epilepsiaEpilepsy and paroxysmal conditionsЭпилепсия и пароксизмальные состояния2077-83332311-4088IRBIS LLC10.17749/2077-8333/epi.par.con.2025.198epilepsia-1187Research ArticleORIGINAL ARTICLESОРИГИНАЛЬНЫЕ СТАТЬИCow’s milk in infant diet is a risk factor for hypocalcemic seizuresКоровье молоко в рационе младенцев – фактор риска развития гипокальциемических приступовhttps://orcid.org/0000-0001-6253-1016АрункартикK.ArunkarthikK.

Кришнан Арункартик 

Порур, Ченнаи, Тамилнад 600116 

Krishnan Arunkarthik 

Porur, Chennai, Tamil Nadu 600116 

https://orcid.org/0000-0002-4897-5400Тасма СантанакришнанA.Thasma SanthanakrishnanA.

Арунпрасат Тасма Сантанакришнан, доцент 

Порур, Ченнаи, Тамилнад 600116 

Arunprasath Thasma Santhanakrishnan, Assoc. Prof.  

Porur, Chennai, Tamil Nadu 600116 

Институт высшего образования и научных исследований Шри РамачандрыИндияSri Ramachandra Institute of Higher Education and ResearchIndia2025020520251714853Copyright © Arunkarthik K., Thasma Santhanakrishnan A., 20252025Арункартик K., Тасма Сантанакришнан A.Arunkarthik K., Thasma Santhanakrishnan A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.epilepsia.su/jour/article/view/1187Background

Background. Seizures are common in infants due to the inherent sensitivity of the developing brain to various insults, with metabolic alterations being a ordinary cause. Among these, hypocalcemia is a prevalent factor. Early diagnosis of hypocalcemic seizures is essential as the management and prognosis differ from other seizure causes.

Objective

Objective: To investigate the prevalence and associated risk factors of hypocalcemic seizures in children aged 1 month to 2 years.

Material and methods

Material and methods. This prospective observational study was conducted over 18 months in a tertiary care teaching hospital, following institutional ethics committee approval. All children in the specified age group presenting with seizures were enrolled and given standard care. Demographic and relevant risk factor details were recorded in a pre-designed proforma. Children with hypocalcemia underwent further testing for vitamin D, parathormone, alkaline phosphatase, and magnesium blood levels. Based on a previous study, a sample size of 225 was calculated to achieve a power of 80% and a confidence interval of 95%, with a marginal error rate of 0.06.

Results

Results. Of the 225 children enrolled (53.7% boys), the most common type of seizures was simple febrile seizures (46.2%). The prevalence of hypocalcemic seizures was 3.6% (8 cases). Significant factors associated with hypocalcemic seizures included age and the administration of cow’s milk before 1-year age. All children with hypocalcemic seizures had vitamin D deficiency, with a mean vitamin D level of 7.77 ng/dl, and elevated alkaline phosphatase levels (mean 841.8 U/l).

Conclusion

Conclusion. Hypocalcemic seizures should be considered in the evaluation of seizures in children, particularly in young infants and when cow’s milk is introduced before 1-year age.

Актуальность

Актуальность. Из-за врожденной чувствительности развивающегося мозга к различным повреждениям у младенцев нередко наблюдаются судороги, причиной которых часто служат метаболические изменения. Среди них распространенным фактором является гипокальциемия. Большое значение имеет ранняя диагностика гипокальциемических приступов, поскольку их ведение и прогноз отличаются от таковых при других вариантах судорог.

Цель

Цель: изучить распространенность гипокальциемических приступов и связанные с ними факторы риска у детей в возрасте от 1 мес до 2 лет.

Материал и методы

Материал и методы. Проспективное наблюдательное исследование проводилось в течение 18 мес в высокоспециализированной клинической больнице после одобрения местного этического комитета. Все дети в указанной возрастной группе, у которых наблюдались приступы, были включены в исследование и получили стандартную медицинскую помощь. Демографические данные и соответствующие факторы риска были внесены в ранее разработанную карту пациента. Дети с гипокальциемией прошли дополнительное тестирование с измерением уровней витамина D, паратгормона, щелочной фосфатазы и магния в крови. На основе предыдущего исследования был определен размер группы в 225 человек для достижения мощности 80% и доверительного интервала 95% с предельной частотой ошибок 0,06.

