Neurofiziološki aspekt prvog gubitka svesti kod dece

Uzroci gubitka svesti su različiti i teško ih je diferencirati. Razlikovanja epileptičkih od neepileptičkih gubitaka svesti je od krucijalnog značaja za ispitivanje, lečenja i prognoze ovih poremećaja. Elektroencefalografija (EEG) je standardna, neinvazivna metoda koja se koristi u ispitivanju nakon gubitka svesti. Inicijalni EEG nalaz nakon prvog gubitka svesti može biti normalan, specifičan ili nespecifičan. Procenat patološkog EEG nalaza je veći kod rano urađenog EEG pregleda. Kod dece rani EEG pregled u roku od 48h ne pokazuje statistički značajne abnormalnosti. Spontanim spavanjem ili EEG pregledom nakon deprivacije spavanja se beleži značajno veća prisutnost epileptiformnih promena kod dece starije od 3 godine, čak i kada je prvi EEG u budnom stanju normalan. Kombinacijama pregleda u budnom stanju i spavanju povećava prisutnost patoloških promena u EEG zapisu. Materijal metode: Istraživanje je obuhvatilo 198 dece uzrasta od 3-12 godine života nakon prvog gubitka svesti. Ispitanici su klasifikovani u dve grupe na osnovu otpusne dijagnoze: na grupu dece kod kojih dijagnoza epilepsije nije postavljena i na grupu dece kod kojih je dijagnoza epilepsije potvrđena. Korelirani su nalazi EEG-a u budnom stanju i spavanju (spontanom ili nakon deprivacije spavanja) sa anamnestičkim i kliničkim podacima o gubitku svesti, podacima o dužini trajanja gubitka svesti i vremena oporavka, vremenom kada je urađen prvi EEG u odnosu na gubitak svesti kao i sa podacima o ličnoj i porodičnoj anamnezi, a koji su navedeni u protokolu istraživanja. Ispitanici su potom podeljeni prema uzrastu u pet grupa u intervalima od 2 godine (3-4; 5-6; 7-8; 9-10; 11-12). Rezultati: Nakon prvog gubitka svesti specifičan (epileptiformni) nalaz EEG u budnom stanju imalo je 41,97% ispitanika, a 58,03% je imalo nespecifičan ili uredan EEG nalaz u budnom stanju, dok je specifičan nalaz EEG u spavanju imalo je 73,57% ispitanika, a 26,43% je imalo nespecifičan ili uredan EEG nalaz u spavanju. Ispitanici koji
The reasons for the loss of consciousness are various and difficult to be differentiated. It is of utmost importance to differentiate between epileptic and non-epileptic losses of consciousness for the purpose of testing, treating and giving prognosis related to this disorder. Electroencephalography (EEG) is a standard, non-invasive method used in testing after the loss of consciousness. The initial EEG after the first loss of consciousness can be normal, specific and non-specific. The percentage of pathological EEG findings is higher in EEG exams performed at an earlier stage. In children, an early EEG exam within 48 hours does not reveal any statistically relevant abnormalities. Spontaneous sleeping or an EEG examination after sleep deprivation leads to a significantly higher number of epileptiform changes in children above the age of 3, even in cases when the first EEG in the awake state was normal. Combinations of examinations in the awake state and during sleep lead to an increased presence of pathological changes in the EEG recording. Material and methods: The research included 198 children aged 3-12 who have experienced their first loss of consciousness. The subjects were classified into two groups, based on their discharge diagnosis: children who have not been diagnosed with epilepsy and children who have had epilepsy confirmed. A correlation was established between EEG findings in the awake state and sleep (spontaneous or following sleep deprivation) and medical history and clinical data related to the loss of consciousness, the information about the length of the loss of consciousness and recovery time, the time when the first EEG examination was performed in relation to the loss of consciousness, as well as the data from the personal and family history. The subjects were further divided into five groups, depending on their age, with each group covering a 2-year period (3-4; 5-6; 7-8; 9-10; 11-12). Results: Following the first loss of consciousness, specif