امروز : دوشنبه 28 آبان 1397 Rss | صفحه اصلی دانشکده
29 آبان 1395

بررسی فراوانی BEVs وعوامل مرتبط ثبت شده در VEM UNITبیمارستان مرکزطبی کودکان ازاول آذر93 تا اول آذر94

Benign epleptiform variants به امواجی که نادر و یا غیرعادی اند، اما عموما غیر طبیعی نیستند، گفته میشود. 1,2,3 از طرف دیگر آن ها به طور اتفاقی ظاهر می شوند، که می توانند تفسیر کننده مبتدی و بی تجربه را گیج کنند. تشخیص BEVs  ازجهت اجتناب از Overinterpretation و یا misinterpretation بسیار مهم است4 .این مقاله قصد دارد که چنین الگو هایی را بررسی نماید. تغییرات EEG که در طی دوران کودکی رخ می دهند، زمینه چالش بزرگ در دانش نوروفیزیولوژیک است ، که به علت بلوغ مغز(maturation) است ، به ویژه که در طی سال اول زندکی تغییرات به طور سریع رخ می دهند. EEG در شیر خواران و بچه ها به طور طبیعی در مقایسه با بالغین ، از نظر موج و فرکانس تنوع بیشتری دارد، از طرفی دیگر شیرخواران و بچه های کوچک تمایل دارند که در طی ثبت نوار مغز خواب باشند. بنابراین، تغییرات EEG با خواب (sleep)و خواب آلودگی ( drowsiness) در بچه ها بیش از بالغین است . 6 جهت انجام کار BEVs ها در چهار تایپ اصلی بررسی شده اند ، که عبارتند از : 1-hypnagogic hypersynchrony Lambda wave -2 3-per second positive spike discharge6&14 4-Rhythmic temporal theta burst of drowsiness   این مطالعه به بررسی شیوع امواج BEVs  از جمله hypnagogic hypersynchrony, Lambda , RMTD,14&6HZ  در مرکز Video EEG Monitoring بیمارستان مرکز طبی کودکان, اولین مرکز LTM  کشور در طب کودکان , پرداخته است.بیماران ازبدوتولد تا 18سال انتخاب شدند،  226 بیمار مورد مطالعه قرار گرفت که از این تعداد 108نفر دختر (47.8 % ) و 118 نفر پسر 52.7%) بوده اند. بیماران به 5 گروه سنی (یک ماه تا 2 سال ) و (2 سال تا 6 سال ) و (6 سال تا 12 سال ) و ( 12 سال تا 18 سال ) تقسیم شده اند . 26 نفر در گروه سنی ( 1ماه تا 2 سال ) بود که شامل 16 پسر (61%) و 10 دختر (10% ) است . شایعترین BEVs که با آن مواجه شدیم موج HH بود که از 226 نفر , 20 نفر از افراد موج HH در آنها رویت شد که از این تعداد 11 نفر پسر و 9 نفر دختر بوده اند. دومین موجی که بیشتر با آن مواجه شدیم , موج Lambda بود که در 14 نفر از 226 نفر رویت شد. سومین BEVs از نظر شیوع که با آن مواجه شدیم  14&6 HZ  بود که فقط در 3 نفر از 226 نفر رویت شد که شامل 2 دختر 12 و 14 ساله  و یک پسر 9 ساله  بود. در نهایتRTTD  تنها در 2 نفر از 226 نفر گزارش شد که هر 2 دختر بودند و 14 و 15 سال داشتند. مطالعه انجام شده  توسط ما , یک مطالعه single center میباشد. مطالعاتsingle center  اندکی در دنیا به صورت موردی BEVs  را گزارش کرده اند و اغلب مطالعات موجود مولتی سنتریک هستند.   : كليد واژه ها   RMTD: Rhythmic temporal theta burst of drowsiness   VEM: video EEG monitoring   EEG: Electroencephalography, BEVs: Benign epileptiform variants, HH: Hypnogogic hypersynchrony.     مشخصات دانشجو   نام: بهرام یارعلی,    رشته تحصيلي: نورولوژی کودکان     مقطع: فلوشیپ      گروه آموزشي :  مرکزطبی کودکان          پست الكترونيك دانشجو:   bahramyarali@gmail.com اساتيد راهنما و داور: استاد راهنما : دکترمحمودمحمدی, دکترغلامرضا زمانی                : دکتررضاشروین بدو, دکترمحمودمحمدی, دکترغلامرضا زمانی,   اساتيد مشاور:  دکتررضاشروین بدو    اساتيد داور زمان دفاع :    روز چهارشنبه   تاريخ 19 ابان  ساعت 12-13 مكان دفاع به آدرس:بیمارستان مرکز طبی، اسکیل لب اطلاعات به زبان انگليسي Title: Prevalence of benign epileptiform variants and related factor, observed among patients in the EMU, between November 21 2014 , November 21 2015 in  the pediatric medical center excellence. Abstract: The BEVs are rare and unusual waveforms and yet are not routinely considered abnormal. The BEVs occur occasionally and confuse the novice electroencephalographer to distinguish BEVs from the pathological counterparts which they resemble.Diagnosis of BEVs is important to avoid the over interpretation and misinterpretation. The aim of this study was to determine these patterns. EEG changes that occur in the childhood cause the great challenge in the neurophysiologic science, because of the Brain maturation, specially, in the first year of life that changes occur rapidly. EEG has more variety naturally in the frequency and waveform types, among infants and young child comparing with adults.Therefore EEG changes among young child, are more than comparing with adults, during sleep and Drowsiness. We identified the BEVs in four type below: 1.      Hypnogogic hypersynchrony 2.      Lambda 3.      14 & 6 Hz positive Spike Discharge 4.      RMTD: Rhythmic Midtemporal Discharges In this study, we studied the prevalence of BEV types such as, Hypnogogic hypersynchrony, Lambda, 14 & 6 Hz positive Spike Discharge, RMTD in the video EEG monitoring unit in the pediatric medical center excellence. Patients are selected that their ages ranged from newborn to 18 year. 226 patients were studied that was compromised of 118 males and 108 females. Patient distribution by age was follow: 1mouh-2year, 2year-6year, 6year-12year, 12year-18year. 26 patients are between ages, 12 and 18 years. The most frequency encountered BEVs was, Hypnogogic hypersynchrony, that occur among 20 patients from 226 cases, including 11 males and 9 females. The second BEV was Lambda wave that occurs in 14 patients. The third encountered BEV, was 14 & 6 Hz positive Spike Discharge that occur in just 3 patients, including 2 girls ( 12year & 14year) and one boy. At the end, RTTD occur only in 2 patients that both of them are female ( 14year & 15year ). This study was considered a single Centre study. There are not many singe Centre reports on the prevalence of the various types of BEVs, however individual BEVs have been reported and the most of them were multicenter studies. Keywords:  RMTD: Rhythmic temporal theta burst of drowsiness   VEM: video EEG monitoring   EEG: Electroencephalography, BEVs: Benign epileptiform variants, HH: Hypnogogic hypersynchrony. فهرست منابع و ماخذ فارسي و لاتين:    1.Zivin L, Marsan CA. Incidence and prognostic significance of ‘epileptiform’activity’ in the EEG of non-epileptic subjects. Brain 1968;91:751–78. 2.Westmoreland BF. Epileptiform electroencephalographic patterns. Mayo ClinProc 1996;71:501–11. 3.Drury I, Beydoun A. Pitfalls of EEG interpretation in epilepsy. 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