Jeneralize Tonik Klonik Nöbetler
Özet
Jeneralize tonik klonik nöbetler, herhangi bir uyarı olmaksızın aniden başlayan, bilinç kaybı ile tonik ve klonik kasılmaların karakterize ettiği nöbetlerdir. Tanı sürecinde klinik muayene ile birlikte EEG ve MRG gibi görüntüleme yöntemlerinden yararlanılarak primer veya sekonder başlangıç ayrımı yapılmaktadır. Tedavide öncelikli olarak antiepileptik ilaçlar kullanılırken, dirençli vakalarda Vagus sinir stimülasyonu veya ketojenik diyet gibi alternatif yöntemler değerlendirilmektedir. Bu nöbet türü, özellikle SUDEP gibi ciddi komplikasyon riskleri taşıdığı için hastaların düzenli takibi hayati önem arz eder.
Generalized tonic-clonic seizures are characterized by an abrupt onset without warning, presenting with loss of consciousness followed by tonic and clonic muscle contractions. Diagnosis relies on clinical evaluation combined with EEG and MRI findings to distinguish between primary generalized and focal-to-bilateral seizures. While antiepileptic drug therapy remains the primary treatment, alternative approaches such as Vagus nerve stimulation or ketogenic diets are considered for refractory cases. Due to the associated risk of serious complications like SUDEP, close patient monitoring is essential.
Referanslar
Fisher RS, Cross JH, French JA et al. Operational classification of seizure types by the International League Against Epilepsy: Position Paper of the ILAE Commission for Classification and Terminology. Epilepsia 2017;58(4):522-30.
Scheffer IE, Berkovic S, Capovilla G et al. ILAE classification of the epilepsies: Position paper of the ILAE Commission for Classification and Terminology. Epilepsia 2017;58(4):512-21.
Generalised epileptic seizures. Panayiotopoulos CP, editör. A clinical guide to epileptic syndromes and their treatment. İkinci baskı. Springer Healthcare Ltd.2010.p.32-58
Kurland LT: The incidence and prevalence of convulsive disorders in a small urban community. Epilepsia 1959;1:143-69.
Ross EM, Peckham CS, West PB, Butler NR. Epilepsy in childhood: Findings from the National Child Development Study. Br Med J 1980;280(6209):207-10.
Vierck E, Cauley R, Kugler SL, Mandelbaum D, Pal DK, Durner M. Polyspike and Waves Do Not Predict Generalized Tonic-Clonic Seizures in Childhood Absence Epilepsy. J Child Neurol 2010;25(4):475-81.
Unterberger I, Trinka E, Luef G, Bauer G, Idiopathic generalized epilepsies with pure grand mal:clinical data and genetics. Epilepsy Res. 2001;41(1:19-25.
Oller-Daurella I, Oller LFV. Epilepsy with generalized tonic clonic seizures in childhood. Does a childhood grand mal syndrome exist? Roger J, Bureau M, Dravet C, Dreifuss FE, Perret A, Wolf P editörler. Epileptic Syndromes in Infancy, Childhood and Adolescence, İkinci baskı. John Libbey, Londra, pp:161-71.
Camfield P, Camfield C. Idiopathic generalized epilepsy with generalizes tonic clonic seizures (IGE-GTC): a population based cohort with 20 year follow up for medical and social outcome. Epilepsy Behav 2010;18(1-2):61-3.
Caraballo R, Silva S, Beltran L, Calvo A, Caballero R. Childhood-only epilepsy with generalized tonic-clonic seizures: A well-defined epileptic syndrome. Epilepsy Res 2019;158:28-33.
Corff C, Nordli DR. Do generalized tonic clonic seizures exist in infancy? Neurology 2005;65:1750-3.
Panayiotopoulos CP Idiopathic epileptic seizures and syndromes in infancy. Panayiotopoulos CP, editör. The epilepsies: seizures, syndromes and management. Chipping Norton: Bladon Medical Publishing, 2005.p. 117–33.
Dravet C, Bureau M, Oguni H, Fukuyama Y, Cokar O. Severe myoclonic epilepsy in infancy: Dravet syndrome. Adv Neurol 2005;95:71–102.
