Çocuk Acil Ünitesine Febril Konvülziyon Tanısıyla Başvuran Beş Ay-Beş Yaş Arasındaki Çocukların Retrospektif Olarak İncelenmesi

Öz

Amaç: Bu çalışmamızda acil çocuk ünitesine başvurarak febril konvülziyon FK tanısı alan hastaların özelliklerini saptayarak, hastaların FK tanısı alırken yapılan hataları ve izlemde değişik tedavi alternatiflerinin etkinliklerini değerlendirmeyi amaçladık. Yöntemler: Bir yıllık zaman dilimi içinde çocuk acil ünitesine FK nedeniyle başvurmuş ve müşahadeye alınmış 326 çocuk çalışmaya alındı. Çalışmaya alınacak olan çocukların yaş sınırı 5 ay - 5 yaş 60 ay olarak belirlendi. Daha önceden bilinen konjenital sorunları, kafa travması öyküsü, mental retardasyonu olan vakalar çalışmaya alınmadı. Vakalar yaş, cinsiyet, ateş düzeyi, sodyum ve kalsiyum düzeyi, CRP düzeyi, Lökosit sayısı, serum Glukoz düzeyi, aile öyküsü, yapılan tedavi, müşahade altında kalış süresi ve sonrasında yapılan yatış yönünden incelendi. İstatistiksel analizler için SPSS Statistical Package for Social Sciences for Windows 13.0 programı kullanıldı. Bu çalışma Bakırköy Dr. Sadi Konuk Eğitim ve Araştırma Hastanesi Etik Kurul tarafından onaylandı. Bulgular: Vakaların ortalama yaşı 25.0±15.3 aydır. Vakaların 147 % 45.1 ’si kız, 179 % 54.9 ’u ise erkektir. Çocukların 29 % 8.9 ’unda aile öyküsü görülmekteydi. Ateş düzeyleri 36.8 ile 41 derece arasında değişmekte olup, ortalama 38.49±0.64’tür. ÜSYE % 75.8’lik oranla konvülziyona en sık neden olan infeksiyon olarak bulunmuştur. Konvülziyon tipine göre tedavi şekilleri arasında istatistiksel olarak anlamlı farklılık görülmektedir p

Anahtar Kelimeler

• Ateş,konvülziyon,çocuklar

Retrospective Analysis of Febril Convulsion Patients Aged Between 5 Months-5 Years Old

Öz

Objective: The purpose of this study was to determine the demographic characteristics of patients admitted to emergency unit with febrile convulsions, and the mistakes during diagnosis so as to evaluate various treatment modalities. Methods: The study was conducted with 326 patients aged 5 months to 5 years admitted to emergency unit because of febrile convulsions. Patients with congenital anomalies, history of head trauma and mental retardation were excluded from the study. Patients were evaluated as for age, gender, temperature, sodium and calcium levels, C-reactive protein, leucocyte count, serum glucose, family history, treatment and hospitalization. SPSS for Windows 13.0 software programme was used for statistical analysis. This study was approved by the ethics committee of the Bakırköy Dr. Sadi Konuk Hospital. Results: Mean age of the cases was 25.0±15.3 months, while 147 45.1 % of them were female and 179 54.9 % of them were male, and 29 8.9 % patients had familial history of febrile convulsions. Body temperature levels changed between 36.8 Co and 41°C and mean temperature was 38.49±0.64. Upper respiratory tract infections were found to be the most common causes of the febrile convulsions with a rate of 75.8 %. Paracetamol use was significantly higher in simple convulsions, however midazolam use was significantly higher in complicated convulsions p

Anahtar Kelimeler

• Fever,convulsion,children

Kaynakça

1. Hirtz D. Febrile seizures. Pediatr Rev 1997;18:5-9. http://dx.doi.org/10.1542/pir.18-1-5 PMid:8993063
2. Racacho l. Mc lachlan RS, Ebers GC, Maher J, Bulman D.e. Evidence favoring genetic heterogeneity for febrile con- vulsions. Epilepsia 2000;41:132. http://dx.doi.org/10.1111/j.1528-1157.2000.tb00132.x PMid:10691109
3. Camfield p, Camfield C, Kurlemann G. Febrile seizures. In: Roger J, Bureau M, Draved Ch, Genton P, Tassinari CA, Wolf P, (eds). Epileptic syndromes in Infancy, Childhood and Adolescense. 3rd ed Malaysia: John Libbey Co, 2002; 145-52.
4. Hauser WA. The prevelance and indcidence of convulsive disorders in children. Epilepsia 1994;35(suppl 2):S1-6. http://dx.doi.org/10.1111/j.1528-1157.1994.tb05932.x PMid:8275976
5. Verity CM, Butler NR, Golding J. Febrile convulsions in a national cohort followed up from birth.I-prevelance and recu- rence in the first five years of life. BMJ 1985;2901307-10. http://dx.doi.org/10.1136/bmj.290.6478.1307 PMid:3922469 PMCid:1415577
6. Gökyiğit A, Çalışkan A. Prävalenz der Fiberkrämpfe in İstanbuler Grundschulen. Internationale Pädiatre 1988;19:69-73.
7. Öztürk MK, Önal AE, Tümerdem Y, et al. Prevelance of febrile convulsions in a group of children aged 0 to 9 years in a slum in İstanbul. Med Bull İstanbul 2002;35:79-84.
8. Okumura A, uemura N, Suzuki M, Itomi K, Watanabe K. Unconsciousness and delirious behavior in children with feb- rile seizures. Pediatr Neurol 2004;30:316-9. http://dx.doi.org/10.1016/j.pediatrneurol.2003.10.010 PMid:15165632

