Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
권호 표지

Clinical study in children with cerebral palsy associated with or without epilepsy

뇌성마비아의 간질 발생에 대한 임상연구

  • Ahn, Yongjoo (Department of Pediatrics, College of Medicine, Kyunghee University Hospital) ;
  • Chung, Hyejeon (Department of Pediatrics, College of Medicine, Kyunghee University Hospital) ;
  • Youn, Suk (Department of Pediatrics, College of Medicine, Kyunghee University Hospital) ;
  • Cho, Euihyun (Chungju Medical Center) ;
  • Chung, Sajun (Department of Pediatrics, College of Medicine, Kyunghee University Hospital)
  • 안용주 (경희대학교 의과대학 소아과학교실) ;
  • 정혜전 (경희대학교 의과대학 소아과학교실) ;
  • 윤석 (경희대학교 의과대학 소아과학교실) ;
  • 조의현 (청주의료원 소아과) ;
  • 정사준 (경희대학교 의과대학 소아과학교실)
  • Received : 2005.12.02
  • Accepted : 2006.01.19
  • Published : 2006.05.15
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose : To study the spectrum of epilepsy in children with cerebral palsy. Methods : A total of 93 consecutive patients with cerebral palsy(CP) were retrospectively suited. Criteria for inclusion were a follow-up period of at least 2 years. The study examined the correlation between the incidence of epilepsy and seizure types in the different forms of CP. Other factors associated with epilepsy, such as age of first seizure, occurrence of abnormalities on brain imaging, and electroencephalogram were also analyzed. Results : The overall prevalence of epilepsy in children with CP was 46.2 percent. The incidence of epilepsy was predominant in patients with mixed, diplegic, and quadriplegic palsies : 55.5 percent, 51.6 percent, and 50.0 percent in frequency. The first seizure occurred during the first year of life in 48.8 percent of patients with epilepsy. Generalized tonic-clonic seizures were the most common seizure type(44.2 percent), predominant in diplegic patients(64.3 percent). On the other hand, infantile spasms and myoclonic seizures were the main cause of seizures among quadriplegic children(60 percent and 40 percent, respectively). The occurrence of epilepsy was more popular in the group with abnormal brain imagings; especially encephalomalacia and cortical atrophy. All children with epilepsy in this study showed abnormal electroencephalogram(EEG) findings: Generalized abnormalities were observed in 55.8 percent of children with epilepsy; more dominantly in quadriplegic children(80.0 percent); and 40 percent of children with diplegia showed focal abnormalities. Conclusion : Cerebral palsy is associated with a higher incidence of seizure disorders, which, in the majority, has its onset in the first year of life; brain imaging and EEG are most effective in spotting epilepsy in children with CP.

목 적 : 뇌성마비는 뇌의 여러 가지 원인에 의해 뇌에 발생한 비진행성 손상으로, 이러한 뇌성마비를 가진 환아의 간질 발생 빈도는 15-90%로 다양하게 나타난다. 이렇게 뇌성마비와 간질이 중복 되서 나타나는 경우에 심각한 중복 장애를 남길 수 있다. 따라서 뇌성마비아 중 간질의 발생아와 비발생아의 특징을 비교하여 장기적인 진료 및 예후의 지표를 삼고자 하였다. 방 법 : 1995년부터 2004년까지 9년간 경희의료원 소아과 외래에서 뇌성마비로 진단받고 추적관찰이 가능하였던 93명을 대상으로 조사하였으며, 이들의 뇌성마비를 분류하고, 간질의 형태와 발병 당시의 나이, 뇌영상소견과 뇌파 소견을 비교하였다. 결 과 : 뇌성마비에서의 간질의 유병률은 93명 중 43명으로 46.2%이었으며, 발작의 초 발 연령은 평균 21.5개월로 1세 미만에서 발생한 경우가 21례(48.8%)로 가장 많았고, 1세 미만에서는 영아 연축과 근간대성 발작의 빈도가 의미 있게 높았으며, 전체적으로는 강직성-간대성 발작이 44.2%로 가장 많이 나타났다. 뇌영상소견에서 가장 많이 동반된 이상은 뇌 피질 위축으로 간질 발생군과 비간질 발생군에서 각각 22례(23.6%)와 12례(12.1%)였으며, 뇌파 소견에서는 간질 발생아의 전례에서 이상 소견을 보였다. 결 론 : 뇌성마비아에서 간질이 동반된 경우 어린 나이에 발생하는 경우가 많았으며, 간질의 형태로는 전신성 간대성-강직성 발작이 가장 많았다. 또한 뇌 영상검사와 뇌파검사에서 뇌성마비아 중 간질 발생아와 비간질 발생아에서 의미 있는 빈도 차이를 보여 조기 진단에 도움을 줄 것으로 생각된다.

