{"id":618,"date":"2012-07-18T20:00:08","date_gmt":"2012-07-18T17:00:08","guid":{"rendered":"http:\/\/www.hvtd.org\/?p=618"},"modified":"2012-07-18T20:00:08","modified_gmt":"2012-07-18T17:00:08","slug":"subklinik-epileptiform-desarjlar-ve-havacilik","status":"publish","type":"post","link":"https:\/\/www.hvtd.org\/?p=618","title":{"rendered":"Subklinik Epileptiform De\u015farjlar ve Havac\u0131l\u0131k"},"content":{"rendered":"
\n

\"\"<\/a>EEG\u2019de g\u00f6r\u00fclen subklinik epileptiform de\u015farjlar (SD), \u00f6m\u00fcr boyu n\u00f6bete yol a\u00e7mayabilir. SD\u2019lerin asl\u0131nda san\u0131ld\u0131\u011f\u0131 kadar masum olmad\u0131\u011f\u0131, klinikte g\u00f6zlemlenmesi zor olan n\u00f6betlere, bilin\u00e7 de\u011fi\u015fikliklerine ve kognitif fonksiyonlarda bozulmaya yol a\u00e7t\u0131\u011f\u0131 ileri s\u00fcr\u00fclm\u00fc\u015ft\u00fcr. Bu y\u00fczden pilot ve hava trafik kontrol\u00f6r adaylar\u0131nda EEG de\u011fi\u015fiklikleri b\u00fcy\u00fck \u00f6nem ta\u015f\u0131maktad\u0131r.<\/p>\n

SD\u2019lerin anlam\u0131:<\/strong> Bir tek interiktal de\u015farj\u0131n bile beyinde ger\u00e7ekle\u015fen her \u015feyi etkiledi\u011fi, n\u00f6ronal, vask\u00fcler ve metabolik de\u011fi\u015fikliklere yol a\u00e7t\u0131\u011f\u0131 bilinmektedir.1 Oksipital dikeni olan hastalar, dikenin ortaya \u00e7\u0131kt\u0131\u011f\u0131 anda kar\u015f\u0131la\u015ft\u0131klara g\u00f6rsel uyarana cevap vermezler veya ge\u00e7 cevap verirler.2 SD olan ki\u015filer otomobil kullan\u0131rken, de\u015farj\u0131n ortaya \u00e7\u0131kt\u0131\u011f\u0131 s\u0131rada otomobilin lateral pozisyonunda anlaml\u0131 sapmalar g\u00f6zlenir. B\u00f6yle birinde s\u00fcr\u00fc\u015f performans\u0131ndaki azalma, 5 mg diazepam\u0131n yapt\u0131\u011f\u0131 etkiye e\u015fde\u011ferdir.3 Bu ki\u015filer s\u00fcr\u00fc\u015f s\u0131ras\u0131nda dikkat testlerinde daha \u00e7ok hatalar yapar.4<\/p>\n

EEG\u2019de g\u00f6r\u00fclen jeneralize veya parsiyel de\u015farjlar \u00f6m\u00fcr boyu n\u00f6bete yol a\u00e7mayabilir, yani \u2018subklinik\u2019 veya \u2018interiktal\u2019 kalabilir. Hatta k\u0131sa s\u00fcreli \u015fuur de\u011fi\u015fikliklerine yol a\u00e7an n\u00f6betler, ki\u015finin kendisi ve \u00e7evresi taraf\u0131ndan fark edilmeyebilir. Ama yar\u0131m saniye kadar k\u0131sa s\u00fcren n\u00f6betlerin bile kognitif fonksiyonlar\u0131 bozdu\u011fu g\u00f6sterilmi\u015ftir.5<\/p>\n

