Febril konvülsiyonlu olgularda antiepileptik ilaç profilaksisinin nöbet tekrarını önlemedeki etkinliğinin değerlendirilmesi

Amaç: Febril konvülsiyonlar çocuklardaki en sık nöbet tipidir. Prognozları genellikle iyidir. Ancak üçte bir olguda ilk nöbetten sonra tekrar ve %2-10 olguda ileride epilepsi gelişimi söz konusudur. Antiepileptik ilaçlarla profilaktik tedavinin febril konvülsiyonların tekrarlama riskini anlamlı olarak azalttığı bildirilmiştir. Nöbet tekrarı açısından risk faktörü taşıyan olgularda profilaktik antiepileptik ilaç tedavisi önerilmektedir. Ancak profilakside hangi ilacın tercih edileceği halen tartışmalı bir konudur. Bu çalışmada rekürren febril konvülsiyon açısından risk faktörü taşıyan hastalarda febril nöbetleri önlemede profılaksi amacıyla kullanılan fenobarbital, valproat ve rektal diazepamın etkinlikleri retrospektif olarak karşılaştırılmıştır. Bulgular: Risk faktörü taşıyan 89 febril konvülziyonlu olguya profilaktik antiepileptik ilaç tedavisi verilmiştir. Bunlardan 21'inin (%23.59) profilaktik ilacı çeşitli nedenlerle optimal olarak kullanmadığı gözlenmiştir. Kalan olguların 22'si (%32.35) fenobarbital, 21'i (%30.88) valproik asit ve 25'i (%36.76) intermittent rektal diazepam profîlaksisi almıştır. Profilaktik tedavi almayan olgularda nöbet tekrar oranı %56.18 iken, profilaksi alanlarda bu oran %17.65 olarak saptanmıştır. Bu fark istatistiksel olarak anlamlı bulunmuştur. Kullanılan antiepileptik ilaçlar arasında nöbet tekrarını önleme bakımından istatistiksel anlamlı fark bulunmamakla beraber rektal diazepamın nöbet tekrarını önlemede diğer ilaçlara göre daha etkili olduğu gözlenmiştir. Sonuç: Risk faktörü taşıyan olgulara profilaktik antiepileptik tedavi verilmesinin yararlı olduğu sonucuna varılmıştır. Antiepileptik ilaçlar arasında etkinliğinin fazla ve uygulanmasının daha güvenli olması nedeniyle intermittent rektal diazepam kullanımının uygun olduğu düşünülmüştür.

Anahtar Kelimeler:

Nöbetler, febril, Tekrarlama, Çocuk, Risk faktörleri, Antikonvülzanlar, İlaç tedavisi

The evaluation of the efficacy of prophylactic antiepileptic drug treatment in preventing seizure recurrence in patients with febrile convulsion

Objective: Febrile convulsions are the most frequent seizure type in children. They usually have a good prognosis. But approximately one third of children with a first febrile seizure experience a recurrence and 2-10% of children who have febrile seizures subsequently develop epilepsy. It has been reported that, prophylactic treatment with antiepileptic drugs significantly reduced the risk of, febrile seizure recurrence. Prophylactic antiepileptic drug treatment is recommended for patients with risk factors for recurrent seizures. But the choice of the antiepileptic drug for prophylactic treatment is at present in debate. In this study, it was aimed to compare the efficacy 'of the antiepileptic 'drugs, including phenobarbital valproate and rectal diazepam in preventing febrile -, seizure recurrences retrospectively by patients who experience risk factors for future febrile seizures. Results Eightynine patients with risk factors for febrile seizures were prescripted prophylactic antiepileptic drug. However, it has been detected that 21 (23.59%) of them were not taken the drug optimally. Of the remaining 68 patients, 22 (32.35%) were prescripted phenobarbital 21 (30.88%) valproate and 25 (36.76%) intermittent rectal diazepam prophylaxis. Of the patients, who were not taken any prophylactic treatment, 56.18% experienced recurrent febrile seizures. In contrast, only 17.65% of patients treated with prophylactic antiepileptic drugs experienced recurrent febrile seizures. The difference was statistically significant. Although there was no significant difference between the efficacy of antiepileptic drugs used, rectal diazepam has been found more efficacious in preventing febrile seizure recurrence. Conclusion: We conclude that, patients with risk factors have to be treated with prophylactic antiepileptic drugs. Between the antiepileptic drugs, intermittent prophylactic treatment with rectal diazepam has been found more efficacious with less side effects.

Keywords:

Seizures, Febrile, Recurrence, Child, Risk Factors, Anticonvulsants, Drug Therapy,

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