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İlk Kez Afebril Nöbet Geçiren Çocuklarda Nörogörüntüleme Bulguları

Year 2019, Volume: 13 Issue: 2, 67 - 72, 26.03.2019

Altan Güneş Dilek Cebeci

https://doi.org/10.12956/tchd.539057

Abstract






 Amaç: İlk kez afebril nöbet geçiren çocuklarda, anormal nörogörüntüleme bulgularını öngörmede, başta klinik bulgular olmak üzere etkili olabilecek değişkenlerin araştırılması amaçlandı. 


Gereç ve Yöntemler: Çalışmamız hastane etik kurul onayı alınarak yapıldı. Ocak 2016 ile Ocak 2018 tarihleri arasında, ilk kez afebril nöbet geçirmiş, beyin bilgisayarlı tomografisi (BT) ve/veya manyetik rezonans görüntülemesi (MRG) yapılmış ardışık 64 hastanın (39 erkek, 25 kız, ortalama yaş 7.5±5.7 yıl, yaşları 0.1–17 yıl arasında), medikal ve görüntüleme bulguları geriye dönük tarandı. Kategorik-sayısal değişkenler Ki-kare, Fisher, t-testi ile analiz edildi ve lojistik regresyon analizi yapıldı. 


Bulgular: Hastaların tamamına BT çekilmiş, %70.3’üne MRG yapılmıştı. Hastaların % 26.6’sında BT ve MRG’de anormal bulgular, %21.9’unda klinik olarak önemli anormal bulgular saptandı. Nöbet sayısının birden fazla olması (p=0.031), nöbet açısından risk faktörünün (p=0.025) ve anormal nörolojik muayenenin varlığı (p=0.037) ile klinik olarak önemli anormal nörogörüntüleme bulguları arasında anlamlı ilişki saptandı. Lojistik regresyon analizinde, anormal nörogörüntüleme bulgularını öngörmede, erkek cinsiyet (p=0.015), 3 yaştan büyük olmak (p=0.038) ve nöbet açısından risk faktörünün varlığı (p=0.036) anlamlı bulundu. Hastaların % 62.5’i epilepsi, % 6.3’ü santral sinir sistemi enfeksiyonu tanısı almıştı. Hastaların % 23.4’ünün nöbeti, ortalama 1 yıllık takip süresince tekrarlamamış ve tek afebril nöbet olarak değerlendirilmiş, % 7.8’inde acil müdahele gerektiren anormallik saptanmıştı (kitle, kanama, iskemi). 


Sonuç: İlk kez afebril nöbet geçiren çocuklarda, nöbet açısından risk faktörünün ve anormal nörolojik muayenenin varlığında, nöbet sayısının birden fazla olması durumunda yapılan nörogörüntüleme bilgilendirici olmaktadır. BT, yer kaplayan kitle ve kanama gibi acil müdahale gerektiren lezyonları göstermede olguların çoğunda yeterlidir. Klinik olarak önemli anormal bulguları göstermede MRG, uygun şartlarda çocuklarda tercih edilmesi gereken görüntüleme yöntemidir. 

