Serebral palsili hastaların demografik ve klinik özellikleri
Yıl 2019, Cilt 58, Sayı 3, 265 - 273, 20.09.2019Öz
Amaç: Çalışmamızın amacı serebral palsi (SP) polikliniğinde SP tanısı ile takip ve tedavisi yapılan hastalarımızın demografik ve klinik özelliklerini belirlemektir.
Gereç ve Yöntem: Düzenli takibi olan 577 hastanın bilgileri geriye dönük incelendi. Hastaların yaşı, cinsiyeti, etiyolojik faktörleri, problemlerin fark edildiği yaş, SP tipi, kaba motor fonksiyon klasifikasyon sistemiyle (KMFKS) değerlendirmesi, eşlik eden ikincil problemleri, muayene bulguları, rehabilitasyon merkezinde düzenli tedavi hizmeti alımı, ortez ve yardımcı cihazları, medikal tedavileri, uygulanan konservatif ve cerrahi tedavi yaklaşımları kaydedildi.
Bulgular: Hastalarımızın %41,9’u kız, %58,1’i erkek, yaş ortalaması 6,57 (±3,17) yıl idi. Tanı alma yaşı 0-6 ayda %31,4; 6-12 ayda %36,7; 1-2 yaşta %21,9 ve iki yaşından sonra %10,1 idi. Olguların %23,2’sinde spastik unilateral tip, %72,4’ünde spastik bilateral tip, %1,2’sinde diskinetik tip, %0,2’sinde hipotonik tip ve %2,9’unda mikst tip tutulum mevcuttu. Etiyolojik faktörler açısından %5 prenatal, %10,6 perinatal, %6,8 postnatal faktörler etkendi. Hastalarımızın %64’ünde birden çok risk faktörü mevcutken, %13,7’sinde risk faktörü saptanmamıştır. Rehabilitasyon merkezine devam süresi 3,05(±2,8) yıldı. Hastaların %51'inde eşlik eden problem mevcutken %49’unda eşlik eden problem yoktu. Hastalarımızın %9,6’sında antispastik tedavi, %22,6‘sında antikonvülzan tedavi, %3,1’inde antispastik ve antikonvülzan tedavi, %8,4’ünde bunların dışında medikal tedavi mevcutken, %56,3’ünde herhangi bir medikal tedavisi yoktu. Hastaların ilk başvuruda %33,1’i ortez, %23,3'ü yardımcı cihaz kullanmaktaydı. KMFKS’ye göre hastaların %18,5’i evre 1, %25,5’i evre 2, %18,4’ü evre 3, %22,7’si evre 4 ve %14,9’u evre 5 idi. En sık ekin yürüyüşü saptandı. Hastalarımızın %42,3’üne botulinum toksin enjeksiyonu, %0,7’sine selektif dorsal rizotomi, %21’ine ortopedik cerrahi uygulanmıştı.
Sonuç: Serebral palsinin epidemiyolojik karakterinin bilinmesi, hastaların düzenli takibi ve tedavisi çocuğun bağımlılığını en aza indirip topluma uyumunun artmasını sağlayabilir.
Anahtar Kelimeler
Serebral palsi, demografik ve klinik özellikler, fonksiyonel seviye, risk faktörleri.
Kaynakça
- Rosenbaum P, Paneth N, Leviton A, et al. A report: the definition and classification of cerebral palsy April 2006. Dev Med Child Neurol Suppl 2007; 109: 8-14.
- Sankar C, Mundkur N. Cerebral palsy, definition, classification, etiology and early diagnosis. Indian J Pediatr 2005; 72: 865-868.
- Dormans J, Susman M, Ozaras N and Yalcin S. Serebral Palsi Tedavi ve Rehabilitasyon. 1. Baskı. İstanbul:Mas Matbaacilik; 2000: 13-93.
- Matthews DJ, Wilson P. Cerebral Palsy. In:Molnar G.E, Alexander MA (ed). Pediatric Rehabilitation, 3nd ed. Philadelphia: Hanley and Belfus Inc; 1999: 193-219.
- Serdaroğlu A, Cansu A, Özkan S and Tezcan S. Prevalance of Cerebral Palsy in Turkish Children between the Ages of 2 and 16 Years. Developmental Medicine Child Neurology 2006; 48: 413-416.
- Dursun N. Serebral Palsi. In: Oğuz H, Dursun E, Dursun, editors. Tıbbi Rehabilitasyon. 1st ed. İstanbul: Nobel Tıp Kitapevleri; 2004: 957-74.
