뇌전증 소아들에서 주의력결핍과잉행동장애와 뇌 MRI 소견의 연관성 = The Correlation between ADHD and Brain MRI Findings in Children with Epilepsy

국문 초록 (Abstract)

목적: 뇌전증 소아들 중 주의력 결핍 과잉행동장애가 중복된 소아들의 뇌 MRI를 분석하여 ADHD와 뇌 MRI의 연관성을 알아 보고, MRI 의 이상 소견이 ADHD 발생의 위험인자가 될 수 있는지의 여부를 알아보고자 하였다.
방법: 2009년 3월부터 2013년 12월까지 가톨릭대학교 서울성모병원 소아신경과에서 뇌전증을 진단 받고, 항경련제 치료를 받는 6세에서 18세까지의 환자들 중 ADHD 가 중복 되었고 최소 1년 이상 추적 관찰이 가능하였던 55명(남자 36명, 여자 19명)의 소아들을 대상으로 하였다. ADHD의 진단은 정신질환 진단 및 통계편람 (DSM-IV, Diagnostic and Statistical Manual of Mental Disorder, 4thedition)의 기준에 따라 진단하였다.
결과: 뇌 MRI가 정상 소견을 보인 환자들은 대부분 주의력결핍형의 ADHD였으나(28명, 96.5%), 뇌 MRI가 비정상 소견을 보인 환자들은 혼합형이 14명(53.8%)으로 가장 많았으며, 주의력결핍형이 12명(46.2%)으로 MRI이상소견의 유무에 따라 ADHD의 아형에 차이가 있었다. 또한 주의력결핍 및 과잉행동-충동에 관한 각각의 문항 9개 중 양성을 보인 개수를 MRI 소견의 이상유무에 따라 비교한 결과, MRI소견에서 이상이 있는 환자군에서 ADHD 증상이 심한 것으로 평가되었다.
결론: 뇌전증 소아 환자들에서 MRI 이상 소견은 ADHD와 밀접한 연관성을 가지고 있을 뿐 아니라 ADHD 의 중증도와 연관될 수 있음을 말해준다. 따라서 MRI에 이상 소견이 발견되는 뇌전증 환자에서는 조기 ADHD 선별검사를 시행해 이에 대한 대책을 수립하는 것이 치료 및 삶의 질 향상에 도움이 될 것이라고 여겨진다.

다국어 초록 (Multilingual Abstract)

Purpose: We analyze the brain magnetic resonance imaging (MRI) findings of children with epilepsy and concomitant attention deficit hyperactivity disorder (ADHD) to investigate the correlation between brain MRI and ADHD, and to determine whether abnormal MRI finding can be a risk factor for the development of ADHD.
Methods: A total of 55 patients (36 male, 19 female) were diagnosed as ADHD in children with epilepsy at the pediatric neurology department of Seoul St. Mary hospital from March, 2009 to December, 2013. The records of these patients were retrospectively reviewed.
Results: 29 patients (52.7%) had normal MRI findings, and 26 patients (47.3%) had abnormal MRI findings. The inattention type of ADHD (96.5%) was the largest type in a group of normal brain MRI findings, but the combined type (53.8%) and the inattention type (46.2%) occupied the majority in a group of abnormal MRI findings. The score of symptom in inattention was 7.44/9 in a group of normal MRI findings, while 8.2/9 in a group of abnormal MRI findings. And the score of symptom in hyperactivity was 2.93/9 in a group of normal MRI findings, while it was 4.8/9 in a group of abnormal MRI findings (P<0.001). 7 patients (12.7%) revealed hippocampal sclerosis out of 26 abnormal MRI findings, and they had significantly higher scores of ADHD symptoms (8.57/9, 4.8/9) compared to normal group (7.83/9, 4.23/9).
Conclusion: Abnormal MRI findings in children with epilepsy are not only closely related to ADHD but may also be associated with the severity of ADHD.

목차 (Table of Contents)

• 서론
• 대상 및 방법
• 결과
• 고찰
• 요약
• References

참고문헌 (Reference)

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