Keywords

References

  1. Aicardi J. Epilepsy in brain-injured children. Dev Med Child Neurol 1990;32:191-202 https://doi.org/10.1111/j.1469-8749.1990.tb16925.x
  2. Aicardi J. Epilepsy as a presenting manifestation of brain tumours and of other selected brain disorders. In : Aicardi J, editor. Epilepsy in children(The international review of child neurology). New York, Raven, 1994:350-1
  3. Aksu F. Nature and prognosis of seizures in patients with cerebral palsy. Dev Med Child Neurol 1990;32:661-8 https://doi.org/10.1111/j.1469-8749.1990.tb08426.x
  4. Bruck I, Antoniuk SA, Spessatto A, Bem RS, Hausberger R, Pacheco CG. Epilepsy in children with cerebral palsy. Arq Neuropsiquiatr 2001;59:35-9 https://doi.org/10.1590/S0004-282X2001000100008
  5. Singhi P, Jagirdar S, Khandelwal N, Malhi P. Epilepsy in children with cerebral palsy. J Child Neurol 2003;18:174-9 https://doi.org/10.1177/08830738030180030601
  6. Zafeiriou DI, Kontopoulos EE, Tsikoulas I. Characteristics and prognosis of epilepsy in children with CP. J Child Neurol 1999;14:289-94 https://doi.org/10.1177/088307389901400504
  7. Kulak W, Sobaniec W. Risk factors and prognosis of epilepsy in children with cerebral palsy in north-eastern Poland. Brain Dev 2003;25:499-506 https://doi.org/10.1016/S0387-7604(03)00040-8
  8. Gururaj AK, Sztriha L, Bener A, Dawodu A, Eapen V. Epilepsy in children with cerebral palsy. Seizure 2003;12: 110-4 https://doi.org/10.1016/S1059131102002558
  9. Wallace SJ. Epilepsy in cerebral palsy. Dev Med Child Neurol 2001;43:713-7 https://doi.org/10.1017/S0012162201001281
  10. Edebol-Tysk K. Epidemiology of spastic tetraplegic cerebral palsy in Sweden. I. Impairments and disabilities. Neuropediatrics 1989;20:41-5 https://doi.org/10.1055/s-2008-1071263
  11. Senbil N, Sonel B, Aydin OF, Gurer YK. Epileptic and non-epileptic cerebral palsy : EEG and cranial imaging findings. Brain Dev 2002;24:166-9 https://doi.org/10.1016/S0387-7604(02)00025-6
  12. Kwong KL, Wong SN, So KT. Epilepsy in children with cerebral palsy. Pediatr Neurol 1998;19:31-6 https://doi.org/10.1016/S0887-8994(98)00011-3
  13. Curatolo P, Arpino C, Stazi MA, Medda E. Risk factors for the co-occurrence of partial epilepsy, cerebral palsy and mental retardation. Dev Med Child Neurol 1995;37:776-82 https://doi.org/10.1111/j.1469-8749.1995.tb12061.x
  14. Kuenneth CA, Boyle C, Murphy CC, Yeargin-Allsopp M. Reproductive risk factors for epilepsy among ten-year-old children in metropolitan Atlanta. Paediatr Perinat Epidemiol 1996;10:186-96 https://doi.org/10.1111/j.1365-3016.1996.tb00042.x
  15. Al-Sulaiman A. Electroencephalographic findings in children with cerebral palsy : a study of 151 patients. Funct Neurol 2001;16:325-8
  16. Ellenberg JH, Hirtz DG, Nelson KB. Age at onset of seizures in young children. Ann Neurol 1984;15:127-34 https://doi.org/10.1002/ana.410150204
  17. Levene M. The clinical conundrum of neonatal seizures. Arch Dis Child Fetal Neonatal Ed 2002;86:F75-7 https://doi.org/10.1136/fn.86.2.F75
  18. Delgado MR, Riela AR, Mills J, Pitt A, Browne R. Discontinuation of antiepileptic drug treatment after two seizurefree years in children with cerebral palsy. Pediatrics 1996; 97:192-7
  19. Commission on Classification and Terminology of the International League Against Epilepsy. Proposal for revised clinical and electroencephalographic classification of epileptic seizures. Epilepsia 1981;22:489-501 https://doi.org/10.1111/j.1528-1157.1981.tb06159.x