{"id":1799,"date":"2024-07-26T09:47:38","date_gmt":"2024-07-26T06:47:38","guid":{"rendered":"https:\/\/tatd.org.tr\/arastirma\/?p=1799"},"modified":"2025-05-28T13:47:27","modified_gmt":"2025-05-28T10:47:27","slug":"tatd-akom-cok-merkezli-prospektif-kohort-calismasi-acil-servise-provoke-edilmemis-nobetle-basvuran-yetiskin-hastalarda-erken-donem-nobet-tekrarinin-prediktorlerinin-belirlenmesi-ve-pragmatik-bir-regr","status":"publish","type":"post","link":"https:\/\/tatd.org.tr\/arastirma\/2024\/07\/26\/tatd-akom-cok-merkezli-prospektif-kohort-calismasi-acil-servise-provoke-edilmemis-nobetle-basvuran-yetiskin-hastalarda-erken-donem-nobet-tekrarinin-prediktorlerinin-belirlenmesi-ve-pragmatik-bir-regr\/","title":{"rendered":"TATD-AKOM \u00c7ok Merkezli Prospektif Kohort \u00c7al\u0131\u015fmas\u0131: Acil servise provoke edilmemi\u015f n\u00f6betle ba\u015fvuran yeti\u015fkin hastalarda erken d\u00f6nem n\u00f6bet tekrar\u0131n\u0131n predikt\u00f6rlerinin belirlenmesi ve pragmatik bir regresyon modelinin geli\u015ftirilmesi"},"content":{"rendered":"\t\t
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Acil servise (AS) ba\u015fvurunun \u00f6nemli bir nedeni olan n\u00f6betler yakla\u015f\u0131k her 100 ba\u015fvurudan birini olu\u015fturmaktad\u0131r (1). The International League Against Epilepsy (ILAE), n\u00f6betleri etiyolojik fakt\u00f6rlere g\u00f6re “provoke” ve “provoke olmayan” kategorilere ay\u0131rmaktad\u0131r (2). Provoke edilmi\u015f n\u00f6betler, normal bir beyindeki e\u015fi\u011fi d\u00fc\u015f\u00fcren ve n\u00f6bete yol a\u00e7an ge\u00e7ici nedenlerden kaynaklan\u0131r. Bu n\u00f6betler tipik olarak epilepsi olarak s\u0131n\u0131fland\u0131r\u0131lmazlar. Provoke olmayan n\u00f6betler ise beyin t\u00fcm\u00f6rleri, travmatik beyin hasar\u0131 veya epileptik sendromlar gibi fakt\u00f6rlerden kaynaklanmaktad\u0131r (2). Ara\u015ft\u0131rmalar, tek bir provoke edilmemi\u015f n\u00f6bet ge\u00e7iren bireylerin %27’sinin ilk 6 ay i\u00e7inde ikinci bir n\u00f6bet ge\u00e7irme riskinin artt\u0131\u011f\u0131n\u0131 g\u00f6stermektedir (3). K\u0131sa s\u00fcrede birden fazla n\u00f6bet ge\u00e7iren hastalar, zaman\u0131nda ve uygun \u015fekilde tedavi edilmezse mortalite veya status epileptikus gibi komplikasyonlar\u0131n riski daha artmaktad\u0131r (4,5). N\u00f6bet tekrar\u0131na ili\u015fkin mevcut literat\u00fcr\u00fcn birincil odak noktas\u0131 esas olarak uzun vadeli sonu\u00e7lard\u0131r. \u0130lk 24 saat i\u00e7inde n\u00f6bet tekrar\u0131 gibi k\u0131sa vadeli sonu\u00e7lar\u0131n \u00fczerinde durulmam\u0131\u015ft\u0131r ve erken n\u00f6bet tekrar\u0131n\u0131n potansiyel predikt\u00f6rlerini ve acil serviste optimal takip aral\u0131\u011f\u0131n\u0131 belirlemede yetersiz kalmaktad\u0131r.<\/p>