Keywords

Afebril nöbet Bilgisayarlı tomografi

References

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  • 2.Warden CR, Brownstein DR, Del Beccaro MA. Predictors of abnormal findings of computed tomography of the head in pediatric patients presenting with seizures. Ann Emerg Med 1997;29:518-23.
  • 3.Sharma S, Riviello JJ, Harper MB, Baskin MN. The role of emergent neuroimaging in children with new-onset afebrile seizures. Pediatrics 2003;111:1-5.
  • 4.Garvey MA, Gaillard WD, Rusin JA, Ochsenschlager D, Weinstein S, Conry JA, et al. Emergency brain computed tomography in children with seizures: who is most likely to benefit? J Pediatr 1998;133:664–9.
  • 5.Hirtz D, Ashwal S, Berg A, Bettis D, Camfield C, Camfield P, et al. Practice parameter: evaluating a first nonfebrile seizure in children: report of the quality standards subcommittee of the American Academy of Neurology, The Child Neurology Society, and The American Epilepsy Society. Neurology 2000;55:616-23.
  • 6.Berg AT, Testa FM, Levy SR, Shinnar S. Neuroimaging in children with newly diagnosed epilepsy: a community based study. Pediatrics 2000;106:527-32.
  • 7.Shinnar S, O’Dell C, Mitnick R, Berg AT, Moshe SL. Neuroimaging abnormalities in children with an apparent first unprovoked seizure. Epilepsy Res 2001;43:261-9.
  • 8. Maytal J, Krauss JM, Novak G, Nagelberg J, Patel M. The role of brain computed tomography in evaluating children with new onset of seizures in the emergency department. Epilepsia 2000;41:950- 4.
  • 9. Gaillard WD, Chiron C, Cross JH, Harvey AS, Kuzniecky R, Hertz- Pannier L, et al. International League Against Epilepsy, Committee for Neuroimaging, Subcommittee for Pediatric. Guidelines for imaging infants and children with recent-onset epilepsy. Epilepsia 2009;50:2147-53.
  • 10. Harden CL, Huff JS, Schwartz TH, Dubinsky RM, Zimmerman RD, Weinstein S, et al. Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Reassessment: neuroimaging in the emergency patient presenting with seizure (an evidence-based review): report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 2007;69:1772-80.
  • 11. Kalnin AJ, Fastenau PS, deGrauw TJ, Musick BS, Perkins SM, Johnson CS, et al. Magnetic resonance imaging findings in children with a first recognized seizure. Pediatr Neurol 2008;39:404-14.
  • 12. Ghazala QS, Phyllis LH. Afebrile Pediatric Seizures. Emerg Med Clin North Am 2011;29:95-108.
  • 13. Al-Shami R, Kair AM, Elseid M, Ibrahim K, Al-Ahmad A, Elsetouhy A, et al. Neuroimaging evaluation after the first afebrile seizure in children: a retrospective observational study. Seizure 2016;43:26- 31.
  • 14. Singh RK, Stephens S, Berl MM, Chang T, Brown K, Vezina LG, et al. Prospective study of new-onset seizures presenting as status epilepticus in childhood. Neurology 2010;74:636-42.
  • 15. Aprahamian N, Harper MB, Prabhu SP, Monuteaux MC, Sadiq Z, Torres A, et al. Pediatric first time non-febrile seizure with focal manifestations: is emergent imaging indicated? Seizure 2014;23:740-5.
  • 16. McAbee GN, Barasch ES, Kurfist LA. Results of computed tomography in “neurologically normal” children after initial onset of seizures. Pediatr Neurol 1989;5:102-6.
  • 17. Shinnar S, Berg AT, Moshe SL, O’Dell C, Alemany M, Newstein D, et al. The risk of seizure recurrence after a first unprovoked afebrile seizure in childhood: an extended follow-up. Pediatrics 1996;98:216-25.
  • 18. Riviello JJ, Ashwal S, Hirtz D, Glauser T, Ballaban-Gil K, Kelley K, et al. Practice parameter: diagnostic assessment of the child with status epilepticus (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology 2006 67:1542-50.
  • 19. Beghi E, De Maria G, Gobbi G, Veneselli E. Diagnosis and treatment of the first epileptic seizure: guidelines of the Italian League against Epilepsy. Epilepsia 2006;47:2-8.
  • 20. Todd WL, Kara BJ, Kenneth AM, Lise EN, Tobias L, Sanjay PP, et al. Yield of Emergent Neuroimaging in Children with New-Onset Seizure and Status Epilepticus. Seizure 2016;35: 4-10.
  • 21. Ferry PC. Pediatric neurodiagnostic tests: a modern perspective. Pediatr Rev 1992;13:248-55.
  • 22. Vining EP, Freeman JM. Management of nonfebrile seizures. Pediatr Rev 1986;8:185-90.
  • 23. Bautovich T, Numa A. Role of head computed tomography in the evaluation of children admitted to the paediatric intensive care unit with new-onset seizure. Emerg Med Australas 2012;24:313-20.