Результаты

Результаты. Из 225 включенных в исследование детей (53,7% мальчиков) наиболее распространенным типом приступов были простые фебрильные (46,2%). Распространенность гипокальциемических приступов составила 3,6% (8 случаев). Значимые факторы, связанные с гипокальциемическими приступами, включали возраст пациента и употребление коровьего молока до достижения возраста 1 года. У всех детей с гипокальциемическими приступами обнаружен дефицит витамина D (средний уровень 7,77 нг/дл) и повышенное содержание щелочной фосфатазы (средний уровень 841,8 ед/л).

Заключение

Заключение. Гипокальциемические приступы следует учитывать при оценке судорог у детей, особенно у младенцев и при употреблении коровьего молока до достижения ими возраста 1 года.

гипокальциемияприступыкоровье молокомладенцыhypocalcemiaseizurescow’s milkinfantsReferencesRomantseva L., Lin N. Acute seizures-work-up and management in children. Semin Neurol. 2020; 40 (6): 606–16. https://doi.org/10.1055/s-0040-1718718.Romantseva L., Lin N. Acute seizures-work-up and management in children. Semin Neurol. 2020; 40 (6): 606–16. https://doi.org/10.1055/s-0040-1718718.Sharma A. Seizures and epilepsy in children. Indian J Pediatr. 2013; 80 (11): 925–35. https://doi.org/10.1007/s12098-013-1173-x.Sharma A. Seizures and epilepsy in children. Indian J Pediatr. 2013; 80 (11): 925–35. https://doi.org/10.1007/s12098-013-1173-x.Basatemur E., Sutcliffe A. Incidence of hypocalcemic seizures due to vitamin D deficiency in children in the United Kingdom and Ireland. J Clin Endocrinol Metab. 2015; 100 (1): E91–5. https://doi.org/10.1210/jc.2014-2773.Basatemur E., Sutcliffe A. Incidence of hypocalcemic seizures due to vitamin D deficiency in children in the United Kingdom and Ireland. J Clin Endocrinol Metab. 2015; 100 (1): E91–5. https://doi.org/10.1210/jc.2014-2773.Han P., Trinidad B.J., Shi J. Hypocalcemia-induced seizure: demystifying the calcium paradox. ASN Neuro. 2015; 7 (2): 1759091415578050. https://doi.org/10.1177/1759091415578050.Han P., Trinidad B.J., Shi J. Hypocalcemia-induced seizure: demystifying the calcium paradox. ASN Neuro. 2015; 7 (2): 1759091415578050. https://doi.org/10.1177/1759091415578050.Rahman W., Lohana H., Urooj S., et al. Frequency of hypocalcemic fits in children 2 months to 2 years of age, presenting with the first episode of afebrile seizures at hospital settings in urban Pakistan: a cross-sectional study. Open J Pediatr. 2020; 10 (3): 411–22. https://doi.org/10.4236/ojped.2020.103042.Rahman W., Lohana H., Urooj S., et al. Frequency of hypocalcemic fits in children 2 months to 2 years of age, presenting with the first episode of afebrile seizures at hospital settings in urban Pakistan: a cross-sectional study. Open J Pediatr. 2020; 10 (3): 411–22. https://doi.org/10.4236/ojped.2020.103042.Khan M.A., Iqbal S.M.J., Afzal M.F., Sultan M.A. Frequency of hypocalcemic fits in children presenting with afebrile seizures and risk factors for hypocalcemia – a descriptive study. Ann King Edward Medical University. 2011; 17 (1): 31. https://doi.org/10.21649/akemu.v17i1.266.Khan M.A., Iqbal S.M.J., Afzal M.F., Sultan M.A. Frequency of hypocalcemic fits in children presenting with afebrile seizures and risk factors for hypocalcemia – a descriptive study. Ann King Edward Medical University. 2011; 17 (1): 31. https://doi.org/10.21649/akemu.v17i1.266.Kamate M., Sharma K., Patil V. Prevalence of hypocalcemia in seizures in infancy. Indian J Pediatr. 