Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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Clinical characteristics and outcomes of status epilepticus as an initial seizure in children

첫 경련으로 발현된 소아기 간질지속상태(status epilepticus)의 임상 특성과 예후

  • Kim, Mi Jeong (Department of Pediatrics, College of Medicine, Chonnam National University) ;
  • Kim, Young Ok (Department of Pediatrics, College of Medicine, Chonnam National University) ;
  • Kim, Sun Hee (Department of Pediatrics, College of Medicine, Chonnam National University) ;
  • Choi, Woo Yeon (Department of Pediatrics, College of Medicine, Chonnam National University) ;
  • Byun, Hyung Suk (College of Medicine, Seonam University) ;
  • Kim, Chan Jong (Department of Pediatrics, College of Medicine, Chonnam National University) ;
  • Woo, Young Jong (Department of Pediatrics, College of Medicine, Chonnam National University)
  • 김미정 (전남대학교 의과대학 소아과학교실) ;
  • 김영옥 (전남대학교 의과대학 소아과학교실) ;
  • 김선희 (전남대학교 의과대학 소아과학교실) ;
  • 최우연 (전남대학교 의과대학 소아과학교실) ;
  • 변형석 (서남대학교 의과대학 소아과학교실) ;
  • 김찬종 (전남대학교 의과대학 소아과학교실) ;
  • 우영종 (전남대학교 의과대학 소아과학교실)
  • Received : 2006.03.15
  • Accepted : 2006.05.09
  • Published : 2006.06.15
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Abstract

Purpose : To evaluate the morbidity and mortality of children with status epilepticus(SE) as an initial seizure and to compare these according to age groups. Methods : The 78 cases(38 cases <2 years and 38 cases ${\geq}2$ years) with SE as an initial seizure admitted to the Chonnam national university hospital from Jan. 2000 to Jan. 2004 were reviewed. Developmental profiles, laboratory findings, etiologies and seizure types of SE and outcomes were compared in between two age groups, under and over 2 years. Results : SE occurred predominantly in less than 5 years old. Febrile causes were the most common, which is significantly more in those under 2 years than over 2 years(P<0.05). whereas idiopathic and acute symptomatic causes were more common in those over 2 years(P<0.05). Generalized tonic-clonic seizures was the most common type. The mortality rate was 6.4 percent(5 cases : 1 case <2 years and 4 cases ${\geq}2$ years). The estimated occurrence of epilepsy after SE was 24.4 percent(19 cases : 8 cases <2 years and 11 cases ${\geq}2$ years). The neurologic sequelae after SE in cases that had developed normally before SE(62 cases : 32 cases <2 years and 30 cases ${\geq}2$ years) were observed in 20 cases(32.3 percent), and were more frequent over 2 years(21.9 percent vs. 43.3 percent, P<0.05). Conclusion : In this study death was less common and the neurologic sequelaes of SE as an initial seizure were less severe in children under 2 years of age. The reason seemed to be the difference in the etiology of SE with age.

목 적 : 영아 및 소아기에 SE는 발생률이 어른에 비해 높고 첫 경련으로 나타나는 경우가 많으며 뇌 손상을 일으키기 쉽다. 본 연구에서는 첫 경련이 SE로 발현한 소아 환자들을 대상으로 경련의 원인, 임상 특성 및 예후를 알아보고, 초기 발병 연령이 2세 미만과 이상인 경우와 어떠한 차이가 있는지 비교해 보고자 하였다. 방 법 : 2000년 1월부터 2004년 1월까지 전남대학교병원 소아과를 방문한 생후 1개월부터 15세 사이의 소아들 중 첫 경련이 SE로 진단되어 입원하였던 78명(2세 미만 39례와 이상 39례)을 대상으로 하였다. 결 과 : 5세 미만이 62례(79.5%)로 대부분이었으며, 남녀 비는 1.3 : 1이었다. SE의 원인은 발열성이 27례(34.6%)로 가장 많았으며, 발열성 원인은 2세 미만군(46.1%)에서 2세 이상군(23.1%)에 비해 유의하게 많았다(P<0.05). SE의 발작 형태는 전신 강직, 간대, 강직간대발작이 총 67례 (85.9%)로 가장 많았다. SE로 인해 총 5례가 사망하여 사망률은 6.4%였다. SE 후 간질의 발생은 19례(24.4%)에서 볼 수 있었으며 연령군에 따른 차이는 볼 수 없었다. SE 이전에 정상 발달을 보였던 62례(2세 미만 32례, 2세 이상 30례) 중 총 20례(32.3%)에서 SE 후 신경학적 후유증이 관찰되었으며, 2세 이상군에서 보다 높은 발생 빈도를 보였다(2세 미만 7례, 21.9% vs. 2세 이상 13례, 43.3%)(P<0.05). 결 론 : 소아에서 첫 경련이 SE로 발현한 경우 2세 미만군이 2세 이상군에 비해 신경학적 후유증 발생 및 사망률이 의의 있게 낮았으며 이는 SE의 원인 질환의 차이에 기인하는 것으로 사료된다.

Keywords

References

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