\u00c7al\u0131\u015fmalar, erken n\u00f6bet tekrar\u0131 ya\u015fayan hasta grubunu \u00e7e\u015fitli \u015fekillerde tan\u0131mlam\u0131\u015f, baz\u0131lar\u0131 akut n\u00f6bet tekrarlar\u0131n\u0131, baz\u0131lar\u0131 ise n\u00f6bet k\u00fcmelerini tahmin etmeye odaklanm\u0131\u015ft\u0131r (6-9). Bu hastalar\u0131n erken tan\u0131mlanmas\u0131, olumsuz sonu\u00e7lar\u0131n \u00f6nlenmesi, klinik karar vermenin kolayla\u015ft\u0131r\u0131lmas\u0131 ve g\u00fcvenli taburculu\u011fun sa\u011flanmas\u0131 a\u00e7\u0131s\u0131ndan hayati \u00f6neme sahiptir. Ancak bu hasta pop\u00fclasyonunu ara\u015ft\u0131ran s\u0131n\u0131rl\u0131 say\u0131da \u00e7al\u0131\u015fma bulunmaktad\u0131r (6-8,10,11-14). Bu hastalar\u0131n ba\u015fvuru sonras\u0131nda ikincil n\u00f6bet geli\u015fme riski a\u00e7\u0131s\u0131ndan acil serviste ne kadar s\u00fcreyle izlenmesi gerekti\u011fi konusunda herhangi bir \u00f6neri bulunmad\u0131\u011f\u0131 gibi, k\u0131sa vadede n\u00f6bet tekrar\u0131n\u0131 \u00f6ng\u00f6ren fakt\u00f6rler de kapsaml\u0131 bir \u015fekilde ara\u015ft\u0131r\u0131lmam\u0131\u015ft\u0131r (15). Literat\u00fcrde tekrarlayan n\u00f6betlerin predikt\u00f6rlerinin belirlenmesinin gereklili\u011fi vurgulanmakta ve bu konunun \u00f6nemine i\u015faret edilmektedir (16,17). Ek olarak, National Institute for Health and Care Excellence (NICE) k\u0131lavuzu, tekrarlayan n\u00f6betleri tahmin etmeye y\u00f6nelik modellerin geli\u015ftirilmesinin ve do\u011frulanmas\u0131n\u0131n gereklili\u011fini savunmaktad\u0131r (18).<\/p>

Sonu\u00e7 olarak, TATD AKOM olarak planlanan bu \u00e7al\u0131\u015fmada provoke edilmemi\u015f n\u00f6betleri olan hastalarda ba\u015fvurudan sonraki ilk 24 saat i\u00e7inde erken n\u00f6bet tekrar\u0131n\u0131n predikt\u00f6rlerini belirlemeyi, pratik bir tahmin modeli geli\u015ftirip do\u011frulamay\u0131 ve g\u00fcvenli bir taburculuk zaman\u0131 belirlemeyi ama\u00e7lanmaktad\u0131r.<\/p>

\u00c7al\u0131\u015fma merkezlerinin belirlenmesi s\u00fcreci devam etmektedir \u015fu ana kadar belirlenen \u00e7al\u0131\u015fma merkezleri; \u00dcmraniye E\u011fitim ve Ara\u015ft\u0131rma Hastanesi, Marmara \u00dcniversitesi Pendik E\u011fitim ve Ara\u015ft\u0131rma Hastanesi, Gaziantep \u015eehir Hastanesi, Atat\u00fcrk Sanatoryum E\u011fitim ve Ara\u015ft\u0131rma Hastanesi ve Manisa Soma Devlet Hastanesi<\/p>

\u00a0<\/p>

\u00a0<\/strong>TATD-AKOM Ad\u0131na Sorumlu ara\u015ft\u0131rmac\u0131:<\/strong> Do\u00e7ent Dr. Mehmet Muzaffer \u0130slam<\/span><\/p>

