소아 두부 외상 후 경련발작의 임상양상
Clinical Characteristics of Post-traumatic Seizures in Children
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목 적 : 두부 외상 후 경련이 발생했던 소아 환자들에서의 임상적 특징들 및 여러 진단도구들의 소견을 분석함으로써 병의 경과 및 치료에 대한 이해를 높이고자 한다. 방 법 : 분당서울대학교병원에 두부 외상으로 입원치료한 18세 미만의 환아중 경련이 발생한 환자를 대상으로 의무기록을 후향적으로 분석하였다. 자료분석은 환자의 내원 당시 나이, 성별, 경련의 잠복기, 뇌 전산화 단층 촬영 또는 뇌 자기 공명 영상 소견, 뇌파 소견, 항경련제 투여 유무 및 기간과 이후 추가적인 경련의 발생을 조사하였다. 결 과 : 두부 외상 후 경련이 발생한 환자는 총 31명으로 남자는 13명이고 여자는 18명이었다. 외상 당시 평균 나이는 3.2세(4개월 ~ 6.8세)이었으며, 추적 관찰 기간은 외상 후 평균 26.0개월(12개월 ~ 54개월)이었다. 전체 31명의 환자 중 21명 (67.7%)는 외상 후 24시간이내에 경련이 발생하였다. 경련이 발생한 환아에서 83.8%가 내원 당시 영상의학적 이상 소견을 보였고 두개내 출혈성 병변(경막외 또는 경막하 출혈 25.8%, 뇌실질내 출혈 19.3%) 및 뇌 실질내 병변(51.6%)으로 나타났다. 뇌파 검사에서 배경파 이상을 보인 경우는 32.2%, 발작간 간질파는 45.1%에서 나타났다. 두부 외상 후 경련을 보인 모든 환자에서 항경련제를 사용하였으며 평균 12.5 주(4-40주)의 치료기간을 나타내었다. 추적관찰 기간동안 추가 경련이 발생한 환자는 8명(25.8%)이었고 이 중 2명(6.5%)이 두부 외상 후 간질로 진단받았다. 결 론 : 두부 외상 후 발생하는 소아에서의 경련은 일반적으로 양성 임상 경과를 갖는다. 이러한 환자들의 영상의학적 소견 및 뇌파 소견이 임상 경과를 예측하는데 도움을 줄 수 있다.
Abstract
Purpose : Post-traumatic seizures (PTS) are well-recognized complications from head injuries and children are particularly more vulnerable to them. The aim of this study was to investigate the clinical characteristics of PTS in children and the findings of several diagnostic tools and to determine the role of prophylactic anticonvulsants. Methods : We retrospectively reviewed the medical records of patient under 18 years of age who presented with seizures after traumatic brain injuries. Data analyzed included patient’s demographics, clinical presentations, radiological and electroencephalographic findings, management and outcomes. Results : Thirty one patients with PTS were included in the study and consisted of 13 males and 18 females. A mean age of the accident was 3.2 years (4 months-6.8 years) and a mean duration of follow-up was 26.0 months (12 months-54 months). Twenty one patients (67.7%) developed seizures within 24 hours after injury. Focal radiological findings were observed in 83.8% and described as subdural or epidural hematoma (25.8%), intraparenchymal hemorrhage (19.3%) and intracerebral parenchymal lesions (51.6%). Electroecephalographic findings included background abnormalities in 32.2% and interictal epileptiform discharges in 45.1%. All patients were treated with anticonvulsants for a certain period of time and a mean duration of treatment was 12.5 weeks (4-40 weeks). Eight patients (25.8%) developed subsequent seizures during follow-up period and 2 patients (6.5%) were diagnosed afterward with post-traumatic epilepsy. Conclusion : PTS generally take a benign clinical course, but subsequent seizures including epileptic seizures can occur in minor proportion. In these cases, radiological and electroencephalographic findings are helpful in prediction of clinical course of PTS.
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