Ünsal YILMAZ, Rahmi ÖZDEMİR, Tanju ÇELİK, Emel Ataş BERKSOY

Clinical and paraclinical features in children with febrile seizures

Amaç: Febril konvülziyon ile başvuran hastalarda yaklaşım, tanısal incelemeler, izlem ve tedavi halen tartışmalıdır. Bu çalışmada febril konvülziyon nedeniyle başvuran hastaların klinik özellikleri, laboratuvar, elektroensefalografi ve nörogörüntüleme bulguları, aldıkları tedavi ve 1 yıllık izlem sonuçlarının belirlenmesi amaçlandı. Yöntemler: Temmuz 2011 ile Kasım 2013 tarihleri arasında febril konvülziyon nedeniyle çocuk nöroloji polikliniğine yönlendirilen yaşları 3-60 ay arasında olan 109\'u (%40,5) kız, 160\'sı (%59,5) erkek olmak üzere toplam 269 hasta çalışmaya dahil edildi. Bulgular: Ortalama yaş, başvuruda 29,2±15,3 ay iken ilk nöbet sırasında 20,1±12,1 aydı. Hastaların 80\'inde (%29,7) 2, 49\'unda (%18,2) 3, 25\'inde (%9,3) de 3\'ten fazla olmak üzere 154 (%57,2) hastada tekrarlayan febril konvülziyon vardı. Elli beş hastanın (%20,8) birinci derece akrabalarında febril konvülziyon, 37 (%14,0) hastanın ailesinde de epilepsi öyküsü vardı. Başvuruda 6 (%2,2) hasta febril status epileptikus tanısı aldı. Elektroensefalografi incelemesi yapılan 180 (%63,6) hastanın 18\'inde (%10) epileptik aktivite görüldü. Beyin manyetik rezonans görüntüleme incelemesi yapılan 40 hastanın sadece 6\'sında (%15,0) rastlantısal nonspesifik beyaz cevher lezyonları görüldü. Kırk bir (%30,6) hastada anemi saptandı. Yirmi altı (%9,7) hastaya antiepileptik tedavi (8 olguya fenobarbital, 18 hastaya valproat) başlandı, kalan 243 (%90,3) hastaya da rektal diazepam profilaksisi verildi. Hastaların 182\'sinde (%67,7) basit, 87\'sinde (%32,3) ise komplike febril konvülziyon saptandı. Bir yıllık izlem yapılan 124 hastanın 5\'inde (% 4) afebril nöbetler de izlendi ve bu hastalar epilepsi tanısı aldı. Epilepsi tanısı alanların tamamında komplike ve tekrarlayan febril konvülziyon öyküsü vardı. Sonuç: Komplike febril konvülziyon ile başvuran çocuklarda elektroensefalografi incelemesi yapılmalı, epileptiform aktivite görülenler epilepsi gelişimi açısından yakın izleme alınmalıdır. Nörogörüntülemenin basit ve komplike febril konvülziyon ile başvuran hastalarda tanı ve tedaviye katkısı olmadığı düşünüldü.

Anahtar Kelimeler:

Febril konvülziyon; elektroensefalografi; epilepsi.

Clinical and paraclinical features in children with febrile seizures

Objective: The approach, diagnostic investigations, follow-up, and treatment in children presented with febrile seizures are still controversial. We aimed to determine the clinical characteristics, laboratory results, electroencephalography and neuroimaging findings, treatment modalities, and outcome at 1-year-long follow-up period in children presented with febrile seizures. Methods: A total of 269 children (109 females and 160 males) between the ages of 3 and 60 months who were referred to pediatric neurology department due to febrile seizures between July, 2011 and November, 2013 were enrolled into the study. Results: Mean ages at onset of the febrile seizures and at admission were 20.1±12.1 months and 29.2±15.3 months, respectively. A total of 154 (57.2%) patients had recurrent febrile seizures; 2 seizures in 80 (29.7%), 3 in 49 (18.2), and >3 in 25 (9.3%) patients. A history of febrile seizures and epilepsy among the first-degree relatives was obtained in 55(20.8%) and 37 (14.0%) patients, respectively. Six (2.2%) patients presented with febrile status epilepticus. Electroencephalography was performed in 180 (63.6%) patients, and revealed epileptic discharges in 18 (10%) children. Brain magnetic resonance imaging studies were carried out in 40 (14.9%) patients, of them, 6 (15.0%) had incidental nonspecific white matter lesions which were all irrelevant to seizures. Forty one (30.6%) patients were found to have anemia. Antiepileptic medication was initiated in 26 (9.7%) patients (phenobarbital in 8 and valproate in 18 patients); rectal diazepam was prescribed in the remaining 243 (90.3%) patients. The seizures were simple in 182 (67.7%) and complicated in the remaining 87 (32.3%) patients. At the end of 1-year of follow-up period, a diagnosis of epilepsy was made in 5 (4%) of 124 children who had all complicated and recurrent febrile seizures. Conclusion: Electroencephalography should be performed in children presented with complicated seizures, and patients those with epileptic discharges on electroencephalography should be given a close follow-up in regard to epilepsy development. The yield of neuroimaging is not contributory to the diagnostic and therapeutic approach.

Keywords:

Febrile seizures, electroencephalography epilepsy.,

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