Katılma nöbeti olan olguların demografik, klinik, laboratuvar bulguları ve aldıkları tedavilerin değerlendirilmesi
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Dosyalar
Tarih
2022
Yazarlar
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Yayıncı
Trakya Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Katılma nöbetleri çocukluk çağında sık görülen sinirlenme, ağrı gibi olumsuz uyarılarla tetiklenen istemsiz apne ile ortaya çıkan cilt rengi, bilinç ve postüral tonus değişiklikleri ile seyreden steroitipik özellikli bir paroksismal olaydır. Katılma nöbetleri; siyanotik, soluk (pallid) ve karma olarak üçe ayrılır. Ülkemizde yapılan bir prevelans çalışmasında katılma nöbeti sıklığı %3,6 olarak saptanmıştır. Etiyolojide demir eksikliğinin rolü yüksektir. Bu çalışmada kliniğimize başvurarak katılma nöbeti tanısı alan 51 olgunun demografik, klinik, laboratuvar bulgularını saptayarak hastaların özelliklerini ortaya koymayı amaçladık. Bu sayede katılma nöbetinin genel olarak seyrinin tahmin edilmesi ve buna etki eden faktörlerin belirlenmesi ve katılma nöbeti yönetiminde bilgi sağlamasını amaçladık. Çalışmamızda değerlendirdiğimiz olguların %60,8’i erkek, %39,2’si kızdı. Olguların %88 siyanotik atak, %5,8 pallid atak, %5,8 karma tipte atak geçirdiği görüldü. Siyanotik nöbetin en çok, soluk nöbet en az görülen nöbet tipi olarak saptandı. Siyanotik ve mikst tip nöbetler erkek olgularda daha sık gözlenirken soluk tip nöbet kız olgularda daha fazla saptandı. Katılma nöbetinde etiyolojik faktörleri incelediğimizde gestasyon yaşı, YDYBÜ yatışı, doğum şekli, antropometrik ölçümler, demir profilaksisi kullanımı, akraba evliliği, ailede katılma nöbeti öyküsü, ailede epilepsi öyküsü, nörolojik gelişim ve ek hastalık öyküsü açısından anlamlı bir fark bulunmadı. Siyanotik atak geçiren olguların ortalama B12 değeri, pallid atak geçiren olgulara oranla anlamlı düzeyde düşük saptandı. Demir eksikliği anemisi gözlenen olgular toplam olguların %9,8’ini oluştururken anemi gelişmeden demir eksikliği saptanan olgu oranı %31,4 olarak izlendi. Çalışmamızda değerlendirilen olguların yarısından fazlasında demir eksikliği veya demir eksikliği anemisi izlenmedi. Hastaların demir eksikliği anemisi olan, demir eksikliği olan ve olmayan olarak karşılaştırıldığında atak süresi, atak sayısı, atak ağırlığı, atak tipi ve tedavi yanıtı açısından anlamlı fark saptanmamıştır. Psikojenik faktörlerin siyanotik tip nöbet geçiren olgularda daha sık görüldüğü saptandı. Olguların %80,39’unda tedavi sonrası atak tekrarı izlenmedi. Sonuç olarak; demir eksikliği katılma nöbeti için tetikleyici bir faktördür ve tedavide tek başına demir replasmanı ile atak tekrarı engellenebilmektedir. Özellikle siyanotik ataklarda eşlik eden B12 vitamini eksikliği akılda tutulmalıdır.
