the informant who has witnessed the seizure episode. All details obtained from history, examination and investigations were recorded in a predefined case proforma.

In clinical history more emphasis was given on the points, which are helpful in classification and diagnosis of seizures. Age is one of the important characters, as different seizure types are presented in a specific age group. Age of patients was divided in 3 groups as {\textless}1 year (infant), 1 to 5 years (toddlers and preschool children) and 6 to 18 years (school going and adolescents). Each patient's sex and consanguinity were also noted. Details of the seizure episode were recorded as, type of convulsion that is, generalised or focal, motor manifestation  as tonic, clonic or tonic-clonic, autonomic components like vomiting or bowel-bladder incontinence, level of consciousness was measured by using AVPU scale \unskip~\citep{855782:20050002}, duration of convulsion, associated symptoms like cyanosis or fever, post-ictal level of consciousness,focal neurological deficit, number of seizure episodes, that is 1,2, {\textgreater}/= 3 (multiple), interval between repeated seizure episodes was within 24 hours or 24 hours apart.

Lumbar puncture was done in any child who presents with a seizure and fever and \textless\ 1 year, fever with meningeal signs and symptoms (neck stiffness, Kernig and/or Brudzinski signs) or History suggestive of neuro infection or meningitis \unskip~\citep{855782:20049995} Lumbar puncture was done after fundus examination, to rule out increased intracranial pressure, under  aseptic precautions. EEGs were done on computerised ``Neuropage plus'' machine using 23 electrode system. All EEGs were done at least 24 hours after last episode of convulsion \unskip~\citep{855782:20049995}. Patients were classified according to the International Classification of Epileptic Seizures \unskip~\citep{855782:20050000}.
    
\section{Results and Discussion}
\textbf{Age distribution of patients studied}

Majority of subjects studied were in the age group of 1 to 5 years 66(44.0\%). (Figure~\ref{f-064ec110cef9})

\textbf{Gender distribution of patients}

Majority of patients were Females 77 (51.3\%). (Figure~\ref{f-1573128d9185})

\textbf{Distribution of patients born to consanguineously married parents }

Majority of patients were born to non {\textendash} consanguineous parents. (Table~\ref{tw-cdc8d5c84def})

\textbf{Type of Seizures in the patients}

Majority of patients (73.4\%) had generalized seizure. (Figure~\ref{f-d353ae8e3018})

\textbf{Motor Manifestations of Seizures in the patients }

In this study, majority (56.6\%) patients had Tonic clonic seizures. (Table~\ref{tw-f694a3d8b926})

\textbf{Patients who had seizures associated with fever}

58\% of patients studied had seizures associated with fever. (Figure~\ref{f-698a03e07c78})

\textbf{Events during Seizure episode}

In the study 92.0\% of patients had Loss of Consciousness during seizure episode. (Table~\ref{tw-8d053e215d34})

\textbf{Post ictal phenomenon in seizure subjects}

58.7\% were awake at admission to hospital and 4\% had Neurological Deficits. (Table~\ref{tw-5e1ee6422104})

\textbf{Risk factors for seizures}

8\% had Family History of Seizures and 3.3\% had History of Birth Asphyxia. (Figure~\ref{f-cdfbbaec67af})

\textbf{Neurological manifestations in patients}

4\% had microcephaly, 4\% had signs of UMN leison, 6.0\% had signs of meningeal irritation. (Table~\ref{tw-0d79dc6c14e2})

\textbf{Laboratory findings in patients}

In the study 3.3\% showed malarial parasite in peripheral smear, 0.7\% had hyponatremia, 4\% had hypocalcemia. (Table~\ref{tw-883d543a579b})

\textbf{CT scan findings in patients with seizures}

25.6\% showed signs of Neurocysticercosis (Parietal NCC was common site). (Figure~\ref{f-2e9d065edce2})

\textbf{MRI Diagnosis of patients} \textbf{with seizures}

52\% showed signs of Neurocysticercosis. (Figure~\ref{f-14c531604be6})

\textbf{EEG Findings in patients with seizures}

22.2\% were abnormal pattern. Generalized epileptiform activity was the most common pattern observed in EEG. (Figure~\ref{f-2f5d211b8b23})

\textbf{Gender distribution of febrile seizure patients}

Majority (79.3\%) patients had simple febrile seizures with male predominance. (Figure~\ref{f-aca06b6d3476})

\textbf{Age distribution of febrile seizure patients}

Mean age for febrile seizure was 24.05 months. (Table~\ref{tw-3545bed77952})

\textbf{Temperature at admission in febrile seizure patient}

Mean temperature on admission to hospital in febrile seizure patients was 101.43\ensuremath{^{0}}F. (Table~\ref{tw-68765044e994})

\textbf{Etiological Diagnosis of patients with Seizures}

Infectious causes were the most common causes for seizures in the study (42.7\%), followed by Febrile seizures (38.7\%) and other causes (Metabolic and CP). In 8.7\% Etiological diagnosis was not found. (Table~\ref{tw-dafec5a9d8ce})

