Clinical and Experimental Pediatrics

대한소아청소년과학회 (The Korean Pediatric Society)
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급성 증후성 경련 환아에서 비유발성 경련의 위험인자들에 대한 연구

Risk Factors of Unprovoked Seizures after Acute Symptomatic Seizures in Children

  • 이은주 (충북대학교 의과대학 소아과학교실) ;
  • 김원섭 (충북대학교 의과대학 소아과학교실)
  • Lee, Eun Ju (Department of Pediatrics, College of Medicine and Medical Research Institute, Chungbuk National University) ;
  • Kim, Won Seop (Department of Pediatrics, College of Medicine and Medical Research Institute, Chungbuk National University)
  • 투고 : 2007.08.02
  • 심사 : 2007.09.10
  • 발행 : 2007.11.15
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초록

목 적 : 급성 증후성 경련이란 일시적인 중추 신경계 또는 전신적인 병태생리의 변화와 밀접히 연관되어 발생하는 경련으로 이와 달리 특별한 유발 인자 없이 발생하는 경련은 비유발성 경련으로 분류한다. 급성 증후성 경련이 추후에 비유발성 경련으로 이행할 수 있다는 문헌은 다수 보고되고 있으나 증후성 경련에서 비유발성 경련의 이행에 영향을 미치는 관련 인자들에 대한 자료는 미비한 실정이다. 이에 본 논문에서는 증후성 경련으로 입원한 환아들을 대상으로 지속적인 추적 관찰을 통해 비유발성 경련과 관련된 인자들에 대해 후향적으로 조사하였고, 이러한 관련 인자들과 비유발성 경련 이행 여부에 관해 통계적인 분석을 통해 그 유의성을 알아보고자 하였다. 방 법 : 급성 증후성 경련으로 진단된 환아들을 대상으로 최소 1년간의 추적 관찰을 통해 비유발성 경련으로의 이행 여부를 후향적으로 조사하였고, 이에 따른 관련 인자로써 호발 연령, 성별, 가족력, 경련의 유형, 발달 정도 등을 포함하여 다양한 원인들을 분류하고 뇌파 검사 및 뇌영상 검사 등의 결과를 조사하여 비유발성 경련과의 관계를 통계적으로 분석하였다. 결 과 : 급성 증후성 경련에서 비유발성 경련으로 이행하는 경우는 2-6세에 가장 호발하고 성별에 따른 차이는 없으며 뇌증과 중추 신경계 감염이 많은 원인을 차지한다. 비유발성 경련으로 이행하는 경우의 관련 인자로는 간질 지속 상태를 동반한 경우와 부분 발작의 경우에 통계적으로 유의한 차이를 보이며, 이외에 뇌파 검사와 뇌 영상검사에서 이상 소견을 보이는 경우에도 비유발성 경련으로 이행하는 데 있어 통계적으로 유의한 값을 보였다. 그러나 성별, 경련성 질환의 가족력, 발달 정도, 경련시의 각성 상태 등의 인자들과 비유발성 경련의 관계에는 통계적인 유의성을 갖지 못하였다. 결 론 : 급성 증후성 경련 환아들의 비유발성 경련 이행에 따른 관련 인자로는 경련의 지속 시간, 경련의 유형, 이상 뇌파 소견 및 이상 뇌 영상검사 소견을 들 수 있다. 따라서 이러한 인자들에 해당하는 경우에는 급성 증후성 경련의 치료 후에도 지속적인 추적 관찰을 통해 향후 발생할 수 있는 비유발성 경련에 대한 적절한 검사와 대처가 필요하다고 생각된다.

Purpose : Acute symptomatic seizure is defined as a temporary seizure together with acute systemic, metabolic, or toxic insult in association with an acute central nervous system insult. And unprovoked seizure is defined as seizure without provocating factors. We studied the risk factors of unprovoked seizures after acute symptomatic seizure in children. Methods : We retrospectively reviewed the records of one hundred and ten children with acute symptomatic seizures who were admitted to the pediatric department of Chungbuk National University Hospital between January, 1998 and December, 2003. We analyzed overall risk factors of unprovoked seizures after acute symptomatic seizures involving etiology, incidence, type of seizure, duration and neuroimaging. Results : We analyzed records of 110 children with acute symptomatic seizures aged from 1 month to 17 years. 24 children had unprovoked seizures (21.8%) after acute symptomatic seizures. Causes in order of frequency were encephalopathy, central nervous system infection, brain tumor, cerebrovascular disease. The risk of unprovoked seizure was significantly greater for those with status epilepticus (68.4%) than without status epilepticus, with partial seizure (64.7%) than generalized seizure. And the risk of unprovoked seizure was strongly associated with abnormal finding of electroencephalogram (79.1%) and neuroimaging (41.6%). Conclusion : In conclusion, the leading cause of subsequent unprovoked seizure in children with acute symptomatic seizure was encephalopathy and age specific incidence was high in the group aged 24-72 months. The risk for subsequent unprovoked seizure was greater for those with partial seizure, status epilepticus, abnormal finding of neuroimaging and electroencephalography.

키워드

과제정보

연구 과제 주관 기관 : 충북대학교

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