열을 동반한 경련시 뇌척수액 검사의 대상에 관한 연구 = CSF Examination in the First Febrile Seizure

국문 초록 (Abstract)

목 적 : 열성 경련은 소아의 2-5%에서 발생하는 질환으로 대부분 양성 경과를 취하게 되지만, 간혹 세균성 뇌수막염 같은 중추신경계의 감염으로 나타날 수가 있기 때문에 이러한 질환을 감별해 내는 것이 무엇보다도 중요하다고 할 수 있다. 그런데 뇌척수액 검사가 쉽게 선택할 수 있는 검사는 아니어서 첫 열성 경련시 뇌척수액 검사의 대상을 알아보고 뇌수막염의 조기 진단과 치료에 도움이 되고자 이 연구를 시작하였다.방 법 : 1995년 3월부터 2003년 9월까지 8년 8개월 동안 열을 동반한 초회의 열성 경련으로 전주 예수병원에서 치료받은 3개월에서 5세 사이의 환아를 대상으로 초발 연령, 경련 형태, 뇌척수액 검사, 뇌수막염 여부 등을 살펴보고 열성 경련의 연령 분포, 뇌척수액 검사율, 뇌수막염 발생률에 대하여 조사하였다. 또한 동일한 기간에 동일한 연령 군에서 세균성 뇌수막염으로 치료받은 환아를 조사하였다.

다국어 초록 (Multilingual Abstract)

Purpose:This study was launched to classify subjects of the CSF examination and improve early diagnosis of meningitis and its treatment in children who have had a first febrile seizure.
Methods:From March 1995 to September 2003, children aged 3 months to 5 years who had had treatment for febrile seizure were analyzed as to their age at first seizure, type of seizure, CSF examination, and prevalence of meningitis.
Results:The largest age group distribution among the 780 children was 356(45.6%) children who were under 18 months. One hundred ninteen(15.3%) patients received the CSF examination, and out of those 68(19.1%) were less than 18 months old. Twenty five(3.2%) children were diagnosed with meningitis; those less than 18 months old were 15(4.2%). Two(0.2%) were diagnosed as bacterial meningitis. Out of 780 patients 599(76.8%) were simple febrile seizure patients. Out of 32(5.3%) who received the CSF examination, nine were diagnosed as meningitis. In complex febrile seizure, 86(52.1 %) out of 165(21.2%) received CSF examinations and 16(9.7%) of those were diagnosed as meningitis. Thus, there was a higher prevalence of meningitis in children presenting complex febrile seizure.
Conclusion:To diagnose meningitis with the CSF examination in the first febrile seizure, the patient's general condition, such as clinical symptoms and types of seizure, are more important than the ages of the patients. We suggest that experienced physicians should be concerned with doing an early diagnosis of meningitis and thus reduce the number of CSF examinations of children with febrile seizures.

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