{"id":1057,"date":"2023-11-23T20:57:22","date_gmt":"2023-11-23T19:57:22","guid":{"rendered":"https:\/\/neurokidbossa.rs\/?p=1057"},"modified":"2023-11-25T14:01:10","modified_gmt":"2023-11-25T13:01:10","slug":"decja-apsansna-epilepsija","status":"publish","type":"post","link":"https:\/\/neurokidbossa.rs\/en\/decja-apsansna-epilepsija\/","title":{"rendered":"Apsansna epilepsija detinjstva (Childhood Absence Epilepsy – CAE)"},"content":{"rendered":"

<\/p>\n\n\n\n

Epidemiologija i definicija apsansnih napada<\/strong><\/p>\n\n\n\n

De\u010dja apsansna epilepsija po klasifikaciji Internacionalne lige za borbu protiv Epilepsije poznata kao Childhood Absence Epilepsy (CAE), ranije nazvana  \u201c piknolepsija \u201c , \u201c Petit mal\u201d ili \u201cmali napadi\u201d, predstavlja oblik primarno generalizovanih napada (epilepsije) koja po\u010dinje u pred\u0161kolskom i ranom \u0161kolsom uzrastu. Obi\u010dno se javlja izme\u0111u 3. i 11. godine \u017eivota sa pikom javljanja izme\u0111u 5 i 8 godina.  Od ukupnog broja dece sa epilepsijom oko 10% ima apsansnu epiepsiju detinjstva.
Apsansi-apsansni napadi predstavljaju jedinu vrstu epilepti\u010dnih napada koja se javlja u Apsansnoj epilepsiji detinjstva. Ovo je va\u017eno jer razli\u010diti epilepti\u010dni sindromi u de\u010djem uzrastu mogu imati vi\u0161e tipova epilepti\u010dnih napada.  O ovome \u0107e biti re\u010di u jednom od narednih tekstova na blogu.<\/p>\n\n\n\n


Klini\u010dke karakteristike apsansnih napada:<\/strong>
– Tokom napada deca se zagledvaju ili imaju prazan pogled (\u201cZure\u201d) i u period od 5,10 najvi\u0161e 30 sekundi – Ne odgovaraju na pozive i ne reaguju. 
– Mo\u017ee se javiti i treptanje o\u010diju kao i pogled usmeren na gore.
– Ako su zapo\u010deli neku radnju kad apsansni napad pro\u0111e nastavi\u0107e sa istom onde gde su stali
– Napadi se javljaju iznenada i iznenada prestaju
– Po zavr\u0161etku napada ne treba vremena za oporavak ve\u0107 se nastavlja sa zapo\u010detom aktivno\u0161\u0107u, i obi\u010dno deca nemaju se\u0107anje \u0161ta se desilo
– Javlaju se svakodnevno po vi\u0161e desetina puta na dan i s obzirom da kratko traju (u sekundama) nekada ih je te\u0161ko opservirati
– Deca imaju normalan razvoj pre i posle napada, ali ako su napadi \u010desti i nekontrolisani mogu se razviti te\u0161ko\u0107e u u\u010denju, problem sa pa\u017enjom i koncentracijom kao i te\u0161ko\u0107e u pam\u0107enju.<\/p>\n\n\n\n


Kako se dijagnostikuje apsansna epilepsija?<\/strong><\/p>\n\n\n\n

Ve\u0107 smo napomenuli da je dijagnoza Epilepsije pa i apsansne klini\u010dka, \u0161to zna\u010di da se pa\u017eljivo uzetom anamnezom od roditelja koji se \u017eale na \u201codsutnost\u201d deteta i zagledavanje koji se ponavljaju \u010desto tokom dana mo\u017ee postaviti dijagnoza. Tako\u0111e se \u010desto u\u010ditelji \u017eale da su ta deca manje koncentrisana i \u201cnepa\u017eljiva\u201d i odsutna tokom nastave \u0161to mo\u017ee biti jo\u0161 jedan znak da dete ima problem sa prisutno\u0161\u0107u a koja je posledica apsansnih napada.
Neurolo\u0161ki nalaz je kod dece sa apsansnom epilepsijom uredan, ali ga treba obavezno obaviti. Tokom pregleda treba zamoliti pacijenta da duboko di\u0161e par minuta jer hiperventilacija provocira apsansne napade te se na licu mesta tokom pregleda dijagnoza mo\u017ee potvrditi.
Elektroencefalogram (EEG) je jako bitna pomo\u0107na dijagnosti\u010dka metoda jer apsansni napadi imaju karakteristi\u010dan EEG crte\u017e: visoko voltirane \u0161iljak talas komplekse u trajanju od 3 Hz\/sec (vidi sliku) a koji koreliraju sa klini\u010dki ispoljenim zagledavanjem ili tretpanjem. Idealno je ako EEG laboratorija ima video EEG na kome se istovremeno mo\u017ee pratiti na videu pona\u0161anje  pacijenta i EEG promene.<\/p>\n\n\n\n

Kompjuterizovana tomografija mozga (CT) i Magnetna rezonanca (MRI mozga) su normalni i nije potrebno uraditi ni jednu od ovih pretraga ako se sumnja na apsansnu epilepsiju.<\/p>\n\n\n\n

