DOI QR코드

DOI QR Code

Lennox-Gastaut syndrome 환아의 전신마취 하 치아우식 치료: 증례보고

DENTAL TREATMENT OF A PATIENT WITH LENNOX-GASTAUT SYNDROME UNDER GENERAL ANESTHESIA: CASE REPORT

  • 서희원 (서울대학교 치의학대학원 소아치과학교실) ;
  • 송지수 (서울대학교 치의학대학원 소아치과학교실) ;
  • 신터전 (서울대학교 치의학대학원 소아치과학교실) ;
  • 현홍근 (서울대학교 치의학대학원 소아치과학교실) ;
  • 김영재 (서울대학교 치의학대학원 소아치과학교실) ;
  • 김정욱 (서울대학교 치의학대학원 소아치과학교실) ;
  • 이상훈 (서울대학교 치의학대학원 소아치과학교실) ;
  • 장기택 (서울대학교 치의학대학원 소아치과학교실)
  • Suh, Heewon (Department of Pediatric Dentistry, School of Dentistry, Seoul National University) ;
  • Song, Ji-Soo (Department of Pediatric Dentistry, School of Dentistry, Seoul National University) ;
  • Shin, Teo Jeon (Department of Pediatric Dentistry, School of Dentistry, Seoul National University) ;
  • Hyun, Hong-Keun (Department of Pediatric Dentistry, School of Dentistry, Seoul National University) ;
  • Kim, Young-Jae (Department of Pediatric Dentistry, School of Dentistry, Seoul National University) ;
  • Kim, Jung-Wook (Department of Pediatric Dentistry, School of Dentistry, Seoul National University) ;
  • Lee, Sang-Hoon (Department of Pediatric Dentistry, School of Dentistry, Seoul National University) ;
  • Jang, Ki-Taeg (Department of Pediatric Dentistry, School of Dentistry, Seoul National University)
  • 투고 : 2018.05.17
  • 심사 : 2018.06.19
  • 발행 : 2018.06.30

초록

레녹스-가스토 증후군은 다양한 종류의 발작이 복합적으로 나타나는 질환으로 치료가 어렵고, 예후가 좋지 않다. 복용 중인 약물에 의해 구강 내 치은 부종 등의 증상이 나타날 수 있고, 치태 축적에 의한 우식의 위험성이 높기 때문에 구강 위생 관리가 중요하다. 치과치료를 필요로 하는 경우, 발작의 정도, 복용 중인 약물 및 환아의 협조도를 고려해 치료계획을 세워야 한다. 발작의 정도가 심하고, 협조도가 좋지 않은 경우, 전신마취를 계획할 수 있으며, 이 때 의과적 자문을 반드시 고려해야 한다.

Lennox-Gastaut syndrome (LGS) is one of the most severe epileptic encephalopathies of childhood onset. It is characterized by multiple types of generalized seizures, slowness of intellectual growth, and specific electroencephalogram pattern. It is one of the most difficult epilepsy syndromes to treat and is frequently resistant to treatment. In this case report, we report a case of dental treatment under general anesthesia in a child with LGS. A 4-year-6-month old boy with LGS visited Seoul National University Dental Hospital for dental treatment. Dental treatment was planned under general anesthesia because of his medical condition. Treatment was successfully done without any postoperative complications. If a LGS patient requires dental treatment, a treatment plan should be established to take into account the degree of seizure, the medication being used, and the cooperation of the patient. If the degree of seizure is severe and the patient's cooperation is poor, dental treatment under general anesthesia would be advantageous.

키워드

참고문헌

  1. Abu Saleh T, Stephen L : Lennox gastaut syndrome, review of the literature and a case report. Head Face Med, 4:9, 2008. https://doi.org/10.1186/1746-160X-4-9
  2. Archer JS, Warren AE, Jackson GD, Abbott DF : Conceptualizing lennox-gastaut syndrome as a secondary network epilepsy. Front Neurol, 5:225, 2014.
  3. Crumrine PK : Lennox-Gastaut syndrome. J Child Neurol, 1:70-75, 2002.
  4. Gastaut H, Roger J, Saint-Jean M, et al. : Childhood Epileptic Encephalopathy with Diffuse Slow Spike-Waves (otherwise known as “Petit Mal Variant”) or Lennox Syndrome. Epilepsia, 7:139-179, 1966.
  5. Ostendorf AP, Ng YT : Treatment-resistant Lennox- Gastaut syndrome: therapeutic trends, challenges and future directions. Neuropsychiatr Dis Treat, 13:1131-1140, 2017. https://doi.org/10.2147/NDT.S115996
  6. Shields WD : Diagnosis of infantile spasms, Lennox- Gastaut syndrome, and progressive myoclonic epilepsy. Epilepsia, 5:2-4, 2004.
  7. Markand ON : Lennox-Gastaut syndrome (childhood epileptic encephalopathy). J Clin Neurophysiol, 20:426-441, 2003. https://doi.org/10.1097/00004691-200311000-00005
  8. Oguni H, Hayashi K, Osawa M : Long-term prognosis of Lennox-Gastaut syndrome. Epilepsia, 3:44-47, 1996.
  9. Yagi K : Evolution of Lennox-Gastaut syndrome: a longterm longitudinal study. Epilepsia, 3:48-51, 1996.
  10. Arzimanoglou A, French J, Wheless JW, et al. : Lennox- Gastaut syndrome: a consensus approach on diagnosis, assessment, management, and trial methodology. Lancet Neurol, 8:82-93, 2009. https://doi.org/10.1016/S1474-4422(08)70292-8
  11. van Rijckevorsel K : Treatment of Lennox-Gastaut syndrome: overview and recent findings. Neuropsychiatr Dis Treat, 4:1001-1019, 2008.
  12. Hancock EC, Cross JH : Treatment of Lennox-Gastaut syndrome. Cochrane Database Syst Rev, 28:CD003277, 2013.
  13. Christianson AL, Zwane ME, Kromberg JG, et al. : Epilepsy in rural South African children-prevalence, associated disability and management. S Afr Med J, 90:262-266, 2000.
  14. