Katılma nöbetli hastaların klinik ve laboratuvar bulguları
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Date
2009
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Uludağ Üniversitesi
Abstract
Amaç: Bu prospektif çalışmanın amacı katılma nöbeti olan çocukların klinik özelliklerinin, fizik muayene bulgularının, eşlik eden hematolojik, kardiyak ve nörolojik sorunların tedavi yaklaşımlarının ve prognozun değerlendirilmesidir. Gereç ve Yöntem: Katılma nöbeti ile başvuran 70 hasta incelendi. Ayrıntılı anamnez ve fizik muayene ile değerlendirme yapıldı. Başvuru sırasında tam kan sayımı, serum demir ve demir bağlama kapasitesi çalışıldı, kardiyak (telekardiyografi, elektrokardiyografi, gerekirse ekokardiyografi ve event recorder kaydı) ve nörolojik (EEG) incelemeler yapıldı. Tetkikler sonucunda demir eksikliği anemisi ve demir eksikliği saptananlara demir tedavisi verildi. Anemi saptanmayanlara ilaç tedavisi uygulanmadı. Başvuruda demir tedavisi verilen hastaların iki aylık aralarla hematolojik değerlendirmeleri tekrarlandı. Grupların kontrollerdeki nöbet sıklıkları, nöbet sonlanma yaşları ve sonlanma oranları karşılaştırıldı. Bulgular: Çalışmaya alınan 70 hastanın %67,1’inde siyanotik, %14,3’ünde soluk ve %18,6’sında mikst tipte katılma nöbeti görüldü. Hastaların %77,1’inde psikojenik faktörlerin rol oynadığı saptandı. 39 hastada (%55,7) demir eksikliği anemisi, 12 hastada (%17,2) demir eksikliği ve 19 hastada (%27,1) normal hematolojik parametreler saptandı. Tüm hastalarda QTc normaldi. EEG, 56 hastada (%80) normal, 11 hastada (%15,7) disritmik, 3 hastada (%4,3) ise patolojik saptandı. Katılma nöbetli hastaların %44,3’ünde ailede de katılma öyküsü mevcuttu. Sonuç: Çalışmamızda anemi derinleştikçe tablonun ağırlaştığı ve verilen tedaviye o oranda hızlı yanıt alınarak nöbet sayısının azaldığı görülmüştür. Erken dönemde daha düşük dozlarda demir desteği ile hastaların yaklaşık %92'sine yakın bir oranında nöbetlerin sonlandığı gözlenmiştir.
Aim: The aim of this prospective study was to evaluate the clinical characteristics; physical findings, cardiological, hematological and neurological problems; treatment approaches; and the prognosis of children with breath holding spells. Materials and Method: Seventhy patients were included in this study. All patients were evaluated with detailed history and physical examination. Complete blood count, serum iron and iron binding capacity were studied; cardiological (telecardiography, electrocardiography, if necessary echocardiography and event recorder) and neurological investigations (electroencephalography) were done during the admission. Patients with iron deficiency anemia and iron deficiency were treated with ferrous sulphate orally. In patients with normal hematological values, no medication was used. After a two-month treatment period patients underwent control hematological evaluation. Frequency of the spells, age of disappearance of spells (defined as 6 months without spells), disappearance ratios between the three groups were compared. Results: The percentage of cyanotic, palloric and mixt type of breath holding spells of 70 patients included in the study were 67.1, 14.3 and 18.6, respectively. It was determined that psychogenic factors played a role in 77.1% of our patients. There were iron deficiency anemia in 39 (55.7%), iron deficiency in 12 (17.2%) and normal hematological parameters in 19 (27.1%) of 70 patients. The QTc values were normal in all of them. EEG’s were normal in 56 (80%), dysrhythmic in 11 (15.7%) and pathologic in (4.3%). There was a positive family history of breath holding spells in 44.3% of those with breath holding spells. Conclusion: We determined that there was a correlation between the iron levels and the frequency of spells. The lower the iron levels the higher the frequency of spells. There was a dramatic decrease of 92% in spells with low doses of iron supplementation especially in the anemic group.
Aim: The aim of this prospective study was to evaluate the clinical characteristics; physical findings, cardiological, hematological and neurological problems; treatment approaches; and the prognosis of children with breath holding spells. Materials and Method: Seventhy patients were included in this study. All patients were evaluated with detailed history and physical examination. Complete blood count, serum iron and iron binding capacity were studied; cardiological (telecardiography, electrocardiography, if necessary echocardiography and event recorder) and neurological investigations (electroencephalography) were done during the admission. Patients with iron deficiency anemia and iron deficiency were treated with ferrous sulphate orally. In patients with normal hematological values, no medication was used. After a two-month treatment period patients underwent control hematological evaluation. Frequency of the spells, age of disappearance of spells (defined as 6 months without spells), disappearance ratios between the three groups were compared. Results: The percentage of cyanotic, palloric and mixt type of breath holding spells of 70 patients included in the study were 67.1, 14.3 and 18.6, respectively. It was determined that psychogenic factors played a role in 77.1% of our patients. There were iron deficiency anemia in 39 (55.7%), iron deficiency in 12 (17.2%) and normal hematological parameters in 19 (27.1%) of 70 patients. The QTc values were normal in all of them. EEG’s were normal in 56 (80%), dysrhythmic in 11 (15.7%) and pathologic in (4.3%). There was a positive family history of breath holding spells in 44.3% of those with breath holding spells. Conclusion: We determined that there was a correlation between the iron levels and the frequency of spells. The lower the iron levels the higher the frequency of spells. There was a dramatic decrease of 92% in spells with low doses of iron supplementation especially in the anemic group.
Description
Keywords
Katılma nöbeti, Demir eksikliği anemisi, Epilepsi, Breath holding spells, Iron deficiency anemia, Epilepsy
Citation
Özdemir, Ö. (2009). "Katılma nöbetli hastaların klinik ve laboratuvar bulguları". Güncel Pediatri, 7(2), 68-75.