Uludağ Üniversitesi Tıp fakültesi hastanesi çocuk acil servisi ve çocuk genel polikliniğine nöbet geçirme yakınması ile başvuran hastaların retrospektif olarak degerlendirilmesi
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Date
2019
Authors
Öztürk, Erdem
Journal Title
Journal ISSN
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Publisher
Uludağ Üniversitesi
Abstract
Nöbet; nöronların anormal, zaman sınırlı, istemsiz ritmik deşarjlarından kaynaklanan paroksismal semptomlarıdır. 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. Çalışmada Uludağ Üniversitesi Tıp Fakültesi Çocuk Sağlığı ve Hastalıkları Anabilim Dalı Çocuk Acil servisi ve Çocuk Genel polikliniğine 24.04.2017-24.04.2018 tarihleri arasındaki bir yıllık dönemde nöbet şikayeti ile başvuran 1 ay-18 yaş arasındaki hastaların dosya kayıtları retrospektif olarak tarandı. Hastaların başvurudaki kan şekeri, böbrek fonksiyon testleri, karaciğer fonksiyon testleri, serum elektrolitleri, amonyak ve kan gazı sonuçlarI, eski ve yeni çekilen EEG ve MRG sonuçları kaydedildi. Acil servisten nasıl ayrıldığı, ilaç başlanıp başlanmadığı, altta yatan etiyolojik faktörlerin ne olduğu saptandı. Toplam 481 hasta analiz edildi. Hastaların %52,3'ünü erkek, %47,7'sini kız cinsiyet oluşturmaktaydı. Hastaların yaş ortalaması ise 70,28±60,8 ay idi (sınırlar: 1 ay-215 ay). Hastaların %55,9'u (n=270) 1 ay-5 yaş arasında, %23,7'si (n=113) 5,01-10 yaş arasında ve %20,3'ü (n=98) 10 yaş üzerindeydi. Olguların 398'i (%82,7) acil servis başvurusu, 83'ü (%17,3) genel poliklinik başvurusu idi. Nöbetlerin %21,8'i (n=105) fokal, %68,4'ü (n=329) jeneralize idi. Hastaların %33,2'sine (n=159) ilk defa antiepileptik ilaç başlandı, 12 hastanın (%2,5) ise ilacı başka bir antiepileptik ilaç ile değiştirildi. Hastaların 458'inin etiyolojisine ulaşılabildi. Etiyolojide ilk sırayı %33,6'lık oranıyla idiyopatik hasta grubu oluşturdu. İkinci sırada %29,9'luk hasta oranıyla febril konvülziyonlar, üçüncü sırada %6,4 'lük hasta oranıyla uygun olmayan antiepileptik kullanımı ya da mevcut kullandığı antiepileptik ilacın ani kesilmesi olarak saptandı. Bunları %6,1'lik hasta oranı ile HİE izledi. Çalışmamızda çocukluk döneminde konvülziyon etiyolojisinde idiyopatik epilepsi ve febril konvülziyon'un en sık nedenler olduğu saptandı, epileptik olmayan nedenlerin ayrımı ve etiyolojik nedenlerin saptanmasının prognozun belirlenmesinde önemli olduğu düşünüldü. Nöbetle başvuran hastada nöbet ayırımı yapılması ve ardından gerekli olgulara gerekli tetkikler yapıldıktan sonra uygun olan olgulara ilaç başlanması, ilacın uygun dozda verilmesi ve kullanılması, ilaç yan etkileri açısından ve klinik açıdan olguların takibe alınması gerektiğine karar verildi.
