Serebral Palsili Çocukların Retrospektif Olarak Değerlendirilmesi
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Tarih
2022
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Cilt Başlığı
Yayıncı
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Bu çalışmada, Ocak 2010 ile Aralık 2021 yılları arasında Necmettin Erbakan
Üniversitesi Meram Tıp Fakültesi çocuk nörolojisi polikliniğine başvuran, serebral palsi
(SP) tanısı ile takip edilmiş 457 hastanın dosyası retrospektif olarak incelendi. Vakalar
demografik özellikleri, etyolojileri, laboratuvar sonuçları, görüntüleme bulguları, klinik
özellikleri, eşlik eden problemleri, uygulanan tedavileri açısından incelendi.
Çalışmaya dahil edilen hastaların yaş ortalaması 8,64±4,30 yıl (min:2 yıl-max:17
yıl) olup hastaların %62,1’i erkek (n=284) ve %37,9’u kız (n=173) idi. Doksan dört
(%20,7) hasta <1500 gr, 129 (%28,4) hasta 1500-2500 gr, 207 (%45,6) 2500-4000 gr, 24
(%5,3) hasta >4000 gr olarak doğmuştu. İki yüz kırk altı (%54,2) hasta preterm, 201
(%44,3) hasta term, yedi (%1,5) hasta posttermdi. Üç hastanın doğum ile ilgili özellikleri
bilinmediği için değerlendirmeye dahil edilmedi.
Hastaların klinik tiplerini sınıflandırdığımızda; %37’si (n=169) spastik kuadriplejik,
%22,1’i (n=101) spastik diplejik, %36,1’i (n=165) spastik hemiplejik, %2,4’ü (n=11)
ataksik, %1,3’ü (n=6) distonik, %1,1’i (n=5) koreatetoid tip olarak sınıflandırıldı. İşlevsel
sınıflamada ise kaba motor işlevsel sınıflama sistemi (KMİSS) seviyeleri; %7,9 (n=36)
seviye 1, %29,8 (n=136) seviye 2, %8,3 (n=38) seviye 3, %23,4 (n=107) seviye 4, %30,6
(n=140) seviye 5 idi. İnce motor işlev sınıflama sistemi (İMİSS) seviyeleri; %16,6 (n=76)
seviye 1, %31,9 (146) seviye 2, %13,6 (n=62) seviye 3, %12,3 (n=56) seviye 4, %25,6
(n=117) seviye 5 idi.
v
Olguların etyolojik dağılımı; %66,7’si (n=305) natal dönemde, %14,7’si (n=67)
postnatal dönemde, %14,2’si (n=65) prenatal dönemdeydi. Olguların %4,4’ünde (n=20) ise
etyoloji bilinmiyordu. Etyolojik faktörlerin dağılımı; %28,2 (n=129) prematürite, %21
(n=96) zor doğum, %7 (n=32) prematürite ve intrakraniyal kanama idi. Prenatal dönemde
hastaların %43,8’inde (n=200) herhangi bir risk faktörü öyküsü vardı. Bu 200 hastanın risk
faktörleri arasında; en sık %21 (n=42) oranında preeklampsi, ikinci en sık %17,5 (n=35)
oranında erken doğum eylemi idi.
En sık görülen oromotor disfonksiyon %25,8 (n=118) salya akması, ikinci en sık
%13,8 (n=63) yutma güçlüğü idi. Ekstremitelerde kontraktür 120 (%26,3) hastada, skolyoz
78 (%17,1) hastada vardı. Şaşılık 154 hastada (%33) vardı. SP tipleri ile şaşılık arasında
istatistiksel anlamlı fark yoktu (p=0,641). Yüz yetmiş sekiz (%39) hasta normal bir şekilde
yürümekteydi. Yürüme bozuklukları; en sık %17,7 (n=81) oraklama, ikinci en sık %11,6
(n=53) geniş tabanlı yürüme şeklinde idi.
Hastaların %48,1’inde (n=220) epilepsi vardı. Epilepsisi olan 124 hasta (%56,4)
spastik kuadriplejik tipte idi. Epilepsi varlığı ile SP tipleri istatistiksel olarak anlamlıydı
(p<0,001). Hastaların elektroensefalografik görüntüleme (EEG) bulgularınının 167’sinde
(%36,5) anormalik mevcuttu. EEG bulguları; %41,9 (n=70) multifokal epileptiform
aktivite, %20,4 (n=34) fokal epileptiform aktivite, %15,6 (n=26) jeneralize epileptiform
aktivite idi.
