Repozitorij Medicinskog fakulteta Sveučilišta u Zagrebu

Klinički značaj interiktalne jednofotonske emisijske kompjuterizirane tomografije mozga u procjeni funkcionalnog oštećenja mozga u djece s parcijalnom epilepsijom [Clinical value of interictal photon emision computerized tomography in evaluation of functional brain impairment in children with partial epilepsy]

Gjergja Juraški, Romana (2009) Klinički značaj interiktalne jednofotonske emisijske kompjuterizirane tomografije mozga u procjeni funkcionalnog oštećenja mozga u djece s parcijalnom epilepsijom [Clinical value of interictal photon emision computerized tomography in evaluation of functional brain impairment in children with partial epilepsy]. PhD thesis, Sveučilište u Zagrebu.

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    Croatian abstract

    UVOD: Dosadašnja istraživanja o utjecaju kliničkih parametara i osobina bolesnika na ishod kvalitativne/semikvantitativne interiktalne SPECT analize pokazala su nedosljedne rezultate. Nadalje, uporaba SPECT metode kod dječje populacije je evaluirana u manjem broju istraživanja i na manjem uzorku od istraživanja provedenih kod odraslih. CILJ: Svrha ovog istraživanja bila je istražiti klinički značaj interiktalne 99mTc-HMPAO SPECT metode u procjeni postojanja funkcionalnog oštećenja mozga u djece s parcijalnom epilepsijom i utjecaj određenih osobina bolesnika i kliničkih parametara bolesti. REZULTATI: Dječaci sa simptomatskom epilepsijom imaju statistički značajno više obostranih i ljevostranih promjena na 99mTc-HMPAO SPECT mozga, bez obzira na tvrdokornost simptomatske epilepsije, dok djevojčice imaju statistički značajno više urednih 99mTc-HMPAO SPECT nalaza. U djece s idiopatskim parcijalnim epilepsijama prosječan broj ROI s regionalnom hipoperfuzijom postupno raste u odnosu na promjene u psihotestu i taj broj je najveći u djece s graničnim IQ i lakom mentalnom retardacijom te s organitetom, bez obzira na tvrdokornost epilepsije. U djece s kontroliranim epilepsijama i organitetom značajno je više promijenjenih SPECT nalaza i lijevostranih ROI s hipoperfuzijom, dok djeca s kontroliranom simptomatskom epilepsijom i organitetom imaju statistički značajno viši broj lijevostranih frontalnih i temporalnih ROI s hipoperfuzijom. Postoji statistička značajnost korelacije između broja ROI s regionalnom hipoperfuzijom te dobi u vrijeme početka bolesti i trajanja epilepsije bez obzira na tvrdokornost i etiologiju parcijalne epilepsije. Dob u vrijeme početka epilepsije, trajanje epilepsije i/ili dob u vrijeme snimanja 99mTc-HMPAO SPECT-a imaju prediktivnu vrijednost za nalaz broja ROI s regionalnom hipoperfuzijom na 99mTc-HMPAO SPECT mozga, pogotovo u skupini s tvrdokornom idiopatskom epilepsijom. U djece sa sekundarnom generalizacijom napadaja najčešće su ROI s regionalnom hipoperfuzijom u području temporalnih regija, a u djece bez sekundarne generalizacije napada najčešće su to frontalne ROI. Nalaz promjena na 99mTc-HMPAO SPECT-u u djece sa simptomatskom epilepsijom nije uvijek u skladu s anatomskim promjenama na MR mozga, već ovisi o tvrdokornosti epilepsije i odraz je funkcionalnog oštećenja mozga. Kvalitativnaa i semikvantitativna 99mTc-HMPAO SPECT analiza pokazuje statistički značajno više urednih nalaza u odnosu na nalaze EEG-a i 139 promjene češće zahvaćaju samo jednu hemisferu mozga. Broj regija s regionalnom hipoperfuzijom je značajno veći u djece s politerapijom neovisno o etiologiji epilepsije. ZAKLJUČAK: Interiktalna 99mTc-HMPAO SPECT metoda ima klinički značaj u procjeni postojanja funkcionalnog oštećenja mozga u djece s parcijalnom epilepsijom. Osobine bolesnika (dob, spol, rezultati psihotesta, postojanje ranijih febrilnih konvulzija) i klinički parametri bolesti (dob u vrijeme početka bolesti, duljina trajanja bolesti, tvrdokornost, broj antiepileptika u terapiji) mogu utjecati na intenzitet i lokalizaciju regionalne moždane hipoperfuzije neovisno o etiologiji i tvrdokornosti parcijalne epilepsije.