Neuroimaging Findings in Children with New-Onset Afebrile Seizure

Year 2019, Volume: 13 Issue: 2, 67 - 72, 26.03.2019

Altan Güneş Dilek Cebeci

https://doi.org/10.12956/tchd.539057

Abstract

References

  • 1.Chen CY, Chang YJ, Wu HP. New-onset seizures in pediatric emergency. Pediatr Neonatol 2010;51:103-11.
  • 2.Warden CR, Brownstein DR, Del Beccaro MA. Predictors of abnormal findings of computed tomography of the head in pediatric patients presenting with seizures. Ann Emerg Med 1997;29:518-23.
  • 3.Sharma S, Riviello JJ, Harper MB, Baskin MN. The role of emergent neuroimaging in children with new-onset afebrile seizures. Pediatrics 2003;111:1-5.
  • 4.Garvey MA, Gaillard WD, Rusin JA, Ochsenschlager D, Weinstein S, Conry JA, et al. Emergency brain computed tomography in children with seizures: who is most likely to benefit? J Pediatr 1998;133:664–9.
  • 5.Hirtz D, Ashwal S, Berg A, Bettis D, Camfield C, Camfield P, et al. Practice parameter: evaluating a first nonfebrile seizure in children: report of the quality standards subcommittee of the American Academy of Neurology, The Child Neurology Society, and The American Epilepsy Society. Neurology 2000;55:616-23.
  • 6.Berg AT, Testa FM, Levy SR, Shinnar S. Neuroimaging in children with newly diagnosed epilepsy: a community based study. Pediatrics 2000;106:527-32.
  • 7.Shinnar S, O’Dell C, Mitnick R, Berg AT, Moshe SL. Neuroimaging abnormalities in children with an apparent first unprovoked seizure. Epilepsy Res 2001;43:261-9.
  • 8. Maytal J, Krauss JM, Novak G, Nagelberg J, Patel M. The role of brain computed tomography in evaluating children with new onset of seizures in the emergency department. Epilepsia 2000;41:950- 4.
  • 9. Gaillard WD, Chiron C, Cross JH, Harvey AS, Kuzniecky R, Hertz- Pannier L, et al. International League Against Epilepsy, Committee for Neuroimaging, Subcommittee for Pediatric. Guidelines for imaging infants and children with recent-onset epilepsy. Epilepsia 2009;50:2147-53.
  • 10. Harden CL, Huff JS, Schwartz TH, Dubinsky RM, Zimmerman RD, Weinstein S, et al. Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Reassessment: neuroimaging in the emergency patient presenting with seizure (an evidence-based review): report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 2007;69:1772-80.
  • 11. Kalnin AJ, Fastenau PS, deGrauw TJ, Musick BS, Perkins SM, Johnson CS, et al. Magnetic resonance imaging findings in children with a first recognized seizure. Pediatr Neurol 2008;39:404-14.
  • 12. Ghazala QS, Phyllis LH. Afebrile Pediatric Seizures. Emerg Med Clin North Am 2011;29:95-108.
  • 13. Al-Shami R, Kair AM, Elseid M, Ibrahim K, Al-Ahmad A, Elsetouhy A, et al. Neuroimaging evaluation after the first afebrile seizure in children: a retrospective observational study. Seizure 2016;43:26- 31.
  • 14. Singh RK, Stephens S, Berl MM, Chang T, Brown K, Vezina LG, et al. Prospective study of new-onset seizures presenting as status epilepticus in childhood. Neurology 2010;74:636-42.
  • 15. Aprahamian N, Harper MB, Prabhu SP, Monuteaux MC, Sadiq Z, Torres A, et al. Pediatric first time non-febrile seizure with focal manifestations: is emergent imaging indicated? Seizure 2014;23:740-5.
  • 16. McAbee GN, Barasch ES, Kurfist LA. Results of computed tomography in “neurologically normal” children after initial onset of seizures. Pediatr Neurol 1989;5:102-6.
  • 17. Shinnar S, Berg AT, Moshe SL, O’Dell C, Alemany M, Newstein D, et al. The risk of seizure recurrence after a first unprovoked afebrile seizure in childhood: an extended follow-up. Pediatrics 1996;98:216-25.
  • 18. Riviello JJ, Ashwal S, Hirtz D, Glauser T, Ballaban-Gil K, Kelley K, et al. Practice parameter: diagnostic assessment of the child with status epilepticus (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology 2006 67:1542-50.
  • 19. Beghi E, De Maria G, Gobbi G, Veneselli E. Diagnosis and treatment of the first epileptic seizure: guidelines of the Italian League against Epilepsy. Epilepsia 2006;47:2-8.
  • 20. Todd WL, Kara BJ, Kenneth AM, Lise EN, Tobias L, Sanjay PP, et al. Yield of Emergent Neuroimaging in Children with New-Onset Seizure and Status Epilepticus. Seizure 2016;35: 4-10.
  • 21. Ferry PC. Pediatric neurodiagnostic tests: a modern perspective. Pediatr Rev 1992;13:248-55.
  • 22. Vining EP, Freeman JM. Management of nonfebrile seizures. Pediatr Rev 1986;8:185-90.
  • 23. Bautovich T, Numa A. Role of head computed tomography in the evaluation of children admitted to the paediatric intensive care unit with new-onset seizure. Emerg Med Australas 2012;24:313-20.
There are 23 citations in total.

Details

Primary Language Turkish
Subjects ​Internal Diseases
Journal Section ORIGINAL ARTICLES
Authors

Altan Güneş This is me

Dilek Cebeci 0000-0001-8369-4914

Publication Date March 26, 2019
Submission Date September 23, 2018
Published in Issue Year 2019 Volume: 13 Issue: 2

Cite

Vancouver Güneş A, Cebeci D. İlk Kez Afebril Nöbet Geçiren Çocuklarda Nörogörüntüleme Bulguları. Türkiye Çocuk Hast Derg. 2019;13(2):67-72.
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