Kaynaklar<\/strong><\/p>

  1. Martindale JL, Goldstein JN, Pallin DJ. Emergency department seizure epidemiology. Emerg Med Clin North Am. 2011;29(1):15-27. doi:10.1016\/j.emc.2010.08.002.<\/li>
  2. Fisher RS, Acevedo C, Arzimanoglou A, et al. ILAE official report: a practical clinical definition of epilepsy. Epilepsia. 2014;55(4):475-482. doi:10.1111\/epi.12550.<\/li>
  3. Saul H, Deeney B, Cassidy S, Neligan A. What are the chances of having a second epileptic seizure?. BMJ. 2023;383:2285. Published 2023 Oct 13. doi:10.1136\/bmj.p2285.<\/li>
  4. Haut SR. Seizure clusters: characteristics and treatment. Curr Opin Neurol. 2015;28(2):143-150. doi:10.1097\/WCO.0000000000000177.<\/li>
  5. Mitchell WG. Status epilepticus and acute serial seizures in children. J Child Neurol 2002; 17 (Suppl 1):S36\u2013S43.<\/li>
  6. Bozan \u00d6, Ati\u015f \u015eE, \u00c7ekmen B, et al. Factors Predicting the Frequency of Second Seizures in Patients Presenting to the Emergency Department With Seizures: A Prospective Observational Study. Cureus. 2021;13(11):e19271. Published 2021 Nov 5. doi:10.7759\/cureus.19271.<\/li>
  7. Dolek UC, Gokce M, Islam MM, Ozdemir S, Aksel G, Algin A. Factors affecting seizure recurrence in the emergency department. Heliyon. 2024;10(5):e26833. Published 2024 Feb 22. doi:10.1016\/j.heliyon.2024.e26833.<\/li>
  8. \u015eencanlar \u00c7H, \u00c7orbac\u0131o\u011flu \u015eK, Yaz\u0131c\u0131o\u011flu CD, Emektar E, \u00c7evik Y. Determining Prevalence and Risk Factors of Seizure Recurrence in the Early Period in Patients Who Present to the Emergency Department with Epileptic Seizures. Eurasian J Emerg Med. 2023;22(2): 71-81.<\/li>
  9. Jafarpour S, Hirsch LJ, Ga\u00ednza-Lein M, Kellinghaus C, Detyniecki K. Seizure cluster: Definition, prevalence, consequences, and management. Seizure. 2019;68:9-15. doi:10.1016\/j.seizure.2018.05.013.<\/li>
  10. Detyniecki K, O’Bryan J, Choezom T, et al. Prevalence and predictors of seizure clusters: A prospective observational study of adult patients with epilepsy. Epilepsy Behav. 2018;88:349-356. doi:10.1016\/j.yebeh.2018.09.035.<\/li>
  11. K\u0131l\u0131c TY, Yesilaras M, Atilla OD, Sever M, Aksay E. Can venous blood gas analysis be used for predicting seizure recurrence in emergency department?. World J Emerg Med. 2014;5(3):187-191. doi:10.5847\/wjem.j.issn.1920-8642.2014.03.005.<\/li>
  12. Asadollahi M, Maghsudloo F, Simani L, Pakdaman H. Factors predisposing patients with temporal lobe epilepsy to seizure cluster. Curr J Neurol. 2022;21(1):12-16. doi:10.18502\/cjn.v21i1.9355.<\/li>
  13. Choquet C, Depret-Vassal J, Doumenc B, Sarnel S, Casalino E. Predictors of early seizure recurrence in patients admitted for seizures in the Emergency Department. Eur J Emerg Med. 2008;15(5):261-267. doi:10.1097\/MEJ.0b013e3282fce63d.<\/li>
  14. Jafarpour S, Hirsch LJ, Ga\u00ednza-Lein M, Kellinghaus C, Detyniecki K. Seizure cluster: Definition, prevalence, consequences, and management. Seizure. 2019;68:9-15. doi:10.1016\/j.seizure.2018.05.013.<\/li>
  15. Rabin E, Jagoda AS. Seizures. In: Walls RM, editor. Rosen\u2019s Emergency Medicine Concepts and Clinical Practice 9th ed. Philadelphia, PA: Elsevier; 2018. p. 1256-64.<\/li>
  16. Bosl WJ, Leviton A, Loddenkemper T. Prediction of Seizure Recurrence. A Note of Caution. Front Neurol. 2021;12:675728. Published 2021 May 13. doi:10.3389\/fneur.2021.675728.<\/li>
  17. Dumanis SB, French JA, Bernard C, Worrell GA, Fureman BE. Seizure Forecasting from Idea to Reality. Outcomes of the My Seizure Gauge Epilepsy Innovation Institute Workshop. eNeuro. 2017;4(6):ENEURO.0349-17.2017. Published 2017 Dec 27. doi:10.1523\/ENEURO.0349-17.2017.<\/li><\/ol>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"

    Acil servise (AS) ba\u015fvurunun \u00f6nemli bir nedeni olan n\u00f6betler yakla\u015f\u0131k her 100 ba\u015fvurudan birini olu\u015fturmaktad\u0131r (1). The International League Against Epilepsy (ILAE),…<\/p>\n","protected":false},"author":1399,"featured_media":1974,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[10020],"tags":[],"class_list":["post-1799","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-klinik-arastirmalar"],"acf":[],"_links":{"self":[{"href":"https:\/\/tatd.org.tr\/arastirma\/wp-json\/wp\/v2\/posts\/1799","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/tatd.org.tr\/arastirma\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/tatd.org.tr\/arastirma\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/arastirma\/wp-json\/wp\/v2\/users\/1399"}],"replies":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/arastirma\/wp-json\/wp\/v2\/comments?post=1799"}],"version-history":[{"count":0,"href":"https:\/\/tatd.org.tr\/arastirma\/wp-json\/wp\/v2\/posts\/1799\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/arastirma\/wp-json\/wp\/v2\/media\/1974"}],"wp:attachment":[{"href":"https:\/\/tatd.org.tr\/arastirma\/wp-json\/wp\/v2\/media?parent=1799"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tatd.org.tr\/arastirma\/wp-json\/wp\/v2\/categories?post=1799"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tatd.org.tr\/arastirma\/wp-json\/wp\/v2\/tags?post=1799"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}