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Kako se le\u010de apsansni napadi?<\/strong><\/p>\n\n\n\n

Lek izbora za apsansne napade su Valproati (Eftil) i Etosuximide (Suxinutine) i u ve\u0107ini slu\u010dajeva se posti\u017ee dobra kontrola napada sa ovim lekovima. Etosuximide dobro kontroli\u0161e apsansne napade i podjednako je efikasan kao Valproati. S druge strane prolazno opadanje kose i pove\u0107anje apetita su nus efekti koji se mogu o\u010dekivati kod terapije Valproatima, kao i poreme\u0107aj pa\u017enje.
Lamotrigine (Lamictal) se tako\u0111e mo\u017ee koristiti kao druga linija lekova za apsansne napade, kao i Topiramate (Topamax), Levetiracetam (Keppra) i Clobazam (iz grupe Benzodijazepina).
U slu\u010daju da monoterapija (terapija samo jednim lekom) ne dovede do o\u010dekivane kontrole napada, lekovi se mogu kombinovati. Ako je pacijent na terapiji Valproatima zbog metabolizma valproata koji ide preko jetre neophodno je na 6 meseci kontrolisati krvnu sliku i laboratorijske analize za pra\u0107enje jetrine funkcije.<\/p>\n\n\n\n

<\/p>\n\n\n\n


Prognoza i obustava antiepilepti\u010dnih lekova<\/strong><\/p>\n\n\n\n

Posle perioda bez napada a koji traje 2-3 godine savetuje se postepeno ukidanje antiepilepti\u010dkih lekova (preporu\u010deno smanjivanje na mese\u010dnom nivou, do potpunog ukidanja za period od 6 meseci) uz redovno pra\u0107enje elektri\u010dne aktivnosti EEG-om. Ako posle uvo\u0111enja prvog leka nije do\u0161lo do potpune kontrole napada potrebno je pove\u0107ati dozu do maximalne na kg telesne mase. Ako to ne urodi plodom dodavanje jednog od pomenutih antiepileptika drugog reda se preporu\u010duje.<\/p>\n\n\n\n

Apsansna epilepsija ima dobru prognozu i do 80% dece koja uzimaju terapiju tokom perioda od 2-3 godine nikada ne razviju apsansne ili druge napade tokom adolescentnog ili adultnog perioda.<\/p>\n\n\n\n

Oko 10-15%% dece mogu u kasnijem \u017eivotnom dobu razviti i druge vrste epilepti\u010dnih napada kao \u0161to su generalizovani toni\u010dko kloni\u010dki napadi (GTKN) ili miokloni\u010dke napade.<\/p>\n\n\n\n

Apsansi kao tip napada mogu se sresti i kod drugih Generalizovanih epilepti\u010dkih sindroma kao \u0161to su Juvenilna Apsansna Epilepsija (JAE) i Juvenilna Miokloni\u010dka Epilepsija (JME).<\/p>\n\n\n\n


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\"\"<\/figure>\n\n\n\n

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EEG kod de\u010daka uzrasta 9 godina sa Apsansnom epilepsijom detinjstva: tipi\u010dna slika visoko voltiranih, generalizovanih paroksizama \u0161iljak-talas kompleksa 3Hz\/sec u trajanju od 11 sekundi, klini\u010dki pra\u0107ena samo zagledavanjem (\u201c engl. Staring\u201d).<\/em><\/p>\n\n\n\n

<\/p>\n\n\n\n


Vi\u0161e o EEG dijagnostici pogledajte here<\/a><\/p>","protected":false},"excerpt":{"rendered":"

Epidemiologija i definicija apsansnih napada De\u010dja apsansna epilepsija po klasifikaciji Internacionalne lige za borbu protiv Epilepsije poznata kao Childhood Absence Epilepsy (CAE), ranije nazvana  \u201c piknolepsija \u201c , \u201c Petit mal\u201d ili \u201cmali napadi\u201d, predstavlja oblik primarno generalizovanih napada (epilepsije) koja po\u010dinje u pred\u0161kolskom i ranom \u0161kolsom uzrastu. Obi\u010dno se javlja izme\u0111u 3. i 11. […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"set","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[1],"tags":[],"class_list":["post-1057","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"yoast_head":"\nApsansna epilepsija detinjstva (Childhood Absence Epilepsy – CAE) - Neuro Kid Bossa<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/neurokidbossa.rs\/en\/decja-apsansna-epilepsija\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Apsansna epilepsija detinjstva (Childhood Absence Epilepsy – CAE) - Neuro Kid Bossa\" \/>\n<meta property=\"og:description\" content=\"Epidemiologija i definicija apsansnih napada De\u010dja apsansna epilepsija po klasifikaciji Internacionalne lige za borbu protiv Epilepsije poznata kao Childhood Absence Epilepsy (CAE), ranije nazvana  \u201c piknolepsija \u201c , \u201c Petit mal\u201d ili \u201cmali napadi\u201d, predstavlja oblik primarno generalizovanih napada (epilepsije) koja po\u010dinje u pred\u0161kolskom i ranom \u0161kolsom uzrastu. 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Obi\u010dno se javlja izme\u0111u 3. i 11. 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