    English abstract

    INTRODUCTION: Clinical studies about the influence of clinical parameters of epilepsy and characteristics of patients on the result of qualitative/semiquantitative interictal SPECT analysis have been shown inconsistent results. Furthermore, the use of SPECT method in paediatric population has been evaluated in smaller number of studies and in smaller number of cases than adults. AIM: The aim of this study was to investigate clinical importance of interictal 99mTc-HMPAO SPECT method in evaluation of functional brain damage in children with partial epilepsy and the influence of certain patients' characteristics and clinical parameters of epilepsy. RESULTS: Boys with symptomatic epilepsy have statistically higher number of bilateral and left-sided changes on 99mTc-HMPAO SPECT, regardless the refractory nature of symptomatic epilepsy, while girls have more normal 99mTc-HMPAO SPECT findings. Average number of ROI with regional hypoperfusion in children with idiopathic partial epilepsies gradually increases in accordance to decline in pychological testing and that number is highest in children with border IQ/SMR and with positive Bender test, regardless the refractory nature of epilepsy. In children with well controlled epilepsy and positive Bender test there is significantly higher number of altered SPECT findings and left ROI with hypoperfusion, while children with well controlled symptomatic epilepsy and Bender have statistically higher number of ROI with hypoperfusion. There is statistical significance of correlation between the number of ROI with regional hypoperfusion and the age at time of first seizure and duration of epilepsy, not considering the refractory nature and aetiology of partial epilepsy. The age at the time of first seizure, epilepsy duration and/or the age at the time of 99mTc-HMPAO SPECT have predictive value for number of ROI with regional hypoperfusion on 99mTc-HMPAO SPECT, especially in the group of refractory idiopathic epilepsy. In children with secondary generalisation of seizures, the most frequent ROI with regional hypoperfusion are in temporal region and in children without secondary generalization of seizures the most frequent ROI are in frontal regions. The finding of 141 99mTc-HMPAO SPECT changes in children with symptomatic epilepsy is not always in accordance with anatomical changes on brain MRI; it depends on refractory nature of epilepsy and it is reflection of functional brain damage. Visual and semiquantitative 99mTc-HMPAO SPECT analysis reveals statistically higher number of normal findings than EEG findings and these changes are more frequently situated on only one brain hemisphere. Number of regions with regional hypoperfusion is statistically higher in children treated with polytherapy, regardless the aetiology of epilepsy. CONCLUSION: Interictal 99mTc-HMPAO SPECT method has clinical significance in evaluation of functional brain damage in children with partial epilepsy. Characteristics of patients (age, sex, results of psychological testing, previous febriles seizures) and clinical parameters of disease (age ast the the of diagnosis, duration of epilepsiy, intractability, number of antiepileptics in therapy) can influence the intensity and localization of regional brain hypoperfusion regardless the aetiology and catastrophic nature of partial epilepsy.

    Item Type: Thesis (PhD)
    Mentor: Cvitanović-Šojat, Ljerka
    Divisions: Izvan medicinskog fakulteta
    Depositing User: dr.med. Helena Markulin
    University: Sveučilište u Zagrebu
    Institution: Medicinski fakultet
    Number of Pages: 155
    Status: Unpublished
    Creators:
    CreatorsEmail
    Gjergja Juraški, Romana
    Date: 12 November 2009
    Date Deposited: 02 Nov 2012 14:25
    Last Modified: 02 Nov 2012 15:05
    Subjects: WL Nervous System > WL 200-405 Central Nervous System. Disorders. Therapeutics > WL 385-390 Epilepsy. Movement Disorders
    Related URLs:
      URI: http://medlib.mef.hr/id/eprint/1662

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