|
Betegség leírása |
West syndroma
Betegség megnevezésének szinonímái:
- Infantilis spazmus
- West's syndrome
- Developmental delay
- Hypsarrhythmia
- Infantile spasms
- Generalized flexion epilepsy
- Infantile epileptic encephalopathy
- Infantile myoclonic encephalopathy
- Jackknife convulsion
- Massive myoclonia
- Salaam epilepszia
- Salaam spasms
- Blitz-nick-salaam görcsök
- propulsiv petit mal
- BNS roham
- Nictatio spastica
- West-féle tünetegyüttes
- Blitz-nick-salaam roham
- West szindróma
BNO:
Alapadatok:
- Férfi: 3 éves korig
- Nő: 3 éves korig
Betegség leírása:
-
A központi idegredszer működési zavara miatt a korai csecsemőkorban kialakuló sajátos epilepsziaforma, görcsroham, amelyre jellemző egy hirtelen, de tartós izomösszehúzódás az izmokban (infantilis spazmus), agy felszínéről elvezetett elektromos tevékenységnek egy speciális formája, a hypsarrhytmia, továbbá a mentális hanyatlás.
Betegség lefolyása:
-
A csecsemőkor megbetegedése, jellegzetesen 3-12 hónapos korban kialakuló megbetegedés. Leggyakrabban 4-8 hónapos korban lép fel. viszonylag ritka megbetegedés, ezer élveszületésre jut fél-egy megbetegedés.1 éves kor után már korai Lennox-Gastaut szindrómáról beszélünk.Az esetek mintegy 40%-a átalakul Lennox-Gastaut szindrómává.Ezen gyermekek 1/3-ánál végül súlyos temporolimbikus epilepsiába torkollik.
A betegség két fő formája a szimptomás, vagy tüneti és a kriptogén West szindróma.
A betegség sajátsága az ún. infantilis spazmus, amely tulajdonképpen az izmokban jelentkező tartósabb idejű összerándulás, (többnyire szimmetrikus flexió, extensio vagy kevert spasmus az axiális izmokban és a végtagokban), amikor a csecsemő egy előre irányuló rángásszerű mozgást végez, feje hirtelen előreesik, karjait oldalra veti, esetleg egész testével összerándul, vagy fejét és karjait felemeli a mohamedán köszönéshez hasonlóan. Innen a Salaam-epilepszia kifejezés. Előfordulhat az ún. bicskaroham, a karok széttárása nélkül a fej hirtelen előreesése (tisztán flexiós roham). A rohamok jellegzetesen igen gyakran követik egymást, úgymond csomagokban jelentkeznek, (claster) ekkor 100 roham is fennálhat óránként. A rohamok rövid ideig zajlanak (többnyire néhány másodperc). Előfordul, hogy néhány nem szimmetrikus végtagmozgás, vagy arcon kialakult rángás követi a rohamot, vagy azzal egyidőben zajlik (fokális roham)
A betegség másik jellegzetessége amikor az agy felszínéről elvezetett elektromos tevékenység elvezetésére szolgáló EEG-vizsgálat regisztrátuma az ún. hypsarrhytmia-görbét (magasfeszültségű kaotikus agyi tevékenység) mutatja a rohammentes időszakokban.
Harmadrészt a betegség mentális hanyatlással jár együtt. Gyakran a Moró-reflex megmarad, ez egy csecsemőkorban már normálisan nem meglévő újszülöttkori reflex.
A vizsgálatokhoz hozzá tartozik, hogy a rohamok kialakulásának okait képalkotó agyi vizsgálatokkal, CT-vizsgálattal, MRI -vizsgálatokkal meghatározzák. A rohamok hátterében néha sejtszinten kialakuló károsodások, dysgenezisek, vagy a szüléskor esetleg közvetlenül előtte elszenvedett oxigénhiány miatt kialakuló agyi károsodás áll. Anyagcserebetegség, vagy az agyszöveteket károsító fertőzés is okozhatják.
A betegség kezelése gyógyszeres, az kezelés alapja egy hormonkészítmény. Ritkán, de a betegek egy csoportja rohammentessé tehető, gyakoribb azonban, hogy ún, Lennox-Gastaut-syndroma alakul ki, amelyre a továbbra is fennmaradó rohamok jellemzőek, és gyakran nem reagál a kezelésekre. Gyakoriak a mentális és magatartászavarok a későbbi élet folyamán. Jobbindulatúak azok a betegségek melynek hátterében nem mutatható ki súlyos idegrendszeri károsodás.
Megelőzési és más fontos tanácsok:
-
Helyes szüléslevezetéssel, terhesség gondozásával, helyes irányú perinatális diagnosztikával a gyermek idegrendszeri károsodása megelőzhető. Újszülöttkori szűrővizsgálatok anyagcserebetegségeket tárhatnak fel. Roham alatt a csecsemőt védeni kell a sérülésektől. Egyedül való fürdését kerüljük.
Előzmények:
- Ismeretlen kórok
- Betegségek
-
Anyagcsere rendellenességek
-
Szülési sérülés következtében létrejött koponyán belüli roncsolódás és vérzés
-
Phacomatosisok, m.n.o.
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Down-syndroma
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Edwards-syndroma és Patau-syndroma
-
Hemimegalencephalia
-
Corticalis dysgenesis
-
Agenesia corporis callosi
-
Focalis corticalis dysplasia
-
Göbös agykeményedés (sclerosis tuberosa)
- Egyéb prediszponáló tényezők
Gyakoribb panaszok, tünetek:
- Általános panasz
- Fej
-
Ritkán néz az orvos szemébe
- Mozgásszervi panaszok
-
Felső végtag izomzata puha tapintatú
-
Alsó végtag izomzata puha tapintatú
- Idegrendszer és izomrendszer zavarai
-
Spontán elesések
-
Egy izomcsoportra lokalizált akaratlan, gyors rángások
-
Születéstől kezdve fokozott izomtónus
-
Petyhüdt izomzat
- Mentális és viselkedészavarok
-
Érdektelen környezete iránt
-
Elbutulás
-
Értelmi fogyatékos
Fizikális vizsgálatok:
- Általános megfigyelés
-
Megkésett beszédfejlődés
-
Meglassult a mozgás fejlődése
-
Meglassult psychomotoros fejlődés
- Kültakaró
- Mozgásszervek
-
Felső végtag izomzata petyhüdt tapintatú
-
Alsó végtag petyhüdt tapintatú
- Idegrendszer
-
Mentális hanyatlás
-
Mentális retardatio
-
Infantilis spazmus
-
Myoclonusos rohamok
-
{S-}Hypotoniás izomzat
Speciális, műszeres vizsgálatok:
- Neurológia vizsgálatai
-
Vizuális gnózis vizsgálata
-
EEG vizsgálat ( nyugalmi, fotostim., hipervent. próbákkal)
- Képalkotó eljárások
-
CT agykoponya
-
MRI agykoponya
Gyakoribb szövődmények:
- Mentális és viselkedészavar és egyéb psychés okok
-
Mentális retardatio
-
Gyermekkori autizmus (autismus infantilis)
- Idegrendszer betegségei
- Máshová nem osztályozott kóros klinikai tünetek, leletek
Mely szakterületek foglalkoznak ezzel a kórképpel:
-
Neurológia
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Gyermekgyógyászat
Gyógyszeres terápia:
Kapcsolódó oldalak (automatikus legyűjtés eredménye):
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Angol
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Healthwise Knowledgebase - P4Healthcare (Oncology)
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Early myoclonic encephalopathy
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GOALS AND OBJECTIVES
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