SD\u2019lerin kognitif fonksiyonlara etkisi:<\/strong> SD olan \u00e7ok say\u0131da hasta, duyarl\u0131 y\u00f6ntemlerle (baz\u0131 psikolojik testlerle) dikkatle incelendi\u011finde, bu de\u015farjlar s\u0131ras\u0131nda kognitif fonksiyonlar\u0131nda bozulmalar g\u00f6zlenir. Psikolojik testler s\u0131ras\u0131nda de\u015farj tespit edilen hastalar\u0131n yar\u0131s\u0131nda \u2018ge\u00e7ici kognitif bozulma\u2019 (TCI) tespit edilir. Bu y\u00fczden baz\u0131 yazarlara g\u00f6re \u2018EEG\u2019yi de\u011fil hastay\u0131 tedavi edin\u2019 kural\u0131 ge\u00e7erlili\u011fini yitirmektedir.6 SD\u2019lerin kognitif etkileri ki\u015fiden ki\u015fiye b\u00fcy\u00fck farkl\u0131l\u0131klar g\u00f6sterebilir. Bu farkl\u0131l\u0131klar ki\u015finin performans seviyesine ve spontan EEG de\u015farjlar\u0131n\u0131n s\u0131kl\u0131\u011f\u0131na ba\u011fl\u0131 olabilir.7<\/p>\n

\u00c7ocuklarda 10 saniye kadar s\u00fcren k\u0131sa epileptiform de\u015farjlar klinik g\u00f6zlemle genellikle fark edilmez. Ancak bu de\u015farjlar\u0131n se\u00e7im reaksiyon zaman\u0131 testlerini, k\u0131sa vadeli bellek testlerini (verbal, non-verbal) ve okul performans\u0131n\u0131 bozdu\u011fu g\u00f6sterilmi\u015ftir. De\u015farjlar\u0131 sol tarafta fazla olanlar okumada, sa\u011f tarafta fazla olanlar viziospasyal \u00f6devlerde daha k\u00f6t\u00fcd\u00fcr. Bu t\u00fcr EEG de\u015farjlar\u0131n\u0131n antiepileptikle bast\u0131r\u0131lmas\u0131 sonucunda baz\u0131 \u00e7ocuklar\u0131n kognitif fonksiyonlar\u0131 d\u00fczelmi\u015ftir. Ancak de\u015farjlar\u0131n yeterince bast\u0131r\u0131lamamas\u0131 veya antiepileptiklerin kendilerinin kognitif fonksiyonlar\u0131 bozucu yan etkileri y\u00fcz\u00fcnden \u00e7ocuklar\u0131n hepsi ila\u00e7tan yararlanmam\u0131\u015ft\u0131r.8<\/p>\n

Klinikte belli belirsiz semptom veren, tespit edilmesi zor epilepsi n\u00f6beti ge\u00e7iren ve epileptiform EEG de\u015farjlar\u0131 olan \u00e7ocuklarda, bu n\u00f6betlerin veya EEG de\u011fi\u015fikliklerinin s\u00fcresi \u00e7ok k\u0131sa bile olsa, g\u00fcnl\u00fck hayatlar\u0131n\u0131 olduk\u00e7a bozan \u00f6\u011frenme zorluklar\u0131 saptanm\u0131\u015f, en \u00e7ok bozulan kognitif fonksiyonlar\u0131n uyan\u0131kl\u0131k (alertness) ve k\u0131sa vadeli haf\u0131za oldu\u011fu belirlenmi\u015ftir.9<\/p>\n