- Bohannon RW, Smith MB. Interrater reliability of a modified Ashworth Scale of muscle spasticity. Phys Ther 1987; 67 (2): 206-207.
- Ansari NN, Naghdi S, Younesian P. Interand intrarater reliability of the Modified Modified Ashworth Scale in patients with knee extensor poststroke spasticity. Physiother Theory Pract 2008; 24 (3): 205-213.
- Boyd RN, Graham HK. Objective measurement of clinical findings in the use of botulinum toxin type A for the management of children with traumatic brain injury, cerebral palsy and typically developing children. Dev Neurorehabil 2009; 12: 100-105.
- Donker SF, Ledebt A, Roerdink M. Children with cerebral palsy exhibit greater and more regular postural sway than typically developing children. Exp Brain Res 2008; 184: 363-370.
- Liao SF, Yang TF, Hsu TC. Differences in seated postural kontrol in children who are typically developing. Am J Phys Med Rehabil 2003; 82: 622-626.
- Hagberg B, Hagberg G and Olow I. The Changing Panaroma of Cerebralpalsy in Sweden. I. Prevelance and Origin during the Birth Year Period 1983-1986. Acta Paediatrica 1993; 82: 387-393.
- Russell DJ, Rosenbaum PL, Cadman DT. The gross motor function measure: a means to evaluate the effects of physical therapy. Dev Med Child Neurol 1989; 31: 341-352.
- Tütüncüoğlu S, Erermiş S, Aydın M, Özkııl Y, Erciyes H. Serebral Felçli Olguların Değerlendirilmesi. Klinik Bilimler Pediatride Yönelişler 1995; 3: 28-32.
- Laisram N, Srivastava VK, Srivastava RK. Cereb¬ral palsy-an etiological study. Indian J Pediatr 1992; 59 (6): 723-728.
- Johnson A. Prevalance and Characteristics of Children with Cerebral Palsy in Europe. Developmental Medicine Child Neurology. 2002; 44: 633-640.
- Bruck I, Antoniuk SA, Spessatto A, De Bem RS, Hausberger R, Pacheco CG. Epilepsy in children with cerebral palsy. Arq Neuropsiquiatr 2001; 59: 35-39.
- Berker N, Sussman M, Deniz E. Genel Kavramlar. In: Yalçın S, Berker N, Dormans J, Sussman M, editors. Serebral Palsi tedavi ve rehabilitasyon. İstanbul:Mas Matbaacılık; 2000: 15-51.
- Hagberg B, Hagberg G, Beckung E, Uvebrant P. Changing Panorama of Cerebral Palsy in Sweeden. 8th Prevalenceand Origin in The Birth Year Period 1991-94. Acta Pediatr 2001; 90: 271-7.
- Ozmen M, Calişkan M, Apak S, Gökçay G. 8-year clinical experience in cerebral palsy. J Trop Pediatr 1993; 39: 52-4.
- Surveillance of Cerebral Palsy in Europe (SCPE); Prevalence and characteristics of children with cerebral palsy in Europe. Dev Med Child Neurol 2002;44:633-40.
- Oztürk A, Demirci F, Yavuz T, Yildiz S, Değirmenci Y, Döşoğlu M. Antenatal and delivery risk factors and prevalance of cerebral palsy in Düzce (Turkey). Brain Dev 2007;29:39-42.
- Jacobsson B, Hagberg G. Antenatal risk factors for Cerebral Palsy. Best Pract Res Clin Obstet Gynaecol 2004;18:425-36.
- Hamamcı N, Gökçe Kutsal Y, Altıoklar K. Spastik serebral palsili hastalarda yürüme analizi. Romato Tıb Rehab 1991; 3: 169-178.
- Tunçbilek E, İsmet K. Consanguineous Marriage in Turkey and its. Impact on Fertility and Mortality. Ann. Human Genetics 1994; 58: 321-329.
- Aydın G, Caner K, Demir SÖ, Keleş I, Demir M, Orkun S. Serebral palsili 314 olgunun etiyolojik, demografik ve klinik özellikleri ve bu özelliklerin rehabilitasyon sonuçlarına etkisi. Fiziksel Tıp 2005; (8): 33-40.
- Sankar C, Mundkur N. Cerebral Palsy-definition, classification, etiology and early diagnosis. Indian J Pediatr 2005; (72): 865-68.
- Kwong KL, Wong SN, So KT. Epilepsy in children with cerebral palsy. Pediatr Neurol 1998; 19: 31-6.