Seizure; paroxysmal symptoms of neurons due to abnormal, time-limited, involuntary rhythmic discharges. Epilepsy is a common health problem that is characterized by recurrent seizures and is one of the most common serious neurological disorders in children. In this study, the records of patients between the ages of 1 month and 18 years who applied to the Uludağ University Faculty of Medicine, Pediatric Emergency Department and Pediatric General Policlinic between 24.04.2017-24.04.2018 with the complaint of seizure were reviewed retrospectively. At the time of application blood glucose results, renal function tests, liver function tests, serum electrolytes, ammonia and blood gas results, old and new EEG and MRI results of the patients were recorded. It was determined how the emergency room was separated, whether the drug was started, and the underlying etiological factors. 481 patients were analyzed. 52,3% of the patients were male and 47,7% were female. The mean age of the patients was 70,28 ± 60,8 months (range: 1 month-215 months). 55,9% (n = 270) of the patients were between 1 month and 5 years, 23,7% (n = 113) between 5,01 and 10 years and 20.3% (n = 98) were over 10 years old. Of the cases, 398 (82,7%) were admitted to the emergency department and 83 (17,3%) were admitted to general polyclinic. 21,8% (n = 105) of the seizures were focal and 68,4% (n = 329) were generalized. Antiepileptic medication was started for the first time in 33,2% of the patients (n = 159) and the drug was replaced with another antiepileptic drug in 12 patients (2,5%). The etiology of 458 patients was achieved. The idiopathic patient group was the first in the etiology with a rate of 33,6%. The second one was febrile convulsions with a rate of 29,9%, the third line was determined by the use of inappropriate antiepileptic drugs or the sudden discontinuation of the current antiepileptic drug with a rate of 6,4%. These were followed by HIE with a 6,1% patient rate. In our study, it was found that idiopathic epilepsy and febrile convulsions were the most common causes of convulsion in childhood, and it was thought that the separation of non-epileptic causes and the determination of etiological causes were important in determining the prognosis. Seizure separation should be performed in the patient presenting with seizures and necessary examinations should be made to the required cases. Then, appropriate drugs should be started and used in appropriate doses. Afterwards, it was decided that the drug side effect and the clinical aspects should be followed up.
Seizure; paroxysmal symptoms of neurons due to abnormal, time-limited, involuntary rhythmic discharges. Epilepsy is a common health problem that is characterized by recurrent seizures and is one of the most common serious neurological disorders in children. In this study, the records of patients between the ages of 1 month and 18 years who applied to the Uludağ University Faculty of Medicine, Pediatric Emergency Department and Pediatric General Policlinic between 24.04.2017-24.04.2018 with the complaint of seizure were reviewed retrospectively. At the time of application blood glucose results, renal function tests, liver function tests, serum electrolytes, ammonia and blood gas results, old and new EEG and MRI results of the patients were recorded. It was determined how the emergency room was separated, whether the drug was started, and the underlying etiological factors. 481 patients were analyzed. 52,3% of the patients were male and 47,7% were female. The mean age of the patients was 70,28 ± 60,8 months (range: 1 month-215 months). 55,9% (n = 270) of the patients were between 1 month and 5 years, 23,7% (n = 113) between 5,01 and 10 years and 20.3% (n = 98) were over 10 years old. Of the cases, 398 (82,7%) were admitted to the emergency department and 83 (17,3%) were admitted to general polyclinic. 21,8% (n = 105) of the seizures were focal and 68,4% (n = 329) were generalized. Antiepileptic medication was started for the first time in 33,2% of the patients (n = 159) and the drug was replaced with another antiepileptic drug in 12 patients (2,5%). The etiology of 458 patients was achieved. The idiopathic patient group was the first in the etiology with a rate of 33,6%. The second one was febrile convulsions with a rate of 29,9%, the third line was determined by the use of inappropriate antiepileptic drugs or the sudden discontinuation of the current antiepileptic drug with a rate of 6,4%. These were followed by HIE with a 6,1% patient rate. In our study, it was found that idiopathic epilepsy and febrile convulsions were the most common causes of convulsion in childhood, and it was thought that the separation of non-epileptic causes and the determination of etiological causes were important in determining the prognosis. Seizure separation should be performed in the patient presenting with seizures and necessary examinations should be made to the required cases. Then, appropriate drugs should be started and used in appropriate doses. Afterwards, it was decided that the drug side effect and the clinical aspects should be followed up.
Description
Keywords
Epilepsi, Nöbet, Febril konvülziyon, Epilepsy, Seizure, Febrile convulsion
Citation
Öztürk, E. (2019). Uludağ Üniversitesi Tıp Fakültesi Hastanesi Çocuk Acil Servisi ve Çocuk Genel Polikliniğine nöbet geçirme yakınması ile başvuran hastaların retrospektif olarak degerlendirilmesi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.