중심측두엽 극파를 동반한 양성 소아 뇌전증 환자의 장기 임상 경과 및 뇌파 분석
Long-term Clinical Course and Electroencephalographic Analysis in Children with Benign Childhood Epilepsy with Centrotemporal Spikes
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목적: BECTS는 소아에서 발생하는 가장 흔한 양성 국소 뇌전증증후군 중의 하나이다. 본 연구에서는 BECTS 환자들의 임상적 특징과 뇌파를 분석하여 경련 혹은 비정상 뇌파가 평균보다 오래 지속되는 일부 환자들을 예측할 만한 인자가 있는지 알아보았다. 방법: 전남대학교병원 소아청소년과에서 BECTS로 진단되었으며연구 시점의 연령이 18세 이상인 49명의 환자를 대상으로 하였다. 뇌파의 유형에 따른 임상경과의 차이, 치료기간, 비정상뇌파의 지속기간, 경련 발생기간, 뇌파가 처음으로 정상화되기까지 경과된 시간 등의 항목에 대해 분석하였다. 결과: 평균 추적 기간은 4.2±2.4년이었고 경련이 소실된 평균 나이는 9.5±2.0세였으며 비정상뇌파가 소실된 나이는 11.6±2.1세였다. 경련 발생연령이 어릴수록 치료 기간이 유의하게 길었다(P=0.04). 첫 정상뇌파가 관찰되기까지 경과한 시간이 짧을수록 경련 발생기간이 짧았다(P=0.02). 비전형적인 뇌파를 보이는 환자들은 뇌파가 전형적인경우에 비해 약물 치료기간(P<0.01), 경련 발생기간(P=0.02), 비정상뇌파 발생기간(P=0.01)이 유의하게 길었다. 연속으로 시행된 뇌파검사 결과 중 첫 3회의 뇌파를 분석하였을 때 비정상뇌파가 관찰된 뇌파의 비율과 전체 비정상뇌파 발생기간(P =0.01) 및 경련 발생기간(P=0.01), 치료기간(P<0.01) 등이 유의한 상관관계를 보였다. 결론: 비록 양성 경과를 취한다고 하더라도 BECT 환자들의 임상경과는 아주 다양하였으며 임상 인자나 뇌파를 분석함으로써 이를어느 정도 예측해 볼 수 있을 것으로 생각된다.
Abstract
Purpose: Benign childhood epilepsy with centrotemporal spikes (BECTS) is one of the most common and benign focal epilepsy syndromes during childhood. In this study, we analyzed the clinical features and electroencephalogram (EEG) of BECT patients to determine if there were any predictive factors for seizures or abnormal EEG findings lasting longer than the average. Methods: We studied 49 patients who were diagnosed with BECTS at the Department of Pediatrics, Chonnam National University Hospital and were 18 years of age or older at the time of the study. Differences in clinical course according to EEG features, treatment duration, abnormal EEG duration, seizure development period, and time to achieving the first normal EEG were analyzed. Results: Average onset age was 8.3±1.9 years and follow-up duration was 4.2±2.4 years. The average seizure-free age was 9.5±2.0 years, and abnormal EEG-free age was 11.6±2.1 years. Younger-onset patients had a longer duration of medication (P=0.04). Patients who needed shorter time to achieving the first normal EEG had a shorter seizure development period (P=0.02). Patients who did not show typical EEG findings consistent with BECTS had a significantly longer duration of medication (P<0.01) and seizure development period (P=0.02), and abnormal EEG duration (P= 0.01). The ratio of abnormal findings in the first three EEGs was significantly correlated with the seizure development period, abnormal EEG duration, and duration of medication (P<0.01). Conclusion: Although BECTS is known to take a benign course, the actual clinical course varied from patient to patient, and these variations may be predicted by analyzing clinical factors or EEGs.
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