소아 급성 뇌염에서 응급실 방문 첫 24시간 이내 추정 가능한 예후인자
Can be Clinical Outcomes of Pediatric Acute Encephalitis Predicted within 24 hr in Emergency Department?
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목적: 급성 뇌염이 의심되는 증상으로 응급실을 방문한 소아 환자들에서 응급실 방문 첫 24시간 이내에 시행된 혈액 및 뇌척수액 검사, 뇌파, 뇌 자기공명영상촬영에 대해 조사, 분석하고 추정 가능한 예후인자를 파악하고자 하였다. 방법: 부산대 어린이병원에서 2009년부터 2013년까지 급성 무균성 뇌염으로 진단 및 치료받은 소아들을 대상으로 후향적 연구를 시행하였다. 환자들의 예후에 따라 세 군으로 분류하였다(A군; 신경학적 후유증 없이 회복된 환자들, B군; 운동 혹은 인지장애, 행동문제등의 신경학적 합병증이 동반된 환자들, C군; B군 중에서 뇌전증이동반된 환자들). 결과: 전체 대상환자는 128명이었다(A군; 89명, B군; 39명, C군; 26 명). 평균 연령은 C군(7.5±5.3세)이 A군(5.6±4.6세)에 비해 의미있게높았다(P=0.042). 가장 많이 나타난 증상은 발열(102명, 79.7%)이며그 다음은 의식상태 변화(87명, 68%), 경련(77명, 60.2%) 순이었다. B 군과 C군 모두 A군에 비해 급성기 경련발생, 뇌전증지속증, 불응성 뇌전증지속증, 재발성 경련이 모두 유의하게 자주 발생하였고 증상 발생후 치료시작까지 걸린 기간도 의미있게 길었다. 뇌파 및 뇌 MRI 소견에서, B군과 C군에서 A군에 비해 미만성 서파와 뇌전증모양방전, 그리고 조기에 뇌부종 소견이 의미있게 흔히 관찰되었다. 결론: 급성 무균성 뇌염의 소아들에서 응급실 방문한 급성기부터불량한 예후와 연관된 임상 양상 및 검사실 소견 유무를 파악해서이후 치료 경과에 더 적극적인 지지와 면밀한 관찰을 고려하고자 함이다.
Abstract
Purpose: To evaluate the risk and clinical outcome indicators of pediatric acute encephalitis within 24 hour in the emergency department. Methods: The authors retrospectively reviewed the medical charts of children admitted to a tertiary center with the diagnosis of acute encephalitis between 2009 and 2013. Three objectively-defined groups were identified according to clinical outcomes during hospitalization and discharge: (A) favorable outcomes with nearly complete recovery; (B) unfavorable outcomes with cognitive and/or motor deficit or neurological complication; (C) especially, progression to the epilepsy among children of group B. Results: 128 children met the inclusion criteria (89 in group A, 39 in group B, and 26 in group C). The difference among the groups A, B and C respectively was in age (5.6±4.6, 6.8±5.0 and 7.5±5.3 years, P=0.042 [A vs C]). The most common presenting symptoms were fever (79.7%), decreased mentality (68.0%), and seizures (60.2%). Status epilepticus (SE, >5 min) (38.5%, 38.5% vs 12.4%, P<0.001) and relapse seizures after first 24 hr (51.3%, 61.5% vs 2.2%, P<0.001) were more frequent in group B and C than in group A. Continuous diffuse slowing (74.4%, 76.9% vs 51.7%, P=0.017) and epileptiform discharges (30.8%, 34.6% vs 10.1%, P=0.004) on electroencephalogram (EEG) were significantly often in group B and C than in group A. Patients of group B and C (20.5% and 19.2%, P<0.001) had significantly higher incidence of the brain edema on initial brain MRI than them of group A (5.6%). Conclusion: SE, relapse seizures, diffuse slowing on EEG, and brain edema may suggest of the unfavorable outcomes in children of acute encephalitis.
참고문헌 (20)
- Sasaki J, "Outcome of children with acute encephalitis and refractory status epilepticus", J Child Neurol, 29, pp.1638~1644 (2014)
- Fowler A, "Long-term outcomes of acute encephalitis in childhood", Pediatrics, 126, pp.e828~e835 (2010)
- Fowler A, "Childhood encephalitis in Sweden: etiology, clinical presentation and outcome", Eur J Paediatr Neurol, 12, pp.484~490 (2008)
- Specchio N, "Childhood refractory focal epilepsy following acute febrile encephalopathy", Eur J Neurol, 18, pp.952~961 (2011)
- Galanakis E, "A prospective multicenter study of childhood encephalitis in Greece", Pediatr Infect Dis J, 28, pp.740~742 (2009)
- Le VT, "Viral etiology of encephalitis in children in southern Vietnam: results of a one-year prospective descriptive study", PLoS Negl Trop Dis, 4, pp.e854~ (2010)
- Sutter R, "Electroencephalography for diagnosis and prognosis of acute encephalitis", Clin Neurophysiol, 126, pp.1524~1531 (2015)
- Wang IJ, "The correlation between neurological evaluations and neurological outcome in acute encephalitis: a hospital-based study", Eur J Paediatr Neurol, 11, pp.63~69 (2007)
- Lee SY, "Prognostic factors and treatment strategies for acute viral encephalitis", J Korean Child Neurol Soc, 12, pp.66~77 (2004)
- Iff T, "Acute encephalitis in Swiss children: aetiology and outcome", Eur J Paediatr Neurol, 2, pp.233~237 (1998)
- Rautonen J, "Prognostic factors in childhood acute encephalitis", Pediatr Infect Dis J, 10, pp.441~446 (1991)
- Klein SK, "Predictive factors of short-term neurologic outcome in children with encephalitis", Pediatr Neurol, 11, pp.308~312 (1994)
- Lee WT, "Risk factors for postencephalitic epilepsy in children: a hospital-based study in Taiwan", Eur J Paediatr Neurol, 11, pp.302~309 (2007)
- Chen YJ, "Clinical characteristics and prognostic factors of postencephalitic epilepsy in children", J Child Neurol, 21, pp.1047~1051 (2006)
- Lin JJ, "Analysis of status epilepticus related presumed encephalitis in children", Eur J Paediatr Neurol, 12, pp.32~37 (2008)
- Shinnar S, "How long do newonset seizures in children last?", Ann Neurol, 49, pp.659~664 (2001)
- Holtkamp M, "A "malignant" variant of status epilepticus", Arch Neurol, 62, pp.1428~1431 (2005)
- Holtkamp M, "Predictors and prognosis of refractory status epilepticus treated in a neurological intensive care unit", J Neurol Neurosurg Psychiatry, 76, pp.534~539 (2005)
- Rossetti AO, "Refractory status epilepticus: effect of treatment aggressiveness on prognosis", Arch Neurol, 62, pp.1698~1702 (2005)
- Yoshioka M, "Clinical and electroencephalographic studies of postencephalitic epilepsy", Acta Paediatr Jpn, 31, pp.480~483 (1989)