반복되는 두통으로 내원한 소아청소년 환자의 임상양상과 뇌파 검사
Clinical Characteristics and Electroencephalogram in Children with Recurrent Headache
0
조회
0
다운로드
2
인용
0
참고문헌
키워드
초록
목적: 두통은 소아청소년의 흔한 증상으로 두통의 진단과 분류는 병력과 신체진찰에 의해 이루어지고 있고 뇌파검사는 주로 병태생리학적 연구에 이용되고 있다. 본 연구는 소아청소년 시기에 발생하는 두통의 임상양상을 비교하여 진단에 도움이 되는 특징을 알아보고, 뇌파검사 결과를 분석하여 일차두통에서 볼 수 있는 뇌파 소견과 뇌파의 역할에 대해 연구하였다 . 방법: 2010년 11월부터 2013년 10월까지 반복되는 두통으로 고대구로병원 소아청소년과에 내원하여 뇌파검사를 시행한 275명의 의무기록을 분석하였다. 두통은 국제두통질환분류 제2판(the interna tional classification of headache disordersII criteria, ICHDII) 에따라 분류하였으며, 이들 환자에서 시행한 뇌파검사 결과를 두통의 분류와 연관하여 분석하였다 . 결과:일차 두통은 245명(89.1%), 이차 두통은 30명(10.9%)이었다 .일차 두통은 여자가 많은 반면, 이차 두통은 남자가 많았고( P=0.002) 이차두통 환자의 평균나이가 더 어렸으며( P=0.026) 유병기간은 짧았고( P=0.001), 편두통의 가족력은 일차 두통이 많았다( P=0.021). 편두통과 긴장형 두통의 특징을 비교 했을 때 편두통이 긴장형 두통 보다 두통 지속시간이 길고( P=0.005) 박동성 두통( P=0.018)과 증증 강도가 많았으며( P=0.031) 일상생활에 의해 악화되는 경향( P=0.032), 오심( P=0.000), 구토( P=0.000)가 많았다 . ICHDII 진단기준에 포함 되지 않는 항목인 두통의 가족력과 편두통의 가족력은 편두통에서 유의하게 많았다( P=0.001, 0.009). 일차두통 분류에 따른 뇌파이상의 빈도는 차이가 없었고( P=0.855) 모든 일차 두통에서 뇌전증 모양 방전이 가장 빈번하게 나타났다 . 편두통 환자 중 뇌전증 모양 방전을 보였던 환자와 정상 뇌파를 보였던 환자의 특징을 비교했을 때 뇌전증 모양 방전을 보였던 환자가 정상 뇌파를 보였던 환자에 비해 어렸고(P=0.035) 후두부의 통증이 많았으며( P=0.004), 비전형적인 양상의 두통이 많았다(P =0.005). 결론: 소아청소년 두통의 진단에 가장 중요한 것은 자세한 병력청취와 신체진찰로, 뇌파와 일차두통의 종류는 연관이 없었지만 편두통에서 뇌파형태에 따른 특징적 임상양상은 확인할 수 있었다 . 향후뇌파와 두통의 연관성, 뇌파에 따른 두통의 임상양상 에 관한 연구가 더 필요할것으로 생각한다 .
Abstract
Purpose: We compared clinical findings of headaches to find out important characteristics for the differential diagnosis of headaches. We tried to find out specific electroencephalogram (EEG) findings according to the types of primary headache and the relationship between clinical characteristics and EEG findings by analyzing EEGs of migraine. Method: We conducted a retrospective analysis by reviewing medical records of 275 patients who visited the Department of Pediatrics of Korea University Guro Hospital from November 2010 to October 2013. The headaches were classified according to the International Classification of Headache Disorders-II (ICHD-II). EEG was analyzed in relation to the type of headache. Results: 245 (89.1%) were primary headache patients, and 30 (10.9%) were secondary headache patients.There were no differences in the frequencies of abnormal EEG findings according to the type of primary headache (P=0.855), and epileptiform discharge was most common abnormal EEG finding in the primary headache. Comparing the patients with epileptiform discharges to the patients with normal EEG finding in migraine, the patients showing epileptiform discharge were younger (P=0.035) and presented with occipital and atypical (i.e., not pulsating or pressing) headache (P=0.005). Conclusion: History and physical examination are the most important in the diagnosis of headache in children. There were no significant differences in EEG findings among the different types of primary headaches.However,we could find a relationship between clinical features of the migraine and its epileptiform discharge, so more studies correlating EEG findings to clinical features are needed in the future.