\textbf{ILAE Classification of seizure types in patients}

Majority of patients (56.6\%) had as Generalized Tonic-clonic seizures. (Table~\ref{tw-8979f92fedb5})

\textbf{ILAE Classification of epilepsies and epileptic syndromes}

Situation related seizures were the most common (86.6\%) in the present study. (Table~\ref{tw-4acd800835db})

\textbf{Association between Etiological Diagnosis and Types of seizures}

Neurocysticercosis was the most common cause for focal seizures and Simple febrile seizure was the most common cause for generalized seizure. This observation was statistically significant. (Table~\ref{tw-2224e097372f})

\textbf{Age wise distribution of etiology of seizures}

There was significant association between etiological diagnosis and age. In \textless\ 1-year infants \& 1 to 5 years, most common etiology was  imple febrile seizures, 45.4\% \& 54.5\% respectively. In 6 to 18 years age group, most common etiology was Neurocysticercosis (50.0\%). (Table~\ref{tw-cd7b568f0a52})

\textbf{Anticonvulsants used in treatment of patients with Seizures}

During the 1 year study period, total of 150 patients were analyzed. Distribution of cases according to age, was done into 3 groups - {\textless}1 year(infants),1-5 years(toddlers and preschool children),6-18 years(school going and adolescents). Out of 150 patients, 22 (14.7\%) patients were between age group 1 month to {\textless}1 years age, 66 (44\%) patients between 1 to 5 years and 62 (41.3\%) patients were from age group 6 year to 18 years. Mean age of onset of seizure was 5.19 \ensuremath{\pm} 4.37 years, Median age of onset of seizure was 4 years. Female patients were 77 (51.3\%) and males were 73 (48.7\%) out of 150 patients studied. 

Out of 20 cases with epilepsy, 4 (20\%) cases were born to consanguineously married couple. This indicates that consanguinity has a role in occurrence of epilepsy. Family history of seizures was found in 12 (8\%) out of 150 cases. History of seizure was present in siblings in 4 (33\%) cases and in cousins in 8 (67\%) cases out of 12. Majority of children 67 (44.7\%) had single episode of convulsion and 31(20.7\%) had multiple convulsions. In post-ictal state, consciousness was intact in 88 (58.7\%) cases and 6(4\%) were unresponsive. 87(58\%) patients had fever in the present study population. These findings were consistent with study done by \unskip~\citep{855782:20049999} in Nepal, who found that 53.3\% of cases with seizures had fever in their study population. \unskip~\citep{855782:20049999}.\ensuremath{^{}}

Neurocutaneous markers were found in 2 cases and dysmorphic facial features were found in 2 (1.3\%) cases out of 150, which include low set ears and ear tag in both patients. In all of these cases no significant syndromic association was found on evaluation. On central nervous system examination of 150 cases studied, signs of UMN type of lesion were found in 6 (4\%) , clinical signs of meningitis in 9 (6.0\%) (5 females and 4 males), scissoring sign in 2 (1.3\%) and decerebrate posturing in 3 (2\%) cases. All cases with meningitis were associated with high grade fever. Fundus examination was abnormal in 4 (2.6\%) cases of 150 cases, which includes bilateral papilledema in all 4 cases. Abnormal blood reports were found in 33 (22\%) cases of 150 patients. These cases include 9(27.2\%) cases of meningitis, 8 (24.2\%) cases of UTI, 5 (15.1\%) cases of malaria, 2 (6\%) cases (Widal test positive) of enteric fever. Out of 46 CSF samples analyzed, abnormal CSF findings were found in 21 (14\%), which includes 2 (9.5\%) cases of tuberculous meningitis, 7 (33.3\%) cases of pyogenic meningitis and 12 (57.1\%) cases of encephalitis. Thus, CSF analysis was helpful in diagnosing the above conditions.

Cranial CT scan was done in 82 cases, out of which 36 (43.9\%) were abnormal. MRI brain was done in 25 (16.6\%) cases out of 150. It was abnormal in 22 (88\%) cases. The most common brain lesions detected were neurocysticercosis (NCC) in 13 (59.0\%) cases. In our study 58 (38.6\%) cases out of 150 had abnormal brain images. EEG was done in 72 cases, out of which 20 (27.7\%) were abnormal. Most common EEG finding was generalised epileptiform activity, seen in 15 (75\%) cases. Epileptiform foci localised to one or more hemisphere of brain was reported in 5 (25\%) cases. Febrile seizures were seen in 58 (38.6\%) of 150 cases, of which 27 (46.6\%) were female and 31 (53.4\%) were male patients. Maximum cases of febrile seizures were in second year of life. Minimum age was 6 months and maximum age was 5 years with mean age 24.05 months. In our study, the mean temperature at admission to hospital in febrile convulsion patients was 101.43\ensuremath{^\circ}F \ensuremath{\pm} 1.027\ensuremath{^\circ}F. The minimum temperature noted was 100\ensuremath{^\circ}F and maximum temperature noted was 105 \ensuremath{^\circ}F. Maximum number of patients had temperature between 101 to 102\ensuremath{^\circ}F which includes 42(72.4\%) cases out of 58. 