Hastaların eşlik eden diğer bozuklukları; %6,8 (n=31) görme bozukluğu, %3,9
(n=18) işitme bozukluğu, %27,4 (n=125) uyku bozukluğu, %23 (n=105) osteopeni, %3,1
(n=14) kalça çıkığı, %8,5 (n=39) pes ekinovarus, %0,4 (n=2) pes ekinovalgus, %3,5
(n=16) immün yetmezlik, %36,5 (n=167) akciğer sorunları, %2,2 (n=10) kronik akciğer
idi. Otuz bir (%6,8) hastada gastrostomi, 23 (%5) hastada trakeostomi vardı.
Beyin manyetik rezonans görüntüleme (MRG) bulguları incelendiğinde en sık
görülen bulgular; %34,4 (n=157) periventriküler lökomalazi (PVL), %15,5 (n=71)
ensefalomalazi, %9,6 (n=44) normal, %8,3 (n=38) kanama, %6,1 (n=28) hidrosefali, %5,7
(n=26) serebral atrofi, %3,7 (n=17) hipoksik iskemik ensefalopati (HİE) idi. SP tipleri ve
epilepsi varlığı ile sık görülen beyin MRG bulguları arasında istatistiksel anlamlı ilişki
bulundu (her biri için p<0,001).
vi
Uygulanan medikal tedavilerde; 78 hasta (%27,1) antispastisite tedavisi, 210 hasta
(%46) antiepileptik tedavi, 101 hasta (%22,1) antireflü tedavi alıyordu. Kırk beş hastaya
(%9,8) botulinum toksin enjeksiyonu, 16 hastaya (%3,5) intravenöz veya subkutan
immunglobulin uygulanıyordu. Takip edilen hastaların %83,4’ü (n=381) fizik tedavi ve
rehabilitasyon (FTR), %16,6’sı (n=76) konuşma terapisi, %50,5’i (n=231) ise özel eğitim
alıyordu. Yapılan cerrahi tedaviler incelendiğinde 77 hastaya (%16,8) ortopedik cerrahi, 46
(%10,1) hastaya göz ameliyatı, 40 hastaya (%8,8) beyin cerrahi ameliyatı yapıldı.
Sonuç olarak SP multidisipliner yaklaşım gerektiren önemli bir sağlık sorunudur.
Doğum öncesi, doğum ve doğum sonrası bakımın yeterince iyi yapılması halinde SP
olgularının sayısının azalması sağlanabilir. Ayrıca hamilelerin eğitimi ve özellikle daha
önce zor doğum, erken doğum, düşük veya ölü doğum yapmış riskli gebelikler ile birinci
doğumların mutlaka sağlık kuruluşlarında yapılması teşvik edilmelidir. Hastalara verilen
uygun tedaviler, hem hastanın hemde bakım görevini üstlenenlerin konforu açısından önem
taşımaktadır.
In this study, the files of 457 patients with cerebral palsy (CP) who applied to Necmettin Erbakan University Meram Medical Faculty pediatric neurology outpatient clinic between January 2010 and December 2021 were reviewed retrospectively. The cases were analyzed in terms of demographic characteristics, etiology, laboratory results, imaging findings, clinical features, accompanying problems, and treatments. The mean age of the patients included in the study was 8.64±4.30 (min:2-max:17) years, and 62.1% (n=284) of the patients were male and 37.9% (n=173) were female. 94 (20.7%) patients were born <1500 g, 129 (28.4%) patients 1500-2500 g, 207 (45.6%) 2500-4000 g, 24 (5.3%) patients >4000 g. 246 (54.2%) patients were preterm, 201 (44.3%) patients were term, 7 (1.5%) patients were postterm. Three patients were excluded from the evaluation because their birth characteristics were unknown. When we classify the clinical types of the patients; 37% (n=169) were spastic quadriplegic, 22.1% (n=101) were spastic diplegic, 36.1% (n=165) were spastic hemiplegic, 2.4% (n=11) ) were ataxic, 1.3% (n=6) were dystonic, and 1.1% (n=5) were classified as choreathetoid type. In functional classification, gross motor functional classification system (GMFCS) levels; 7.9% (n=36) level 1, 29.8% (n=136) level 2, 8.3% (n=38) level 3, 23.4% (n=107) level 4, 30% .6 (n=140) was level 5. Manual abilities viii classification system, (MACS) levels; 16.6% (n=76) level 1, 31.9% (146) level 2, 13.6% (n=62) level 3, 12.3% (n=56) level 4, 25.6% (n=117) was level 5. Etiological distribution of cases; 66.7% (n=305) were in the natal period, 14.7% (n=67) were in the postnatal period, and 14.2% (n=65) were in the prenatal period. The etiology was unknown in 4.4% (n=20) of the cases. Distribution of etiological factors; 28.2% (n=129) prematurity, 21% (n=96) difficult delivery, 7% (n=32) prematurity and intracranial hemorrhage. In the prenatal period, 43.8% of the patients (n=200) had a history of any risk factor. Among the risk factors of these 200 patients; preeclampsia was the most common 21% (n=42) and preterm labor was the second most common 17.5% (n=35). The most common oromotor dysfunction was drooling in 25.8% (n=18), and swallowing difficulty was the second most common in 13.8% (n=63). Contracture of the extremities was present in 120 (26.3%) patients, and