- Fidan F, Baysal Ö. Epidemiologic Characteristics of Patients with Cerebral Palsy. Journal of Therapy and Rehabilitation 2014; 2: 126-132.
- Eriman EO, Icagasıoglu A, Demirhan E ve ark. Serebral Palsili 202 Olgunun Demografik Verileri ve Klinik Özellikleri. Türkiye Fiziksel Tip ve Rehabilitasyon Dergisi 2009; 55: 94-97.
- Dursun N. Serebral Palsi. In: Oğuz H, Çakırbay H, Yanık B editors. Tıbbi Rehabilitasyon. 3 st ed. İstanbul: Nobel Tıp Kitapevleri; 2015: 819-836.
- Kedem P, Scher DM. Foot deformities in children with cerebral palsy. Curr Opin Pediatr 2015; 27: 67-74.
- Chen YN, Liao SF, Su LF, Huang HY, Lin CC, Wei TS. The effect of long-term conventional physical therapy and independent predictive factors analysis in children with cerebral palsy. Dev Neurorehabil 2013; 16: 357-62.
- Bleck EE. Locomotor prognosis in cerebral palsy. Develop Med Child Neurol 1975; 17: 18-25.
- Molnar GE, Gordon SU. Cerebral palsy: Predictive value of selected clinical signs of early prognostication of motor function. Arch Phys Med Rehabil 1976; 57: 153.
- Sala DA, Grant AD. Prognosis for ambulation in cerebral palsy. Dev Med Child Neurol 1995;37:1020.
- Flett PJ. Rehabilittion of spasticity and related problems in childhood cerebral palsy. J Paediatr Child Health 2003; 39: 6-14.
- El Ö, Peker Ö, Bozan Ö, Berk H, Koşay C. Serebral palsi hastalarının genel özellikleri. Dokuz Eylül Üniversitesi Tıp Fakültesi Dergisi 2007; 21: 75-80.
- Davidof RA. Antispasticity drugs: mechanism of action. Ann Neurol 1985; 17: 107-16.
- Heinen F, Desloovere K, Schroeder AS, et al. The updated European Consensus 2009 on the use of Botulinum toxin for children with cerebral palsy. Eur J Paediatr Neurol 2010; 14: 45-66.
- Berker N, Yalçın S. The HELP Guide to Cerebral Palsy. Washington Global HELP Organisation. 2010; 60-68.
- Çullu E. Serebral Palsi. In Çullu E (ed): Çocuk Ortopedisi. İstanbul: Bayçınar Tıbbi Yayıncılık; 2012: 365-386.
- Yakut A. Serebral Palside Yeni Gelişmeler. Turkiye Klinikleri J Pediatr Sci 2008; 4 (4): 127-38.
Demographic and clinical characteristics of cerebral palsy patients
Yıl 2019, Cilt 58, Sayı 3, 265 - 273, 20.09.2019Öz
Aim: The objective of this study is to identify the demographic and clinical characteristics of our patients who were followed up and treated with cerebral palsy diagnosis.
Materials and Methods: The information of 577 patients was analyzed.
Results: 41.9% of patients were female,58.1% were male, the mean age was 6.57years. Age of diagnosis was 31.4% in 0-6 months; 36.7% at 6-12 months; 21.9% at 1-2 years and 10.1% after two years of age. There was spastic unilateral type in 23.2%, spastic bilateral type in 72.4%, dyskinetic type in 1.2%, hypotonic type in 0.2% and mixed type in 2.9% of the cases. In terms of etiologic factors,5% prenatal,10.6% perinatal,6.8% postnatal factors were affected.64% of our patients had more than one risk factor, 13.7% had no risk factor.
The duration of resumption to the rehabilitation center is 3.05 years. In 51% of the patients there was a concomitant problem, in 49% there was no accompanying problem. Antispastic therapy was used in 9,6% of patients, anticonvulsant therapy in 22,6%, both treatment in 3,1%, others medical treatment in 8,4%. In 56,3% of the patients was no medical treatment.33,1% of patients were using orthosis,23,3% were using assistive devices. According to CMFCS,18.5% of the patients were in stage 1,25.5% in stage 2,18.4% in stage 3, 22.7% in stage 4 and 14.9% in stage 5. Pes equinus was detected most frequently. Botulinum toxin injection was applied in 42,3%, selective dorsal rhizotomy in 0,7% and orthopedic surgery in 21% of our patients.
Conclusion: Knowing the epidemiologic character of cerebral palsy, regular follow-up, treatment of the patients can provide the least dependence on the child, increase the adaptation to the gathering.