2018; 85 (4): 307–8. https://doi.org/10.1007/s12098-017-2546-3.Kamate M., Sharma K., Patil V. Prevalence of hypocalcemia in seizures in infancy. Indian J Pediatr. 2018; 85 (4): 307–8. https://doi.org/10.1007/s12098-017-2546-3.Lo S. Reference intervals for laboratory tests and procedures. In: Kleigmann R., Stanton B., Schor N., et al. (Eds.) Nelson textbook of pediatrics. First South Asia Edition. New Delhi: Reed Elsevier India; 2016: 3466–8.Lo S. Reference intervals for laboratory tests and procedures. In: Kleigmann R., Stanton B., Schor N., et al. (Eds.) Nelson textbook of pediatrics. First South Asia Edition. New Delhi: Reed Elsevier India; 2016: 3466–8.Khadilkar A., Khadilkar V., Chinnappa J., et al. Prevention and treatment of vitamin D and calcium deficiency in children and adolescents: Indian Academy of Pediatrics (IAP) Guidelines. Indian Pediatr. 2017; 54 (7): 567–73. https://doi.org/10.1007/s13312-017-1070-x.Khadilkar A., Khadilkar V., Chinnappa J., et al. Prevention and treatment of vitamin D and calcium deficiency in children and adolescents: Indian Academy of Pediatrics (IAP) Guidelines. Indian Pediatr. 2017; 54 (7): 567–73. https://doi.org/10.1007/s13312-017-1070-x.Nikunj N.K., Mishra D., Juneja M., Talukdar B. Etiology and short-term outcome of first seizure in hospitalized infants. Indian Pediatr. 2016; 53 (10): 924–6.Nikunj N.K., Mishra D., Juneja M., Talukdar B. Etiology and short-term outcome of first seizure in hospitalized infants. Indian Pediatr. 2016; 53 (10): 924–6.Gowda V.K., Kulhalli P., Benakappa N., Benakappa A. Etiological profile of afebrile seizures in infants in a Tertiary Care Center from Southern India. J Pediatr Neurosci. 2019; 14 (2): 82–5. https://doi.org/10.4103/jpn.JPN_61_18.Gowda V.K., Kulhalli P., Benakappa N., Benakappa A. Etiological profile of afebrile seizures in infants in a Tertiary Care Center from Southern India. J Pediatr Neurosci. 2019; 14 (2): 82–5. https://doi.org/10.4103/jpn.JPN_61_18.Dad M.I., Ismael G.A., Al-Oufi A.A., Al-Mohammadi A.H. Clinical pattern of seizures in hospitalized children. Neurosciences (Riyadh). 2003; 8 (2): 107–9.Dad M.I., Ismael G.A., Al-Oufi A.A., Al-Mohammadi A.H. Clinical pattern of seizures in hospitalized children. Neurosciences (Riyadh). 2003; 8 (2): 107–9.Cetinkaya F., Sennaroglu E., Comu S. Etiologies of seizures in young children admitted to an inner city hospital in a developing country. Pediatr Emerg Care. 2008; 24 (11): 761–3. https://doi.org/10.1097/PEC.0b013e31818c2652.Cetinkaya F., Sennaroglu E., Comu S. Etiologies of seizures in young children admitted to an inner city hospital in a developing country. Pediatr Emerg Care. 2008; 24 (11): 761–3. https://doi.org/10.1097/PEC.0b013e31818c2652.Balasubramanian S., Shivbalan S., Kumar P.S. Hypocalcemia due to vitamin D deficiency in exclusively breastfed infants. Indian Pediatr. 2006; 43 (3): 247–51.Balasubramanian S., Shivbalan S., Kumar P.S. Hypocalcemia due to vitamin D deficiency in exclusively breastfed infants. Indian Pediatr. 2006; 43 (3): 247–51.Mehrotra P., Marwaha R.K., Aneja S., et al. Hypovitaminosis D and hypocalcemic seizures in infancy. Indian Pediatr. 2010; 47 (7): 581–6. https://doi.org/10.1007/s13312-010-0131-1.Mehrotra P., Marwaha R.K., Aneja S., et al. Hypovitaminosis D and hypocalcemic seizures in infancy. Indian Pediatr. 2010; 47 (7): 581–6. https://doi.org/10.1007/s13312-010-0131-1.Ladhani S., Srinivasan L., Buchanan C., Allgrove J. Presentation of vitamin D deficiency. Arch Dis Child. 