Cow’s milk in infant diet is a risk factor for hypocalcemic seizures

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