Katılma Nöbetli Hastaların Klinik ve Laboratuvar Bulguları

Year 2009, Volume: 7 Issue: 3, 68 - 75, 01.12.2009

Özlem Özdemir Serpil Çalışkan Can Evren Semizel Mehmet S. Okan

Abstract

Amaç: Bu prospektif çalışmanın amacı katılma nöbeti olan çocukların kliniközelliklerinin, fizik muayene bulgularının, eşlik eden hematolojik, kardiyak venörolojik sorunların tedavi yaklaşımlarının ve prognozun değerlendirilmesidir. Gereç ve Yöntem: Katılma nöbeti ile başvuran 70 hasta incelendi. Ayrıntılıanamnez ve fizik muayene ile değerlendirme yapıldı. Başvuru sırasında tam kansayımı, serum demir ve demir bağlama kapasitesi çalışıldı, kardiyak telekardiyografi, elektrokardiyografi, gerekirse ekokardiyografi ve eventrecorder kaydı ve nörolojik EEG incelemeler yapıldı. Tetkikler sonucundademir eksikliği anemisi ve demir eksikliği saptananlara demir tedavisi verildi.Anemi saptanmayanlara ilaç tedavisi uygulanmadı. Başvuruda demir tedavisiverilen hastaların iki aylık aralarla hematolojik değerlendirmeleri tekrarlandı.Grupların kontrollerdeki nöbet sıklıkları, nöbet sonlanma yaşları ve sonlanmaoranları karşılaştırıldı.Bulgular: Çalışmaya alınan 70 hastanın %67,1’inde siyanotik, %14,3’ünde solukve %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 tedaviyeo oranda hızlı yanıt alınarak nöbet sayısının azaldığı görülmüştür. Erken dönemdedaha düşük dozlarda demir desteği ile hastaların yaklaşık %92'sine yakın biroranında nöbetlerin sonlandığı gözlenmiştir

Keywords

Katılma nöbeti, demir eksikliği anemisi, epilepsi

Clinical and Laboratory Findings of Patients with Breath Holding Spells

Abstract

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

Keywords

Breath holding spells, iron deficiency anemia, epilepsy

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