Çocuk nöroloji polikliniğinde 2009-2012 yılları arasında dirençli epilepsi tanısı alan hastaların etiyolojik değerlendirilmesi
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Date
2015
Authors
Çetinkaya, Fatma
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
Epilepsi tekrarlayan nöbet eğilimi ile karakterize tüm dünyada yaygın olarak görülen önemli bir sağlık problemi olup aynı zamanda çocuklarda en sık görülen ciddi nörolojik bozukluklardan biridir. Dirençli epilepsi kavramının tanımlanması hala tartışma konusudur. En az iki yıl epilepsi nedeni ile takip edilen, üç ve daha fazla antiepileptik ilacı tek tek veya kombinasyonlar halinde ve etkin serum seviyesinde almasına rağmen, son üç ay içinde ortalama her ay nöbet geçiren hastalar dirençli epilepsili hastalar olarak kabul edildi. Bu çalışmada Uludağ Üniversitesi Tıp Fakültesi Pediatrik Nöroloji polikliniğine Ocak 2009 ve Aralık 2012 taihleri arasında başvuran dirençli epilepsili hastaların muhtemel risk faktörlerinin belirlenmesi amaçlandı. Veriler Uludağ Üniversitesi Tıp Fakültesi Çocuk Nöroloji Bilim Dalı Polikliniğinde epilepsi tanısı almış, en az iki yıldır izlemde olan 01.01.2009–31.12.2012 tarihleri arasında takip edilen hastaların dosyaları incelenerek elde edildi. Çalışmaya dirençli grup ve iyi kontrollü grup olmak üzere 2 hasta grubu dahil edildi. Dirençli grupta 125 ve iyi kontrollü grupta 120 tane olmak üzere toplam 245 hasta çalışmaya dahil edildi. Vakaların 120'si (%49) kız, 125'i (%51) erkek çocuktan oluşmaktaydı. Değerlendirilen epilepsi hastalarının yaş aralığı 1 ile 18 yıl arasında değişmekte olup median değer 8,3 (1-18) yıl olarak bulundu. Dirençli grubun yaş ortalaması 7,8 yıl (±4,7), iyi kontrollü grubun yaş ortalaması 9 yıl (±4,8) olarak değerlendirildi. Hastaların izlem sürelerine bakıldığında 3,5-14,8 yıl (ortalama 7,4±2,1) arasındaydı. Çalışmamızda dirençli epilepsi için risk faktörlerini ilk nöbetin bir yaş altında görülmesi, nöromotor gelişm geriliğinin olması, başvuru anında sık nöbet geçirmesi (her gün), nöbet tipinin üçten fazla olması, mikrosefali, hidrosefali, mental retardasyon ve serebral palsi varlığı, birden fazla status epileptikus öyküsünün olması veya geçirmesi olarak belirledik. Dirençli gruptaki hastalar uzun süre nöbet geçirmeye devam ettiklerinden ve çok sayıda ilaç kullandıklarından, bunların sonucunda tıbbi, sosyal ve ekonomik boyutlarının ağır olduğu görülmektedir. Ayrıca ilaç yan etkilerinin ve sık nöbet geçirmeye bağlı davranış ve psikolojik problemlerin görülme riski yüksektir. Bu nedenle hangi hasta grubunun tıbbi tedaviye iyi yanıt vermeyeceği hastalığın erken dönemde tahmin edilebilirse diğer hastalardan farklı olarak bu hasta grubuna erken yeni kuşak antiepileptik kullanımı, vagal sinir uyarımı, ketojenik diyet, uygun vakalara epilepsi cerrahisi gibi değişik tedavi yöntemleri daha erken uygulanabilir.
