Al Ameen Journal of Medical Sciences (Jul 2013)
Convulsions as primary manifestation of nutritional rickets
Abstract
Introduction: Rickets is diagnosed based on classical clinical features like craniotabes, rachitic rosary, widening of wrist joints, pot belly, hypotonia, bowed legs and supported by the laboratory evidence of hypocalcemia, hypophosphatemia, and raised alkaline phosphatase. Hypocalcemic convulsions are a rare manifestation of nutritional rickets. Decline in the magnitude of the rickets requires high index of suspicion to identify this treatable condition. Herewith presenting retrospective study of twelve cases of rickets who presented with hypocalcemic seizures as primary manifestation. Materials and methods: A detailed retrospective analysis of diagnosed cases of rickets presenting with convulsions was done. Children who were admitted with hypocalcemic convulsion and subsequently diagnosed to have rickets were included in the study. Children who did not fulfill the criteria for diagnosis of rickets either clinically or biochemically or radiologically were excluded from the study. Details including age at presentation, weight, sex, gestational age and other associated diseases were collected and analyzed. Rickets was diagnosed on the basis of clinical features, biochemical parameters (serum calcium, phosphorous, alkaline phosphatase) and radiological findings. Results: A Total of 12 children; 8 male and 4 females constituted the study subjects. Mean age of presentation was 6 months. All children had presented with preceding convulsions or active convulsions. One child who presented with active convulsions was treated with parenteral phenobarbitone. All 12 of them were evaluated for the cause and found to have hypocalcemia without any other cause for convulsions. Further clinical examination revealed features of rickets and were subjected to radiological and biochemical investigations. The mean calcium value was 6.3mg/dl, phosphorus -5.35mg/dl, alkaline phosphatase-890.13 units. All the cases had radiological features of rickets. All 12 were treated with parenteral vitamin-D and they responded well to the treatment. Conclusions: Convulsion is a rare manifestation of rickets and as a primary presentation is even rarer. Current observational study indicates that rickets could be a cause of hypocalcemic convulsion in young infants and children. Screening infants and young children presenting with convulsion for rickets can help in early diagnosis and institution of specific therapy.