2004; 89 (8): 781–4. https://doi.org/10.1136/adc.2003.031385.Ladhani S., Srinivasan L., Buchanan C., Allgrove J. Presentation of vitamin D deficiency. Arch Dis Child. 2004; 89 (8): 781–4. https://doi.org/10.1136/adc.2003.031385.Zuckermann E.C., Glaser G.H. Anticonvulsive action of increased calcium concentration in cerebrospinal fluid. Arch Neurol. 1973; 29 (4): 245–52. https://doi.org/10.1001/archneur.1973.00490280057008.Zuckermann E.C., Glaser G.H. Anticonvulsive action of increased calcium concentration in cerebrospinal fluid. Arch Neurol. 1973; 29 (4): 245–52. https://doi.org/10.1001/archneur.1973.00490280057008.Qureshi U.A., Bhat A.S., Jan M., Qureshi U. Late onset hypocalcemic seizures in formula-fed, vitamin D deficient babies: revisited. J Neonatol. 2020; 34 (1–2): 15–8. https://doi.org/10.1177/0973217920927903.Qureshi U.A., Bhat A.S., Jan M., Qureshi U. Late onset hypocalcemic seizures in formula-fed, vitamin D deficient babies: revisited. J Neonatol. 2020; 34 (1–2): 15–8. https://doi.org/10.1177/0973217920927903.Abrams S.A. Calcium absorption in infants and small children: methods of determination and recent findings. Nutrients. 2010; 2 (4): 474–80. https://doi.org/10.3390/nu2040474.Abrams S.A. Calcium absorption in infants and small children: methods of determination and recent findings. Nutrients. 2010; 2 (4): 474–80. https://doi.org/10.3390/nu2040474.Monni R., Beccaria F., Boscaini F., et al. Pearls & Oy-sters: focal hypocalcemic seizures secondary to severe vitamin D deficiency/ rickets. Neurology. 2020; 95 (12): e1764–5. https://doi.org/10.1212/WNL.0000000000009837.Monni R., Beccaria F., Boscaini F., et al. Pearls & Oy-sters: focal hypocalcemic seizures secondary to severe vitamin D deficiency/ rickets. Neurology. 2020; 95 (12): e1764–5. https://doi.org/10.1212/WNL.0000000000009837.Salama M.M., El-Sakka A.S. Hypocalcemic seizures in breastfed infants with rickets secondary to severe maternal vitamin D deficiency. Pak J Biol Sci. 2010; 13 (9): 437–42. https://doi.org/10.3923/pjbs.2010.437.442.Salama M.M., El-Sakka A.S. Hypocalcemic seizures in breastfed infants with rickets secondary to severe maternal vitamin D deficiency. Pak J Biol Sci. 2010; 13 (9): 437–42. https://doi.org/10.3923/pjbs.2010.437.442.Aguiar M., Andronis L., Pallan M., et al. Micronutrient deficiencies and health-related quality of life: the case of children with vitamin D deficiency. Public Health Nutr. 2020; 23 (7): 1165–72. https://doi.org/10.1017/S1368980018003841.Aguiar M., Andronis L., Pallan M., et al. Micronutrient deficiencies and health-related quality of life: the case of children with vitamin D deficiency. Public Health Nutr. 2020; 23 (7): 1165–72. https://doi.org/10.1017/S1368980018003841.Cesur Y., Yuca S.A., Kaya A., et al. Vitamin D deficiency rickets in infants presenting with hypocalcaemic convulsions. West Indian Med J. 2013; 62 (3): 201–4.Cesur Y., Yuca S.A., Kaya A., et al. Vitamin D deficiency rickets in infants presenting with hypocalcaemic convulsions. West Indian Med J. 2013; 62 (3): 201–4.Misra M., Pacaud D., Petryk A., et al. Vitamin D deficiency in children and its management: review of current knowledge and recommendations. Pediatrics. 2008; 122 (2): 398–417. https://doi.org/10.1542/peds.2007-1894.Misra M., Pacaud D., Petryk A., et al. Vitamin D deficiency in children and its management: review of current knowledge and recommendations. Pediatrics. 2008; 122 (2): 398–417. https://doi.org/10.1542/peds.2007-1894.

The authors declare that there are no conflicts of interest present.