9. Knudsen Fu. Febrile seizures-treatment and outcome. Brain Dev 1996;18(6):438-49. http://dx.doi.org/10.1016/S0387-7604(96)00059-9
10. Özmen M, Çalışkan M. Febril konvülsüyonlar. İst Çocuk Klin Derg 1995;30:116-21.
11. ling SG. Febrile convulsions: Acute seizures characteristics and anti-convulsant therapy. Annals of Tropical Ped 2000;20:227-30.
12. Kölfen W, pehle K, König S. Is the long-term outcome of following febrile convulsions favorable? Dev Med Child Neurol 1998;40:667-71. PMid:9851235
13. Wallace SJ. Febrile seizures. Epilepsia 1996;2(1):28-33.
14. Shinnar S, Glauser TA. Febrile Seizures. J Child Neurol 2002;17:S44-S52. http://dx.doi.org/10.1177/08830738020170010601 PMid:11918463
15. Vestergaard M, Basso O, Henriksen TB, et al. Risk factors for febrile convulsions. Epidemiyology 2002;13:282-7. http://dx.doi.org/10.1097/00001648-200205000-00008 PMid:11964929
16. Teach JS, Wallace lH, Evans MJ et al. Human Herpes viruses types 6 and 7 and febrile seizures. Ped Neurol 1999;21:699-703. http://dx.doi.org/10.1016/S0887-8994(99)00068-5
17. Abuekteish F, Daoud AS, al-Sheyyab M, Nou’man M. Demographic characteristics and risk factors of first febrile seizures: a Jordanian experience. Trop Doct 2000;30(1):25-7. PMid:10842518
18. Ranthala H, uhari M, Tarkka H. Viral infections and recur- rences of febrile convulsions. J Ped 1990;116:195-9. http://dx.doi.org/10.1016/S0022-3476(05)82874-4
19. Rutter N, Smales OR. Role of routine investigations presen- ting with their first febrile convulsion. Arc Dis Child 1977;52(3):188-91. http://dx.doi.org/10.1136/adc.52.3.188 PMid:848997 PMCid:1546280
20. Mohebbi MR, Holden KR, Mohammadi M. Peripheral leukocytosis in children with febrile seizures. Journal of Child Neurol 2004;19(1):47-50. http://dx.doi.org/10.1177/08830738040190010704 PMid:15032384
21. Nelson KB, Ellenberg JH. Prognosis in children with febrile seizures. Pediatrics 1978;61:720-7. PMid:662510
22. Shinnar S, Berg AT. Does antiepileptic drug therapy prevent the development of ‘chronic’ epilepsy. Epilepsia 1996;37:701-8. http://dx.doi.org/10.1111/j.1528-1157.1996.tb00639.x PMid:8764806
23. Verrotti A, latini G, di Corcia G, Giannuzzi R, Salladini C, Trotta D, Chiarelli F. Intermittent oral diazepam proph- ylaxis in febrile convulsions: its effectiveness for febrile sei- zure recurrence. Eur J Ped Neurol 2004;8:131-4. http://dx.doi.org/10.1016/j.ejpn.2004.01.008 PMid:15120684
24. Schnaiderman D, lahat E, Sheefer T, Aladjem M. Antipyretic effectiveness of acetaminophen in febrile seizures: ongoing prophylaxis versus sporadic use. Eur J Pediatr 1993;152:747-9. http://dx.doi.org/10.1007/BF01953992 PMid:8223808
25. uhari M, Ranthala H, Vainionpää l, Kurttila R. Effect of acetaminophen and of low intermittent doses of DZP on pre- vention of recurrences of febrile convulsions. J Pediatr 1995;126:991-5. http://dx.doi.org/10.1016/S0022-3476(95)70231-8
26. Van Stuijvenberg M, de Vos S, Tjiang GC, Steryerberg EW, Derksen-lubsen G, Moll HA. Parents’ fear regarding fever and febrile seizures. Acta Paediatr 1999;88(6):618-22. http://dx.doi.org/10.1080/08035259950169260 PMid:10419245
27. Camfield pR, Camfield CS, Shapiro SH, Cummings C. The first febrile seizure-- antipyretic instruction plus either phenobarbital or placebo to prevent a recurrence. J Pediatr 1980;97(1):16-21. http://dx.doi.org/10.1016/S0022-3476(80)80122-3
28. Baumann RJ, Duffner pK. Treatment of chidren with simple febrile seizures: the AAP Practice parameter. American Academy of pediatrics. Pediatr Neurol 2000;23:11-7. http://dx.doi.org/10.1016/S0887-8994(00)00148-X
29. Knudsen Fu. Effectice short-term DZP prophylaxis in febrile convulsions. J Pediatr 1985;106:487-90. http://dx.doi.org/10.1016/S0022-3476(85)80688-0
30. Verity CM, Golding J. Risk of epilepsy after febrile convül- sions: a national cohort study. BMJ 1991;303:1373-6. http://dx.doi.org/10.1136/bmj.303.6814.1373 PMid:1760604 PMCid:1671614
31. American Academy of pediatrics. Provisional Commitee on Quality Improwment: Practice parameter. The neurodiagnos- tic evaluation of the child with a simple febrile seizure. Pediatrics 1996;97:769-75. PMid:8628629
32. Knudsen Fu, paerregaard A, Andersen R, Andersen J. Long-term autcome of prophylaxis for fevrile convülsions. Arch Dis Child 1996;74:13-8. http://dx.doi.org/10.1136/adc.74.1.13 PMid:8660037 PMCid:1511589
33. Saltık S, Angay A, Özkara Ç, Demirbilek V, Dervent A. A retrospective analysis of patients with febrile seizures follo- wed by epilepsy. Seizure 2002;723:1-6.