scoliosis in 78 (17.1%) patients. Strabismus was present in 154 (33%) patients. There was no statistically significant difference between CP types and strabismus (p=0.641). One hundred and seventy-eight (39%) patients were walking normally. Gait disturbances; sickling was the most common 17.7% (n=81) and wide-base walking was the second most common 11.6% (n=53). Epilepsy was present in 48.1% of the patients (n=220). One hundred and twenty four patients (56.4%) with epilepsy were in the spastic quadriplegic type. Presence of epilepsy and CP types were statistically significant (p<0.001). There were abnormalities in 167 (36.5%) of the patients' electroencephalographic imaging (EEG) findings. EEG findings; 41.9% (n=70) multifocal epileptiform activity, 20.4% (n=34) focal epileptiform activity, 15.6% (n=26) generalized epileptiform activity. Other accompanying disorders of the patients; 6.8% (n=31) visual impairment, 3.9% (n=18) hearing impairment, 27.4% (n=125) sleep disturbance, 23% (n=105) osteopenia , 3.1% (n=14) hip dislocation, 8.5% (n=39) equinovarus, 0.4% (n=2) equinovalgus, 3.5% (n=16) immunodeficiency, 36%, 5 (n=167) of them were lung problems, 2.2% (n=10) of them were chronic lung. Thirty one (6.8%) patients had gastrostomy and 23 (5%) patients had tracheostomy. When the brain magnetic resonance imaging (MRI) findings are examined, the most common findings are; 34.4% (n=157) periventricular leukomalacia (PVL), 15.5% (n=71) encephalomalacia, 9.6% (n=44) normal, 8.3% (n=38) bleeding, 6% .1 (n=28) ix hydrocephalus, 5.7% (n=26) cerebral atrophy, 3.7% (n=17) hypoxic ischemic encephalopathy. Statistically significant correlation was found between CP types and presence of epilepsy and common brain MRI findings (p<0.001 for each). Applied medical treatments are also; 78 patients (27.1%) were receiving antispasticity therapy, 210 patients (46%) were receiving antiepileptic therapy, and 101 patients (22.1%) were receiving antireflux therapy. Botox was administered to 45 patients (9.8%), and intravenous or subcutaneous immunoglobulin was administered to 16 patients (3.5%). Of the patients followed, 83.4% (n=381) physical therapy and rehabilitation (PTR), 16.6% (n=76) speech therapy, 50.5% (n=231) special education was taking. When the surgical treatments were examined, orthopedic surgery was performed in 77 patients (16.8%), eye surgery in 46 patients (10.1%), and neurosurgery in 40 patients (8.8%). In conclusion, CP is an important health problem that requires a multidisciplinary approach. The number of CP cases can be reduced if prenatal, natal and postnatal care is provided adequately. In addition, the education of pregnant women and especially risky pregnancies with difficult births, premature births, miscarriages or stillbirths and first births should be encouraged in health institutions. Appropriate treatments given to patients are important for the comfort of both the patient and the caregivers. Keywords:
In this study, the files of 457 patients with cerebral palsy (CP) who applied to Necmettin Erbakan University Meram Medical Faculty pediatric neurology outpatient clinic between January 2010 and December 2021 were reviewed retrospectively. The cases were analyzed in terms of demographic characteristics, etiology, laboratory results, imaging findings, clinical features, accompanying problems, and treatments. The mean age of the patients included in the study was 8.64±4.30 (min:2-max:17) years, and 62.1% (n=284) of the patients were male and 37.9% (n=173) were female. 94 (20.7%) patients were born <1500 g, 129 (28.4%) patients 1500-2500 g, 207 (45.6%) 2500-4000 g, 24 (5.3%) patients >4000 g. 246 (54.2%) patients were preterm, 201 (44.3%) patients were term, 7 (1.5%) patients were postterm. Three patients were excluded from the evaluation because their birth characteristics were unknown. When we classify the clinical types of the patients; 37% (n=169) were spastic quadriplegic, 22.1% (n=101) were spastic diplegic, 36.1% (n=165) were spastic hemiplegic, 2.4% (n=11) ) were ataxic, 1.3% (n=6) were dystonic, and 1.1% (n=5) were classified as choreathetoid type. In functional classification, gross motor functional classification system (GMFCS) levels; 7.9% (n=36) level 1, 29.8% (n=136) level 2, 8.3% (n=38) level 3, 23.4% (n=107) level 4, 30% .6 (n=140) was level 5. Manual