Fujiwara T, Sugawara T, Mazaki-Miyazaki E et al. Mutations of sodium channel a subunit type 1 (SCN1A) in intractable childhood epilepsies with frequent generalized tonic clonic seizures . Brain 2003;126:531-46.
Kotagal P, Bleasel A, Geller E, Kankirawatana P, Moorjani BI, RybickiL L. Lateralizing Value of Asymmetric Tonic Limb Posturing Observed in Secondarily Generalized Tonic–Clonic Seizures. Epilepsia 2000;41(4):457-62.
Hirtz DG. Generalized Tonic–Clonic and Febrile Seizures. Pediatric Clinics of North America 1989, 36(2), 365–82.
Dreifuss FE: Pediatric Epileptology: Classification and Management of Seizures in the Child. Boston, John Wright-PSG Inc, 1983, pp 93-96.
Wang J, Li Y, Wang Y, Huang W. Multimodal Data and Machine Learning for Detecting Specific Biomarkers in Pediatric Epilepsy Patients With Generalized Tonic-Clonic Seizures. Front Neurol 2018;9:1038.
Parsons N, Bowden SC, Vogrin S, D’Souza WJ. Default mode network dysfunction in idiopathic generalized epilepsy. Epilepsy Res 2020;159:106254.
Mullen SA, Berkovich SF. Genetic generalized epilepsies. Epilepsia 2018;59:1148-53.
Gardiner M. Genetics of idiopathic generalized epilepsies.Epilepsia 2005;46:15-20.
Goodin DS, AminoffMJ: Does the interictal EEG have a role in the diagnosis of epilepsy? Lancet 1984;1: 837-8.
Classification of seizures. Fisch BJ, editör. EEG Primer, Basic Principles of Digital and Analog EEG. Üçüncü baskı. Amsterdam:Elsevier Science;1999.p:245-59.
Abnormal Rhythms. Hughes JR, editör. EEG in Clinical Practice. İkinci baskı. Newton: Butterworth-Heinemann;1994.p:150-4.
Trivisano M, Muccioli L, Ferretti A, Lee H, Chi C, Bisulli F . Risk of SUDEP during infancy. Epilepsy Behav 2021; https://doi.org/10.1016/j.yebeh.2021.107896
Shorvon SD, Bermejo PE; Gibbs AA, Huberfeld G, Kalviainen R. Antiepileptic drug treatment of generalized tonic-clonic seizures:an evaluation of regulatory data and five criteria for drug selection. Epilepsy Behav 2018;82:91-103.
Coppola G, Piccorossi A, Operto FF, Verrotti A. Anticonvulsant drugs for generalized tonic-clonic epilepsy . Expert Opin Pharmacother 2017;18(9):925-36.
Tabrizi N, Zarvani A, Rezaei P, Cheraghmakani H, Alizadeh-Navaei R. Levetiracetam in genetic generalizes epilepsy:A prospective unblinded active-controlled trial. Epilepsy Res 2019;157:106214.
Rosenfeld WE, Benbadis S, Edrich P, Tassinari CA, Hirsche E. Levetiracetam as add-on therapy for idiopathic generalized epilepsy syndromes with onset during adolescence: Analysis of two randomized, double-blind, placebo-controlled studies. Epilepsy Res 2009;85:72-80.
Kostov H, LarsonPG, oste GK. Is vagus nerve stimulation a treatment option for patients with drug-resistant idiopathic generalized epilepsy?Acta Neurol Scand2007;115 (suppl 187):55-8.
Ng M, Devinsky O. Vagus nerve stimulation for refractory idiopathic generalized epilepsy. Seizure 2004;13:176-8.
Maydel BV, Wyllie E, Akhtar N et al. Efficacy of the Ketogenic Diet in Focal versus Generalized Seizures. Pediatr Neurol 2001;25(3):208-12.
Vining EP, Freeman GM, Ballaban-Gil K, Camfield CS, Camfield PR, Holmes GL A multicenter study of the efficacy of the ketogenic diet. Arch Neurol 1998;55:1433-7.