Out of 58 cases of febrile convulsion, 46(79.3\%) cases were simple febrile convulsions and 12 (20.6\%) cases were complex febrile convulsions. This indicates that simple febrile convulsions were the most common type in present study. Among febrile seizure patients,45(77.5\%) had upper respiratory tract infection (URTI),8 (13.7\%) cases had urinary tract infection (UTI) ,4 cases (6.8\%) had malaria and 2(3.4\%) had enteric fever. UTI was more common in female children. Out of 137 cases in which etiology was identified, upper respiratory tract infection (URTI) was most common infection present in 45 (32.8\%) cases. In URTI, there was sudden rise in temperature causing febrile seizure mostly simple febrile seizures.

Pyogenic meningitis was one of the infectious causes, which was present in 7 (5.1\%) cases. These findings were consistent with study by \unskip~\citep{855782:20049996}, who found that pyogenic meningitis was present in 4.56\% of study group.\unskip~\citep{855782:20049996} Among the Metabolic causes, hypocalcemia was the leading cause seen in 6(4.3\%) cases. Hypocalcemia lead to acute symptomatic seizures, which includes 4 cases from age less than 1 year and 2 cases from 1-5 years of age. Mean age of patients with hypo calcemic seizures was 10.32 months \ensuremath{\pm} 4.84 months (minimum age 4.07 months and maximum age 18.23 months). These findings, were consistent with the study conducted by \unskip~\citep{855782:20049998} found that hypocalcemic convulsions were occurring with mean age 6.3 months \ensuremath{\pm} 5.9 months. \unskip~\citep{855782:20049998}\ensuremath{^{}}

Cerebral palsy (CP) was seen in 2.6\%. In MRI brain, 2 (33.3\%) patients had periventricular leucomalacia (PVL). All cases of CP had symptomatic generalized epilepsy and mental retardation\ensuremath{^{}}

ILAE Classification by seizure type was done in 150 cases, most common type was generalized which includes generalized tonic clonic (GTC) in 85 (56.6\%) cases (39 females and 46 males), generalized tonic (GT) in 25 (16.6\%) cases. Partial seizures were seen in 40(26.6\%) of 150 cases, out of which 12 (30\%) cases were simple partial seizures and 28 (70\%) were complex partial seizure (CPS).In a study conducted by \unskip~\citep{855782:20049999}, they found that partial seizures occurred in 19.7\% cases. \unskip~\citep{855782:20049999} In a study done by \unskip~\citep{855782:20049997}, partial seizure type was found in 22\% cases. \unskip~\citep{855782:20049997}

Out of 130 cases of situation related seizures, febrile seizures were present in 58 (44.6\%), acute symptomatic seizures in 67(51.6\%) and status epilepticus in 5 (3.8\%). Of 20 cases with epilepsy, generalized epilepsies were found in 15 (75\%) cases.9 (45\%) cases were idiopathic generalized epilepsies, 6 (30\%) cases were symptomatic generalized epilepsies, localisation related epilepsies (LREs) were found in 5 (25\%) of which, symptomatic LREs were present in 2 (40\%) cases and idiopathic LREs in 3 (60\%) cases. 

All these were more common in age group {\textgreater} 1 years. This is a statistically significant finding. (p=0.001). Anticonvulsant monotherapy was used in 77 (51.4\%) cases and 4 (2.7\%) required polytherapy to control seizures. Clobazam was used as a prophylaxis for febrile seizures in 58(38.6\%) cases. Carbamazepine was used in 33(22\%) cases and valproate in 22 (14.7\%) cases out of 150. Intravenous Calcium Gluconate was given in 6 (4\%) cases. (Table~\ref{tw-50f2f0415dcb})
    
\section{Conclusions}
Febrile seizures were the most common cause of seizures below 5 years and neurocysticercosis in older children. Neuroimaging should be advised in all afebrile children for diagnosis of neurocysticercosis in places where neurocysticercosis is endemic. Children diagnosed with epilepsy require long term follow up studies including neuropsychologic studies. Further studies on large scale over longer duration should be carried out, to put forth the diagnostic guidelines and management plans based on clinical presentation and etiological causes in a specific age group.
\section*{Acknowledgement}The author's thanks R.L. Jalappa Hospital and Research Centre, Kolar for providing facilities needed to carry out the research work.

\textbf{Conflict of Interest}

The authors declare that they have no conflict of interest for this study.

\textbf{Funding Support}

The authors declare that they have no funding support for this study.
    

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