abilities viii classification system, (MACS) levels; 16.6% (n=76) level 1, 31.9% (146) level 2, 13.6% (n=62) level 3, 12.3% (n=56) level 4, 25.6% (n=117) was level 5. Etiological distribution of cases; 66.7% (n=305) were in the natal period, 14.7% (n=67) were in the postnatal period, and 14.2% (n=65) were in the prenatal period. The etiology was unknown in 4.4% (n=20) of the cases. Distribution of etiological factors; 28.2% (n=129) prematurity, 21% (n=96) difficult delivery, 7% (n=32) prematurity and intracranial hemorrhage. In the prenatal period, 43.8% of the patients (n=200) had a history of any risk factor. Among the risk factors of these 200 patients; preeclampsia was the most common 21% (n=42) and preterm labor was the second most common 17.5% (n=35). The most common oromotor dysfunction was drooling in 25.8% (n=18), and swallowing difficulty was the second most common in 13.8% (n=63). Contracture of the extremities was present in 120 (26.3%) patients, and scoliosis in 78 (17.1%) patients. Strabismus was present in 154 (33%) patients. There was no statistically significant difference between CP types and strabismus (p=0.641). One hundred and seventy-eight (39%) patients were walking normally. Gait disturbances; sickling was the most common 17.7% (n=81) and wide-base walking was the second most common 11.6% (n=53). Epilepsy was present in 48.1% of the patients (n=220). One hundred and twenty four patients (56.4%) with epilepsy were in the spastic quadriplegic type. Presence of epilepsy and CP types were statistically significant (p<0.001). There were abnormalities in 167 (36.5%) of the patients' electroencephalographic imaging (EEG) findings. EEG findings; 41.9% (n=70) multifocal epileptiform activity, 20.4% (n=34) focal epileptiform activity, 15.6% (n=26) generalized epileptiform activity. Other accompanying disorders of the patients; 6.8% (n=31) visual impairment, 3.9% (n=18) hearing impairment, 27.4% (n=125) sleep disturbance, 23% (n=105) osteopenia , 3.1% (n=14) hip dislocation, 8.5% (n=39) equinovarus, 0.4% (n=2) equinovalgus, 3.5% (n=16) immunodeficiency, 36%, 5 (n=167) of them were lung problems, 2.2% (n=10) of them were chronic lung. Thirty one (6.8%) patients had gastrostomy and 23 (5%) patients had tracheostomy. When the brain magnetic resonance imaging (MRI) findings are examined, the most common findings are; 34.4% (n=157) periventricular leukomalacia (PVL), 15.5% (n=71) encephalomalacia, 9.6% (n=44) normal, 8.3% (n=38) bleeding, 6% .1 (n=28) ix hydrocephalus, 5.7% (n=26) cerebral atrophy, 3.7% (n=17) hypoxic ischemic encephalopathy. Statistically significant correlation was found between CP types and presence of epilepsy and common brain MRI findings (p<0.001 for each). Applied medical treatments are also; 78 patients (27.1%) were receiving antispasticity therapy, 210 patients (46%) were receiving antiepileptic therapy, and 101 patients (22.1%) were receiving antireflux therapy. Botox was administered to 45 patients (9.8%), and intravenous or subcutaneous immunoglobulin was administered to 16 patients (3.5%). Of the patients followed, 83.4% (n=381) physical therapy and rehabilitation (PTR), 16.6% (n=76) speech therapy, 50.5% (n=231) special education was taking. When the surgical treatments were examined, orthopedic surgery was performed in 77 patients (16.8%), eye surgery in 46 patients (10.1%), and neurosurgery in 40 patients (8.8%). In conclusion, CP is an important health problem that requires a multidisciplinary approach. The number of CP cases can be reduced if prenatal, natal and postnatal care is provided adequately. In addition, the education of pregnant women and especially risky pregnancies with difficult births, premature births, miscarriages or stillbirths and first births should be encouraged in health institutions. Appropriate treatments given to patients are important for the comfort of both the patient and the caregivers. Keywords:
Açıklama
Anahtar Kelimeler
Serebral palsi, Epilepsi, Etyoloji, Eşlik eden bozukluklar, Cerebral palsy, Epilepsy, Etiology, Accompanying disorders
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Yılmaz. K. (2023). Serebral Palsili Çocukların Retrospektif Olarak Değerlendirilmesi. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Dahili Tıp Bilimleri Bölümü Çocuk Sağlığı ve Hastalıkları Anabilim Dalı, Konya.
