www.ksmf.org/arhimed   arhimed@ksmf.org   [5/10/2025 9:23:04 AM] http://www.ksmf.org/arhimed/poglej.asp?id=88 Rast glave pri otrocih z infantilnimi spazmi Avtor: Uroš Krivec, Jana Lozar Mentor: prof. dr. David Neubauer, dr. med IZHODIŠCA Infantilni spazmi (IS) so epilepticni sindrom, ki se pojavi v zelo aktivnem obdobju razvoja možganov. Ker spremembe v obsegu glave (OG) v zgodnjem otroštvu natancno odsevajo rast možganov, nas je zanimalo, ali epilepticno dogajanje pri malckih moti razvoj možganov do take mere, da se to opazi v pocasnejši rasti glave. Poleg tega nas je zanimalo, v katerem mesecu starosti oz. v katerem mesecu po nastopu bolezni OG (kot merilo rasti možganov) najbolje napoveduje izid bolezni v kasnejšem življenju. BOLNIKI IN METODE V retrospektivno raziskavo smo vkljucili 38 otrok, 17 deckov in 21 deklic, ki poleg IS niso imeli drugih ocitnih vzrokov za nenormalno rast glave (hidrocefalus, kromosomske in genetske anomalije). Podatke o OG posameznikov smo zbrali iz zdravstvene dokumentacije. Za mejo med primernim in majhnim OG smo izbrali 10. centilo slovenske populacije. Otroke smo glede na umski in razvojno nevrološki izid razvrstili v štiri razrede (1 - normalen do 4 - huda prizadetost). Za ugotavljanje odnosa med OG in izidom bolezni smo uporabili t-test in multiplo linearno regresijo. REZULTATI Ugotovili smo, da je pri otrocih z IS OG v 4. in 5. mesecu po nastopu bolezni najbolj znacilno povezan z izidom umskega razvoja (2.8 pri otrocih z majhnim OG proti 1.7 pri otrocih s primernim OG, p= 0.004). Ta povezava ostane tudi po kontroli etiologije, trajanja spazmov, donošenosti in psihomotoricnega razvoja pred nastopom bolezni. Le 12% otrok z majhnim OG v 4. mesecu po nastopu bolezni je imelo kasneje normalen umski razvoj. Povprecen OG pri otrocih z IS se statisticno ne razlikuje od povprecja za normalno populacijo, vendar je delež otrok z OG pod 10. centilo (27%) vecji kot v normalni populaciji. ZAKLJUCKI Ugotovili smo, da je OG pri otrocih z IS pomemben napovedni dejavnik izida umskega razvoja. Ker je meritev OG enostavna in hitra preiskava z veliko uporabno vrednostjo, svetujemo, da pediatri in pediatrinje te meritve pri vsakdanjih pregledih otrok, posebno tistih z IS, ne zanemarjajo. «» [Abstract / English version] Head Growth in Children with Infantile Spasms Author: Uroš Krivec, Jana Lozar Mentor: prof. dr. David Neubauer, dr. med BACKGROUND Infantile spasms (IS) begin in a very active phase of brain development. Since changes in head circumference (HC) accurately reflect changes in brain growth during infancy, we assumed the possibility that epileptic activity which interferes with brain development would also lead to head growth failure in children affected by IS. The aim of the study was to determine the relationship between outcome and HC at different age or different time after onset of IS. PATIENTS AND METHODS The study involved 38 children (17 boys and 21 girls) with history of IS and no other obvious cause for an abnormal head growth (i.e. hydrocephalus, chromosomal or genetic abnormality). The data for HC were gathered from patients' medical documentation. HCs below the 10th percentile of Slovene population were considered abnormal. In terms of cognitive and neuro-developmental outcome the children were grouped into four categories (1-normal to 4-sever impairment). t-test and multiple linear regression were used to test the relationship between HC and outcome. RESULTS Abnormal HC in the 4th and the 5th month after onset of spasms was significantly associated with abnormal mental development ( 2.8 vs.1.7, p= 0.004). This relation persisted even when several factors like etiology, duration of spasms, gestational age and delayed development before onset of spasms were controlled. In the 4th month after onset of spasms normal mental development was present in only 12% (1:8) of children with abnormal head size. The mean HC of the children with IS was not significantly lower than the mean HC in normal population, even though the proportion of the children with abnormal head size (27%) was larger. CONCLUSIONS It was found that HC represents an important predictive factor for cognitive outcome in children with history of IS. Since HC can be measured quickly and easily its considerable predictive role in follow up should not be ignored in any children and specially not in those with IS.