(A) clinical study of adult onset seizure disorder

의학과/석사[한글] 경련을 일으킬 수 있는 원인은 다양하며 또한 발생연령에 따라 경련의 원인이 상이함은 잘 알려진 사실이다. 소아에서는 선천성기형, 주산기외상, 감염성질환 등이 경련의 흔한 원인이 되지만 원인미상인 원발성인 경우도 많은 반면 성인에서 는 뇌혈관질환, 뇌종양, 두부외상 등의 속발성경련이 많은 것이 특징이라고 할 수 있다. 이러한 원인질환의 상이성은 성인에서 발생 한 경련환자의 경우 혈액검사, 소변검사, 두개골X-선촬영 뿐아니라 뇌파검사 및 뇌전산화단충촬영 등의 검사를 필요로 하게되며 이들의 진단적 가치는 높이 인정되고 있는 실정이다. 본 논문은 경련의 병력이 없었던 16세이상의 성인에서 처음 발생한 경련발작을 주소 로 세브란스병원에 입원하여 가료를 받은 환자 218례를 대상으로하여 임상적 연구를 한 것이다. 남녀비는 1.3 : 1로 남자에서 약간 많았고 연령은 16세에서 74세 사이로 평균 37.5세였으며 청년층에서 제일 높은 발생율을 보였다. 경련형태는 초점성경련발작보다는 전 신경련발작이 많았으며 경련의 원인으로는 원인을 알 수 없었던 경우도 약 1/3이었지만 나머지 경우는 두부외상, 감염성질환, 뇌혈관성질환, 뇌종양 등에 의해서 경련이 유발되 었다. 연령이 증가할수록 기질적원인의 비율이 증가하였고 청장년층에서는 두부외상과 감염이 주된 원인이었고 중년이후에는 뇌혈관성질환이 주된 원인이었다. 청년층에서 염증성 질환의 주된 원인은 결핵과 뇌염인 반면 장년이후에서는 뇌낭미낭충증등 기생충에 의한 감염이 주된 원인이었다. 본 연구에서는 뇌파검사가 뇌전산화단층촬영에 비해 이상소견 발현율이 높았으나 뇌파검사는 많은경우 비특이적인 소견으로 진단에 결정적인 도움을 주지못한 반면에 뇌전산화단층촬영은 대사성질환을 제외한 모든 뇌질환의 진단에 결정적인 도움을 주었다. 또한 대 뇌피질중 전두엽과 두정엽의 병변시에 다른 부위에 비해 경련발작이 잘 유발되어지는 것으로 추정되어지고 있다. A CLINICAL STUDY OF ADULT ONSET SEIZURE DISORDER. Kyoung Gyu Choi Department of Medical Science The Graduate School, Yonsei University (Directed by Professor Il Saing Choi, M.D.) Two hundred and eighteen patients of adult onset seizure admitted to Severance Hospital, Yonsei University Medical Center between 1981 and 1984 have been clinically analyzed and the following results have been obtained. There were 123 men and 95 women. Ages ranged from 16 to 74 years (mean age, 37.5 years), with the peak incidence in adolescence or early adult. In 218 patients of adult onset seizure, generalized seizure was appeared in 159 patients (72.9%) and focal seizure in 59 patients (27.1%). In causes of seizure, inflammatory disease was in 33 patients (15.1%), head trauma in 33 patients (15.1%), cerebrovascular disease in 26 patients (11.9%), brain tumor in 6 patients (2.8%), others in 37 patients (20%) and in 83 patients the cause was unknown. Inflammatory causes of seizure contains cerebral cysticercosis, cerebral tuberculosis, focal cerebritis, encephalitis etc. On EEG, abnormalities were found in 64.7% of generalized seizure and in 68.1% of focal seizure. On CT brain scan that was taken in 192 patients, abnormalities were found in 87 patients and this was found in 32% of adolescence or early adult, in 53.1% of mid-adult, in 60% of late adult and 48.5% of elderly patients. The site of abnormal findings on CT brain scan was most common at parietal lobe (26.4%) and frontal lobe (25.3%) was next common site. Abnormality in CT brain scan was found in 18.5% of normal E E G patients and in 53.9% of abnormal E E G patients. These results were similar to those of the previously reported studies and lead us to suggest that the CT brain scan is a valuable aid in establishing the cause of seizure and in disclosing early lesions. [영문] Two hundred and eighteen patients of adult onset seizure admitted to Severance Hospital, Yonsei University Medical Center between 1981 and 1984 have been clinically analyzed and the following results have been obtained. There were 123 men and 95 women. Ages ranged from 16 to 74 years (mean age, 37.5 years), with the peak incidence in adolescence or early adult. In 218 patients of adult onset seizure, generalized seizure was appeared in 159 patients (72.9%) and focal seizure in 59 patients (27.1%). In causes of seizure, inflammatory disease was in 33 patients (15.1%), head trauma in 33 patients (15.1%), cerebrovascular disease in 26 patients (11.9%), brain tumor in 6 patients (2.8%), others in 37 patients (20%) and in 83 patients the cause was unknown. Inflammatory causes of seizure contains cerebral cysticercosis, cerebral tuberculosis, focal cerebritis, encephalitis etc. On EEG, abnormalities were found in 64.7% of generalized seizure and in 68.1% of focal seizure. On CT brain scan that was taken in 192 patients, abnormalities were found in 87 patients and this was found in 32% of adolescence or early adult, in 53.1% of mid-adult, in 60% of late adult and 48.5% of elderly patients. The site of abnormal findings on CT brain scan was most common at parietal lobe (26.4%) and frontal lobe (25.3%) was next common site. Abnormality in CT brain scan was found in 18.5% of normal E E G patients and in 53.9% of abnormal E E G patients. These results were similar to those of the previously reported studies and lead us to suggest that the CT brain scan is a valuable aid in establishing the cause of seizure and in disclosing early lesions.restrictio