Anahtar Kelimeler
Cerebral palsy, demographic and clinical characteristics, functional level, risk factors.
Kaynakça
- Rosenbaum P, Paneth N, Leviton A, et al. A report: the definition and classification of cerebral palsy April 2006. Dev Med Child Neurol Suppl 2007; 109: 8-14.
- Sankar C, Mundkur N. Cerebral palsy, definition, classification, etiology and early diagnosis. Indian J Pediatr 2005; 72: 865-868.
- Dormans J, Susman M, Ozaras N and Yalcin S. Serebral Palsi Tedavi ve Rehabilitasyon. 1. Baskı. İstanbul:Mas Matbaacilik; 2000: 13-93.
- Matthews DJ, Wilson P. Cerebral Palsy. In:Molnar G.E, Alexander MA (ed). Pediatric Rehabilitation, 3nd ed. Philadelphia: Hanley and Belfus Inc; 1999: 193-219.
- Serdaroğlu A, Cansu A, Özkan S and Tezcan S. Prevalance of Cerebral Palsy in Turkish Children between the Ages of 2 and 16 Years. Developmental Medicine Child Neurology 2006; 48: 413-416.
- Dursun N. Serebral Palsi. In: Oğuz H, Dursun E, Dursun, editors. Tıbbi Rehabilitasyon. 1st ed. İstanbul: Nobel Tıp Kitapevleri; 2004: 957-74.
- Bohannon RW, Smith MB. Interrater reliability of a modified Ashworth Scale of muscle spasticity. Phys Ther 1987; 67 (2): 206-207.
- Ansari NN, Naghdi S, Younesian P. Interand intrarater reliability of the Modified Modified Ashworth Scale in patients with knee extensor poststroke spasticity. Physiother Theory Pract 2008; 24 (3): 205-213.
- Boyd RN, Graham HK. Objective measurement of clinical findings in the use of botulinum toxin type A for the management of children with traumatic brain injury, cerebral palsy and typically developing children. Dev Neurorehabil 2009; 12: 100-105.
- Donker SF, Ledebt A, Roerdink M. Children with cerebral palsy exhibit greater and more regular postural sway than typically developing children. Exp Brain Res 2008; 184: 363-370.
- Liao SF, Yang TF, Hsu TC. Differences in seated postural kontrol in children who are typically developing. Am J Phys Med Rehabil 2003; 82: 622-626.
- Hagberg B, Hagberg G and Olow I. The Changing Panaroma of Cerebralpalsy in Sweden. I. Prevelance and Origin during the Birth Year Period 1983-1986. Acta Paediatrica 1993; 82: 387-393.
- Russell DJ, Rosenbaum PL, Cadman DT. The gross motor function measure: a means to evaluate the effects of physical therapy. Dev Med Child Neurol 1989; 31: 341-352.
- Tütüncüoğlu S, Erermiş S, Aydın M, Özkııl Y, Erciyes H. Serebral Felçli Olguların Değerlendirilmesi. Klinik Bilimler Pediatride Yönelişler 1995; 3: 28-32.
- Laisram N, Srivastava VK, Srivastava RK. Cereb¬ral palsy-an etiological study. Indian J Pediatr 1992; 59 (6): 723-728.
- Johnson A. Prevalance and Characteristics of Children with Cerebral Palsy in Europe. Developmental Medicine Child Neurology. 2002; 44: 633-640.
- Bruck I, Antoniuk SA, Spessatto A, De Bem RS, Hausberger R, Pacheco CG. Epilepsy in children with cerebral palsy. Arq Neuropsiquiatr 2001; 59: 35-39.
- Berker N, Sussman M, Deniz E. Genel Kavramlar. In: Yalçın S, Berker N, Dormans J, Sussman M, editors. Serebral Palsi tedavi ve rehabilitasyon. İstanbul:Mas Matbaacılık; 2000: 15-51.
- Hagberg B, Hagberg G, Beckung E, Uvebrant P. Changing Panorama of Cerebral Palsy in Sweeden. 8th Prevalenceand Origin in The Birth Year Period 1991-94. Acta Pediatr 2001; 90: 271-7.
- Ozmen M, Calişkan M, Apak S, Gökçay G. 8-year clinical experience in cerebral palsy. J Trop Pediatr 1993; 39: 52-4.
- Surveillance of Cerebral Palsy in Europe (SCPE); Prevalence and characteristics of children with cerebral palsy in Europe. Dev Med Child Neurol 2002;44:633-40.
