The Limits of Etiological Diagnosis of Convulsions in Children at the Bangui Pediatric Hospital

Introduction: Convulsions are a frequent cause of admission to paediatric wards in countries with limited resources, and a major cause of neurological and cognitive sequelae. In sub-Saharan Africa, the aetiology of febrile convulsions is dominated by infections of the central nervous system. A detailed clinical examination and laboratory and imaging tests are carried out to identify the cause of the disease. Computed tomography is reserved for emergency situations or as a second line of defence, after Magnetic Resonance Imaging (MRI) to look for calcifications. Imaging thus helps to establish the nature of the epileptogenic lesion, specify its extent and guide its therapeutic management. The aim of this study is to clarify the contribution of MRI in the etiological investigation of convulsions in children at the paediatric university hospital, in addition to the usual means of exploration. Patient and Method: This was a cross-sectional, descriptive study from January 2022 to December 2023. We carried out an exhaustive sampling of all children aged between 1 and 59 months admitted for convulsion with fever or not who had undergone complementary examinations for aetiological purposes in relation to our technical platform during the study period. Results: Thirty patients were recruited. Children aged 12 to 59 months were the most represented (69.7%). The sex ratio was 1.30. The mean age was 36 months (range 30 days to 59 months). Of the 30 patients, 21.8% had a history of febrile convulsions. Most of our patients were from Bangui (73.3%). On admission, the majority of patients presented with an elevated temperature ranging from 38.5 degrees Celsius to 39.4 degrees Celsius in 33.1% of cases. The dominant clinical manifestations were tonic-clonic convulsions (53.2%), tonic convulsions (35.3%) and clonic convulsions (11.5%). According to their characteristics, convulsions were complex in 53.7% of cases and simple in 46.3%. Examinations for infectious diseases, tumors or malformation has been ruled out. The anticonvulsants most commonly used were diazepam, phenobarbital and phenytoin. We recorded a 73.3% cure rate and 4 (13.3%) cases of death. Conclusion: The investigation of seizures in search of aetiology outside the usual means in our context still presents difficulties. MRI is the examination of choice for exploring the posterior fossa and midline lesions. Combined with CT, it is better for exploring hemispheric tumours.