Breath holding spell is a stereotypical paroxysmal event that is common in childhood, triggered by negative stimuli such as irritability and pain, presenting withinvoluntary apnea, and progressing with changes in skin color, consciousness and postural tone. Breath holding spell is divided into 3 types as Cyanotic, Pale (Pallid) and Mixed. Thefrequency of Breath holding spell was found to be 3.6% in a prevalence study conducted in our country. The role of iron deficiency in the etiology is high. In this study, weaimed to determine the demographic, clinical and laboratory characteristics of 51 patients who applied to our clinic and were diagnosed with breath holding spell, to determine the risks for patients' recurrence of participation seizures and to evaluate the responses of the patients to appropriate treatment options in the follow-up. In this way, weaimed to predict the general course of the breath holding spells and to determine the factors affecting it and to provide information in the management of the breath holding spells. Of the cases we evaluated in ourstudy, 60.78% were maleand 39.22% were female. It was observed that 88% of the cases had cyanotic spells, 5.8% pallid spells, and 5.8% mixedtype spells. İt was observer that cyanotic spells were the most common and pale spells were the least common spell type. While cyanotic and mixed type spells were observed more frequently in male cases, pale type spells were observed more frequently in female cases. When we examined the etiological factors in the participation spells, no significant difference was found in terms of prematurity, new born intensive care unit hospitalization, type of birth, anthropometric measurements, use of iron prophylaxis, consanguineous marriage, family history of breath holding spell, neurological development and additional disease history. The mean B12 values of patients who had cyanotic spells were found to be significantly lower than those who had pallid spells. While patients with iron deficiency anemia constituted 9.80% of the total cases, the rate of patients who were found to have iron deficiency stage without developing anemia was 31.37% . Iron deficiency or iron deficiency anemia was not observed in more than half of the patient sevaluated in our study 58.82%. When the patients with iron deficiency anemia, iron deficiency and non-iron deficiency were compared, no significant difference was found in terms of spells duration, spells number, spells severity, spells type and treatment response. It was found statistically significant that psychogenic factors were more common in patients with cyanotic spells. Attack recurrence was not observed in 80.39% (n=41) of the patients after treatment. As a result; iron deficiency is a triggering factor for breath holding spells and relapse can be prevented with iron replacement alone in treatment. Vitamin B12 deficiency accompanying especially in cyanotic spells should be kept in mind.
Breath holding spell is a stereotypical paroxysmal event that is common in childhood, triggered by negative stimuli such as irritability and pain, presenting withinvoluntary apnea, and progressing with changes in skin color, consciousness and postural tone. Breath holding spell is divided into 3 types as Cyanotic, Pale (Pallid) and Mixed. Thefrequency of Breath holding spell was found to be 3.6% in a prevalence study conducted in our country. The role of iron deficiency in the etiology is high. In this study, weaimed to determine the demographic, clinical and laboratory characteristics of 51 patients who applied to our clinic and were diagnosed with breath holding spell, to determine the risks for patients' recurrence of participation seizures and to evaluate the responses of the patients to appropriate treatment options in the follow-up. In this way, weaimed to predict the general course of the breath holding spells and to determine the factors affecting it and to provide information in the management of the breath holding spells. Of the cases we evaluated in ourstudy, 60.78% were maleand 39.22% were female. It was observed that 88% of the cases had cyanotic spells, 5.8% pallid spells, and 5.8% mixedtype spells. İt was observer that cyanotic spells were the most common and pale spells were the least common spell type. While cyanotic and mixed type spells were observed more frequently in male cases, pale type spells were observed more frequently in female cases. When we examined the etiological factors in the participation spells, no significant difference was found in terms of prematurity, new born intensive care unit hospitalization, type of birth, anthropometric measurements, use of iron prophylaxis, consanguineous marriage, family history of breath holding spell, neurological development and additional disease history. The mean B12 values of patients who had cyanotic spells were found to be significantly lower than those who had pallid spells. While patients with iron deficiency anemia constituted 9.80% of the total cases, the rate of patients who were found to have iron deficiency stage without developing anemia was 31.37% . Iron deficiency or iron deficiency anemia was not observed in more than half of the patient sevaluated in our study 58.82%. When the patients with iron deficiency anemia, iron deficiency and non-iron deficiency were compared, no significant difference was found in terms of spells duration, spells number, spells severity, spells type and treatment response. It was found statistically significant that psychogenic factors were more common in patients with cyanotic spells. Attack recurrence was not observed in 80.39% (n=41) of the patients after treatment. As a result; iron deficiency is a triggering factor for breath holding spells and relapse can be prevented with iron replacement alone in treatment. Vitamin B12 deficiency accompanying especially in cyanotic spells should be kept in mind.
Açıklama
Anahtar Kelimeler
Katılma nöbeti, Demir eksikliği anemisi, Anemi, Çocuk, Breath holding, Iron deficiency anemia, Anemia, Child