- Oztürk A, Demirci F, Yavuz T, Yildiz S, Değirmenci Y, Döşoğlu M. Antenatal and delivery risk factors and prevalance of cerebral palsy in Düzce (Turkey). Brain Dev 2007;29:39-42.
- Jacobsson B, Hagberg G. Antenatal risk factors for Cerebral Palsy. Best Pract Res Clin Obstet Gynaecol 2004;18:425-36.
- Hamamcı N, Gökçe Kutsal Y, Altıoklar K. Spastik serebral palsili hastalarda yürüme analizi. Romato Tıb Rehab 1991; 3: 169-178.
- Tunçbilek E, İsmet K. Consanguineous Marriage in Turkey and its. Impact on Fertility and Mortality. Ann. Human Genetics 1994; 58: 321-329.
- Aydın G, Caner K, Demir SÖ, Keleş I, Demir M, Orkun S. Serebral palsili 314 olgunun etiyolojik, demografik ve klinik özellikleri ve bu özelliklerin rehabilitasyon sonuçlarına etkisi. Fiziksel Tıp 2005; (8): 33-40.
- Sankar C, Mundkur N. Cerebral Palsy-definition, classification, etiology and early diagnosis. Indian J Pediatr 2005; (72): 865-68.
- Kwong KL, Wong SN, So KT. Epilepsy in children with cerebral palsy. Pediatr Neurol 1998; 19: 31-6.
- Fidan F, Baysal Ö. Epidemiologic Characteristics of Patients with Cerebral Palsy. Journal of Therapy and Rehabilitation 2014; 2: 126-132.
- Eriman EO, Icagasıoglu A, Demirhan E ve ark. Serebral Palsili 202 Olgunun Demografik Verileri ve Klinik Özellikleri. Türkiye Fiziksel Tip ve Rehabilitasyon Dergisi 2009; 55: 94-97.
- Dursun N. Serebral Palsi. In: Oğuz H, Çakırbay H, Yanık B editors. Tıbbi Rehabilitasyon. 3 st ed. İstanbul: Nobel Tıp Kitapevleri; 2015: 819-836.
- Kedem P, Scher DM. Foot deformities in children with cerebral palsy. Curr Opin Pediatr 2015; 27: 67-74.
- Chen YN, Liao SF, Su LF, Huang HY, Lin CC, Wei TS. The effect of long-term conventional physical therapy and independent predictive factors analysis in children with cerebral palsy. Dev Neurorehabil 2013; 16: 357-62.
- Bleck EE. Locomotor prognosis in cerebral palsy. Develop Med Child Neurol 1975; 17: 18-25.
- Molnar GE, Gordon SU. Cerebral palsy: Predictive value of selected clinical signs of early prognostication of motor function. Arch Phys Med Rehabil 1976; 57: 153.
- Sala DA, Grant AD. Prognosis for ambulation in cerebral palsy. Dev Med Child Neurol 1995;37:1020.
- Flett PJ. Rehabilittion of spasticity and related problems in childhood cerebral palsy. J Paediatr Child Health 2003; 39: 6-14.
- El Ö, Peker Ö, Bozan Ö, Berk H, Koşay C. Serebral palsi hastalarının genel özellikleri. Dokuz Eylül Üniversitesi Tıp Fakültesi Dergisi 2007; 21: 75-80.
- Davidof RA. Antispasticity drugs: mechanism of action. Ann Neurol 1985; 17: 107-16.
- Heinen F, Desloovere K, Schroeder AS, et al. The updated European Consensus 2009 on the use of Botulinum toxin for children with cerebral palsy. Eur J Paediatr Neurol 2010; 14: 45-66.
- Berker N, Yalçın S. The HELP Guide to Cerebral Palsy. Washington Global HELP Organisation. 2010; 60-68.
- Çullu E. Serebral Palsi. In Çullu E (ed): Çocuk Ortopedisi. İstanbul: Bayçınar Tıbbi Yayıncılık; 2012: 365-386.
- Yakut A. Serebral Palside Yeni Gelişmeler. Turkiye Klinikleri J Pediatr Sci 2008; 4 (4): 127-38.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Bilimleri ve Hizmetleri |
| Bölüm | Araştırma Makaleleri |
| Yazarlar |
|
| Yayımlanma Tarihi | 20 Eylül 2019 |
| Başvuru Tarihi | 21 Nisan 2018 |
| Kabul Tarihi | 31 Temmuz 2018 |
| Yayınlandığı Sayı | Yıl 2019, Cilt 58, Sayı 3 |
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