참고문헌 (31)
- Rho YI, "Prevalence and clinical characteristics of primary headaches among school children in South Korea : a nationwide survey", Headache, 52, pp.592~599 (2012)
- 심지윤, "우리나라 학생들에서 두통과 생활 습관과의 관계", 대한소아신경학회지, 21(2), pp.39~45 (2013), 대한소아신경학회
- Roser T, "Primary versus secondary headache in children : a frequent diagnostic challenge in clinical routine", Neuropediatrics, 44, pp.34~39 (2013)
- Headache Classification Committee of the International Headache Society, "The international classification of headache disorders", Cephalalgia, 24, pp.9~ (2004)
- Anttila P, "Tension-type headache in childhood and adolescence", Lancet Neurol, 5, pp.268~274 (2006)
- Aguggia M., "Neurophysiological tests in primary headaches", Neurol Sci, 25(Suppl 3), pp.S203~S205 (2004)
- Ozkan M, "Electroencephalogram variations in pediatric migraines and tension-type headaches", Pediatr Neurol, 46, pp.154~157 (2012)
- Jay GW, "Epilepsy, migraine, and EEG abnormalities in children : a review and hypothesis", Headache : The Journal of Headache, 22, pp.110~114 (1982)
- Parain D, "Migraine aura lasting 1–24 h in children: a sequence of EEG slow-wave abnormalities vs. vascular events", Cephalalgia, 27, pp.1043~1049 (2007)
- Photic EEG-driving responses related to ictal phases and trigger sensitivity in migraine:a longitudinal, controlled study, "Bjørk M", ~
- Kramer U, "The value of EEG in children with chronic headaches", Brain Dev, 16, pp.304~308 (1994)
- Bjørk MH, "Interictal quantitative EEG in migraine : a blinded controlled study", J Headache Pain, 10, pp.331~339 (2009)
- Bjørk M, "What initiates a migraine attack? Conclusions from four longitudinal studies of quantitative EEG and steady‐state visual‐evoked potentials in migraineurs", Acta Neurol Scand Suppl, 191, pp.56~63 (2011)
- Abu-Arafeh I, "Prevalence of headache and migraine in children and adolescents : a systematic review of population‐based studies", Dev Med Child Neurol, 52, pp.1088~1097 (2010)
- Pacheva I, "Evaluation of diagnostic and prognostic value of clinical characteristics of migraine and tension type headache included in the diagnostic criteria for children and adolescents in International Classification of Headache Disorders-second edition", Int J Clin Pract, 66, pp.1168~1177 (2012)
- Pro S, "Primary headache pathophysiology in children : the contribution of clinical neurophysiology", Clin Neurophysiol, 125, pp.6~12 (2014)
- Silberstein SD, "Migraine pathophysiology and its clinical implications", Cephalalgia, 24, pp.2~7 (2004)
- Moskowitz MA, "Basic mechanisms in vascular headache", Neurol Clin, 8, pp.801~815 (1990)
- Longoni M, "Inflammation and excitotoxicity: role in migraine pathogenesis", Neurol Sci, 27(Suppl 2), pp.S107~S110 (2006)
- Peroutka SJ, "Migraine : a chronic sympathetic nervous system disorder", Headache, 44, pp.53~64 (2004)
- Lipton RB, "Wolfe Award. Sumatriptan for the range of headaches in migraine sufferers: results of the Spectrum Study", Headache, 40, pp.783~791 (2000)
- Piccinelli P, "Relationship between migraine and epilepsy in pediatric age", Headache, 46, pp.413~421 (2006)
- Martens D, "Cerebral MRI and EEG studies in the initial management of pediatric headaches", Swiss Med Wkly, 142, pp.w13625~ (2012)
- Niedermeyer E., "Electroencephalography: basic principles, clinical applications, and related fields", pp.595~602 (1999), Lippincott Williams & Wilkins
- Gronseth GS, "The utility of the electroencephalogram in the evaluation of patients presenting with headache a review of the literature", Neurology, 45, pp.1263~1267 (1995)
- Sand T, "EEG in migraine : a review of the literature", Funct Neurol, 6, pp.7~22 (1991)
- Kaiser DA, "What is quantitative EEG?", J Neurother, 10, pp.37~52 (2007)
- Sand T., "Electroencephalography in migraine: a review with focus on quantitative electroencephalography and the migraine vs. epilepsy relationship", Cephalalgia, 23(Suppl 1), pp.5~11 (2003)
- Seri S, "Computerized EEG topography in childhood migraine between and during attacks", Cephalalgia, 13, pp.53~56 (1993)
- Tommaso Md, "EEG spectral analysis in migraine without aura attacks", Cephalalgia, 18, pp.324~328 (1998)
- Bigal ME, "Migraine in the triptan era : lessons from epidemiology, pathophysiology, and clinical science", Headache, 49, pp.21~33 (2009)