SD ve havac\u0131l\u0131k:<\/strong> Hava trafik kontrol\u00f6rlerinde k\u0131sa s\u00fcreli \u015fuur de\u011fi\u015fiklikleri ve kognitif bozulmalar kabul edilemez; bu y\u00fczden Eurocontrol 1995\u2019ten beri EEG\u2019yi bir tarama testi olarak kullanmaktad\u0131r. EEG\u2019ye dayan\u0131larak g\u00f6reve uygun olmad\u0131\u011f\u0131na karar verilen havac\u0131 (veya havac\u0131 aday\u0131) say\u0131s\u0131 \u00e7ok az oldu\u011fu i\u00e7in, havac\u0131l\u0131k t\u0131bb\u0131nda EEG\u2019nin de\u011feri sorgulanm\u0131\u015ft\u0131r. Ge\u00e7mi\u015finde epileptik n\u00f6bet hikayesi bulunmayan, ancak epileptiform EEG\u2019si olan birinin ileride n\u00f6bet ge\u00e7irme ihtimali %25\u2019tir. Halbuki EEG\u2019si normal olanlarda bu oran %2\u2019dir. Epileptiform EEG, n\u00f6bet riskini 12,5 kat artt\u0131rmakla kalmamakta, epizodik fonksiyon bozulmalar\u0131na da yol a\u00e7maktad\u0131r ki, bu durum u\u00e7u\u015f i\u00e7in b\u00fcy\u00fck bir risktir. Epileptiform EEG\u2019si olan b\u00fct\u00fcn pilotlar\u0131n u\u00e7u\u015ftan men edilmesi gerekti\u011fi, yanl\u0131\u015f pozitif EEG\u2019si olan k\u00fc\u00e7\u00fck bir grup bundan ma\u011fdur olsa da kamu g\u00fcvenli\u011fi a\u00e7\u0131s\u0131ndan kazanc\u0131n \u00e7ok daha b\u00fcy\u00fck olaca\u011f\u0131 ileri s\u00fcr\u00fclm\u00fc\u015ft\u00fcr.10 \u00d6te yandan EEG\u2019si bozuk olan sa\u011fl\u0131kl\u0131 eri\u015fkinlerde n\u00f6bet insidans\u0131n\u0131n olduk\u00e7a d\u00fc\u015f\u00fck oldu\u011fu bildirilmi\u015ftir.11<\/p>\n

Pilotlar s\u0131k s\u0131k uyku deprivasyonu ya\u015farlar ve u\u00e7u\u015f s\u0131ras\u0131nda kuvvetli g\u00fcne\u015f \u0131\u015f\u0131\u011f\u0131na maruz kal\u0131rlar, hava trafik kontrol\u00f6rleri ise stres alt\u0131ndad\u0131rlar ve devaml\u0131 monit\u00f6rlerle \u00e7al\u0131\u015f\u0131rlar. Bunlar\u0131n da n\u00f6bet riskini artt\u0131ran fakt\u00f6rler oldu\u011fu unutulmamal\u0131d\u0131r.12 \u00d6te yandan baz\u0131 mental aktivitelerin de epileptiform de\u015farjlar\u0131 provoke etti\u011fi bilinmektedir. Dolay\u0131s\u0131yla yo\u011fun mental aktivite gerektiren faaliyetler, epileptiform de\u015farjlar\u0131 artt\u0131rarak performans\u0131 iyice d\u00fc\u015f\u00fcrebilir.<\/p>\n

Sonu\u00e7:<\/strong> EEG\u2019sinde SD olanlar\u0131n kognitif fonksiyonlar\u0131nda ve otomobil kullanma performanslar\u0131nda belirgin d\u00fc\u015f\u00fc\u015fler g\u00f6zlenmi\u015ftir. EEG bozukluklar\u0131n\u0131n pilot adaylar\u0131n\u0131 de\u011ferlendirmedeki rol\u00fc sorgulanm\u0131\u015f, epileptiform EEG\u2019si olan b\u00fct\u00fcn pilotlar\u0131n u\u00e7u\u015ftan men edilmesi gerekti\u011fi dahi ileri s\u00fcr\u00fclm\u00fc\u015ft\u00fcr.<\/p>\n

Kaynaklar:<\/strong><\/p>\n

1. Hughes JR. The significance of the interictal spike discharge: a review. J Clin Neurophysiol 1989;6(3):207-26<\/p>\n

2. Shewmon DA, Erwin RJ. The effect of focal interictal spikes on perception and reaction time. I. General considerations. EEG Clin Neurophysiol 1988;69(4):319-37<\/p>\n

