발작을 주소로 입원한 환아의 임상적 연구
Clinical Review of the of Seizures among Children
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목 적:급성 발작은 전 인구의 11%가 일생 동안 한번은 겪게 되는 비교적 흔한 증상으로써, 이 중 대부분이 소아기에 발생하며, 신경학적 후유증을 남길 수 있는 중요한 원인이 되기 때문에, 저자는 급성 발작으로 입원한 환아들의 연령별 원인, 발작의 양상, 뇌파 검사와 뇌 영상검사의 이상 유무 등을 분석하여 경련 환자의 치료에 도움이 되고자 본 연구를 시행하였다. 급성 발작의 원인 중 특별한 후유증을 남기지 않는 열성 경련은 제외하였다. 방 법:2007년 1월부터 2009년 12월까지 만 3년 동안 한림대학교 성심병원에 발작으로 입원한 18세 미만의 환아 756명 중 단순 열성 경련 환아 535명을 제외한 221명을 대상으로 하였다. 이들에 대한 분석은 의무 기록지를 통한 후향적 고찰을 하였다. 결 과:남녀비는 1.3:1로 남아에게 더 많았고, 영아에서 만 6세 미만의 환자군이 140명으로(63%) 가장 많았다. 발작의 원인을 연령별로 살펴보면, 신생아기의 가장 흔한 경련 원인은 저산소성 허혈성 뇌손상과 저칼슘혈증이고(각각 41%), 영아기부터 5세까지 가장 흔한 원인은 위장관염에 동반된 양성 경련이었다(47%). 6세 이상에서는 비유발성 경련이 57명(80%)으로 가장 많은 비율을 차지하였다. 뇌파 검사와 뇌 영상검사에서 이상을 나타낸 비율은 각각, 20%, 14%였다. 결 론:발작은 소아기에 가장 흔한 신경학적 질환으로써 연령에 따라 발생 원인에 차이가 있음을 알 수 있었고 원인 질환에 따른 정확한 치료가 필요할 것으로 생각된다. 급성 증후성 발작과 비유발성 발작, 특히 간질로의 이행에 따른 위험 인자 분석은 보다 많은 연구가 필요할 것으로 사료된다.
Abstract
Purpose:The purpose of this study was to evaluate childhood seizures to provide appropriate medical services. Methods:We retrospectively reviewed the medical records of 221 chidren under 18 years of age with seizures (excluding febrile convulsion), who were admitted to the pediatric department of Sacred Heart Hospital, Hallym University from 2007 to 2009. Results:The male to female was 1.3:1 and the peak age was 6 years or less, accounting for 63%. The most common causes of seizures according to age were listed as follows; hypocalcemia (41%) and hypoxic ischemic encephalopathies (41%) in the neonatal period, benign convulsion with mild gastroenteritis (BCwMG, 47%) in preschool children (1month and 5 years), and unprovoked seizure (80%) more than 6 years. Electroencephalogram and neuroimaging abnormalities were found in the ratio from 20% and 14% respectively. Conclusion:Seizure is the most common neurologic disease in the childhood. The above results reveal that the causes of childhood seizures in the different age group are different. Therefore, the exact diagnosis of disease according to age is needed. We hope that further clinical studies on this topic will be performed.
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