Epilepsia, characterized by tendency to recurrent convulsion, is a globally common and important health problem which at the same time is one of the most frequent neurogical disorders in children. The definition of intractable epilepsia is stil controversial. The children who were followed for epilepsia for 2 years, who were given three or more antiepileptic in combination or separately but had seizures in three months although effective serum concentration was achieved and who had at least one seizure in every month were accepted as intractable epilepsia patients. The aim of this study was to define the risk factors of the intractable epilepsia patients who admitted to Uludag University Faculty of Medicine Department of Pediatric Neurology Policlinic between January 2009 and December 2012. The data were obtained from the records of the epilepsia patients who were followed up at least for two years in the Uludag University Faculty of Medicine Department of Pediatric Neurology Policlinic between January 2009 and December 2012. Two patient groups such as intractable group and well-controlled group were included in the study. There were total 245 patients whom of 125 were in intractable group and 120 were in well-controlled group. There were 120 female (49%) and 125 male (51%) patients. The epilepsia diagnosis of the patients were 1-18 years (mean, 8,3). The follow-up period of the patients were 2,1–13,9 years (mean 6,9±2,6y). The intractable epilepsia diagnosis of the patient's age were mean 7,8 (±4,7y) and ıt was mean 9 (±4,8y) in well-controlled group. The follow-up period of the patients were 3,5–14,8 years (mean 7,4±2,1y). The risk factors for intractable epilepsia in our study were found as follows: diagnosed before one year, neuromotor development delay, frequent seizure at admission (every day), had seizures more than three types, had microcephaly, hidrocephaly, mental retardation and cerebral palsy, had or history of status epilepticus one more than. The intractable epilepsia patients had medical, social and economic problems due to the multiple medications and long term seizures. The frequency of adverse effects of the drugs and behavioural and psychological problems were also more common in these patient groups. Therefore, as according to the risk factors, different therapy starategies such as using new antiepileptic drugs, vagal nerve stimulation, ketogenic diet, and epilepsia surgery in appropriate cases must be considered in the early period in these patients.
Epilepsia, characterized by tendency to recurrent convulsion, is a globally common and important health problem which at the same time is one of the most frequent neurogical disorders in children. The definition of intractable epilepsia is stil controversial. The children who were followed for epilepsia for 2 years, who were given three or more antiepileptic in combination or separately but had seizures in three months although effective serum concentration was achieved and who had at least one seizure in every month were accepted as intractable epilepsia patients. The aim of this study was to define the risk factors of the intractable epilepsia patients who admitted to Uludag University Faculty of Medicine Department of Pediatric Neurology Policlinic between January 2009 and December 2012. The data were obtained from the records of the epilepsia patients who were followed up at least for two years in the Uludag University Faculty of Medicine Department of Pediatric Neurology Policlinic between January 2009 and December 2012. Two patient groups such as intractable group and well-controlled group were included in the study. There were total 245 patients whom of 125 were in intractable group and 120 were in well-controlled group. There were 120 female (49%) and 125 male (51%) patients. The epilepsia diagnosis of the patients were 1-18 years (mean, 8,3). The follow-up period of the patients were 2,1–13,9 years (mean 6,9±2,6y). The intractable epilepsia diagnosis of the patient's age were mean 7,8 (±4,7y) and ıt was mean 9 (±4,8y) in well-controlled group. The follow-up period of the patients were 3,5–14,8 years (mean 7,4±2,1y). The risk factors for intractable epilepsia in our study were found as follows: diagnosed before one year, neuromotor development delay, frequent seizure at admission (every day), had seizures more than three types, had microcephaly, hidrocephaly, mental retardation and cerebral palsy, had or history of status epilepticus one more than. The intractable epilepsia patients had medical, social and economic problems due to the multiple medications and long term seizures. The frequency of adverse effects of the drugs and behavioural and psychological problems were also more common in these patient groups. Therefore, as according to the risk factors, different therapy starategies such as using new antiepileptic drugs, vagal nerve stimulation, ketogenic diet, and epilepsia surgery in appropriate cases must be considered in the early period in these patients.
Description
Keywords
Çocukluk çağı epilepsileri, Dirençli epilepsi, Risk faktörleri, Childhood epilepsies, Intractable epilepsia, Risk factors
Citation
Çetinkaya, F. (2015). Çocuk nöroloji polikliniğinde 2009-2012 yılları arasında dirençli epilepsi tanısı alan hastaların etiyolojik değerlendirilmesi. :Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.