Elif YAYLACI TATLIDİL, Özgür Bilgin TOPÇUOĞLU, Sertaç GÜVEN, Sermin KESEBİR

İlk atak manide EEG Anormalliği: Çocukluk çağı travmalarının izi

Amaç: Bu çalışmanın amacı ilk atak manide EEG anormalliği sıklığını araştırmak, EEG anormalliği olan ve olmayan olguları, iki uçlu bozukluğun klinik özellikleri yönünden karşılaştırmaktır. Yöntem: Bu çalışmada, ayaktan tedavi merkezimize veya acil servisimize son bir yıl içerisinde başvuran, 18-65 yaş arası, bilgilendirilmiş onam formu birinci derece yakınları tarafından onaylanan, DSM-IV’e göre iki uçlu bozukluk, Manik Dönem olarak değerlendirilen, ilk dönem 69 olgu ardışık olarak değerlendirilmiştir. Olgularda öncesinde depresif dönem bulundurmama, herhangi bir nörolojik hastalığı, kafa travması ve/ veya bilinç kaybı öyküsü olmama, EEG çekimi öncesi, elektroensefalografik aktiviteyi etkileyecek ilaç (antiepileptik, anksiyolitik, antidepresan ve antipsikotik) almamış olma şartları aranmıştır. Dışlama ölçütleri haricinde 50 olguya ait veriler değerlendirmeye alınmıştır. Tanı görüşmeleri SCID-I (DSM-IV Yapılandırılmış Klinik Görüşmesi) ile yapılmış, hastalıkla ilgili bilgiler SKIP-TURK (Duygudurum Bozuklukları Tanı ve İzlem Formu) ile kaydedilmiş, manik belirtilerin şiddeti YMDÖ (Young Mani Derecelendirme Ölçeği) ile, çocukluk çağı travmasının varlığı ETI (Erken Travmatik Yaşantı Envanteri) ile belirlenmiştir. EEG çekimi digital EEG cihazı ile 16 kanal olarak yapılmış, 23 adet yüzey elektrodu uluslararası 10-20 sistemine göre yerleştirilmiştir. Bulgular: İlk manik dönem iki uçlu olgular arasında epileptik EEG 2 olguda (%4), epileptik olmayan anormal EEG 10 olguda (%20.8) saptanmıştır. İlk dönem manide EEG anormalliği kadın cinsiyette daha sıktır (p=0.012). Çocukluk çağı travması, çocukluk çağı psikiyatrik hastalık öyküsü, şimdiki fiziksel hastalık eştanısı, intihar girişimi öyküsü ve birinci derece yakınlarda aile öyküsü EEG anormalliği olan grupta daha sık bulunmuştur (p= 0.016, 0.012, 0.001, 0.005 ve 0.032). Çocukluk çağı travması, regresyon analizinde ilk atak mani olgularında EEG bozukluğunun öngörücüsü olarak saptanmıştır (p= 0.004). Sonuç: Bir kısım iki uçlu olguda anormal EEG, hastalığın başlangıcından itibaren mevcuttur ve klinik özellikler ile ilişkilidir.

Anahtar Kelimeler:

EEG, ilk atak, mani

EEG abnormality in first episode mania: remark of childhood trauma

Objective: The aim of this study is to investigate the frequency of abnormal EEG findings in first episode mania and to compare cases with and without abnormal EEG findings with regard to their clinical characteristics of bipolar disorder. Method: In the present study, among the admissions to our outpatient clinic or emergency service within the last year 69 consecutive first attack mania cases, between the ages of 18-65, who were diagnosed with Bipolar Disorder Manic Episode according to the DSM-IV criteria and whose informed consent form was signed by first degree relatives were evaluated. Inclusion criteria were absence of any previous depressive episode neurologic disorder, history of head trauma and/or loss of consciousness and not any drug use at the enrollment which can influence electroencephalographic activity EEG (antiepileptic, anxiolytic, antidepressant and antipsychotics). Records of 50 patients who also did not met exclusion criteria have been evaluated. Diagnostic interviews were made by using SCID-I (DSM-IV Structured Clinical Interview). Information about then disease itself was recorded on SKIP-TURK (Mood Disorder Diagnosis and Following Form) and the severity of manic symptoms was determined by using YMRS (Young Mania Rating Scale). Childhood trauma was determined by using ETI (Early Trauma Inventory). EEG recordings were made with digital EEG device in 16 channels and 23 surface electrodes were placed according to international 10-20 system. Results: Epileptic EEG was found in 2 (4%) and nonepileptic abnormal EEG was found in 10 (20.8%) patients with first episode mania. Abnormal EEG in first episode mania was more frequent in females (p= 0.012). Childhood trauma, childhood history of psychiatric disorder, comorbid pshysical disease, history of suicide attempt and familiy history in first degree relatives were found to be more frequent in the group with EEG abnormality (p=0.016, 0.012, 0.001, 0.005 and 0.032). Childhood trauma was found to be a predictor of EEG abnormality in first episode mania cases as determined by regression analysis (p=0.004). Conclusion: In some bipolar cases, abnormal EEG is present from the onset of disease and is associated with clinical characteristics.

Keywords:

EEG, first episode, mania,

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