3. Kasteleijn-Nolst Trenite DG, Riemersma JB, Binnie CD, Smit AM, Meinardi H. The influence of subclinical epileptiform EEG discharges on driving behaviour. EEG Clin Neurophysiol 1987;67(2):167-70<\/p>\n

4. Binnie CD, Marston D. Cognitive correlates of interictal discharges. Epilepsia 1992;33 Suppl 6:S11-7<\/p>\n

5. Kasteleijn-Nolst Trenite DG, Vermeiren R. The impact of subclinical epileptiform discharges on complex tasks and cognition: relevance for aircrew and air traffic controllers. Epilepsy Behav 2005;6(1):31-4<\/p>\n

6. Binnie CD. Cognitive impairment during epileptiform discharges: is it ever justifiable to treat the EEG? Lancet Neurol 2003;2(12):725-30<\/p>\n

7. Kasteleijn-Nolst Trenite DG, Vermeiren R. The impact of subclinical epileptiform discharges on complex tasks and cognition: relevance for aircrew and air traffic controllers. Epilepsy Behav 2005;6(1):31-4<\/p>\n

8. Kasteleijn-Nolst Trenite DG. Transient cognitive impairment during subclinical epileptiform electroencephalographic discharges. Semin Pediatr Neurol 1995;2(4):246-53<\/p>\n

9. Aldenkamp AP, Arends J, Overweg-Plandsoen TC, van Bronswijk KJ, Schyns-Soeterboek A, Linden I, Diepman L. Acute cognitive effects of nonconvulsive difficult-to-detect epileptic seizures and epileptiform EEG discharges. J Child Neurol 2001;16(2):119-23<\/p>\n

10. Hendriksen IJ, Elderson A. The use of EEG in aircrew selection. Aviat Space Environ Med 2001;72(11): 1025-33<\/p>\n

11. Murdoch BD. The EEG in pilot selection. Aviat Space Environ Med 1991;62(11):1096-8<\/p>\n

12. Kasteleijn-Nolst Trenite DG. Intermittent photic stimulation as an activation method for EEG screening of aircrew applicants. Epilepsy Behav 2005;6(1):21-6<\/p>\n

\nHaz\u0131rlayan :<\/strong> Dr. O\u011fuz TAN. Psikiyatrist. (Memory Center, \u0130stanbul)<\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

EEG\u2019de g\u00f6r\u00fclen subklinik epileptiform de\u015farjlar (SD), \u00f6m\u00fcr boyu n\u00f6bete yol a\u00e7mayabilir. SD\u2019lerin asl\u0131nda san\u0131ld\u0131\u011f\u0131 kadar masum olmad\u0131\u011f\u0131, klinikte g\u00f6zlemlenmesi zor olan n\u00f6betlere, bilin\u00e7 de\u011fi\u015fikliklerine ve kognitif fonksiyonlarda bozulmaya yol a\u00e7t\u0131\u011f\u0131 ileri s\u00fcr\u00fclm\u00fc\u015ft\u00fcr. Bu y\u00fczden pilot ve hava trafik kontrol\u00f6r adaylar\u0131nda EEG de\u011fi\u015fiklikleri b\u00fcy\u00fck \u00f6nem ta\u015f\u0131maktad\u0131r. SD\u2019lerin anlam\u0131: Bir tek interiktal de\u015farj\u0131n bile beyinde ger\u00e7ekle\u015fen her \u015feyi etkiledi\u011fi, n\u00f6ronal, vask\u00fcler ve […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_eb_attr":"","_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[6],"tags":[],"class_list":["post-618","post","type-post","status-publish","format-standard","hentry","category-bulten"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"jetpack-related-posts":[],"_links":{"self":[{"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/posts\/618","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=618"}],"version-history":[{"count":1,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/posts\/618\/revisions"}],"predecessor-version":[{"id":620,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=\/wp\/v2\/posts\/618\/revisions\/620"}],"wp:attachment":[{"href":"https:\/\/www.hvtd.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=618"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=618"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.hvtd.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=618"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}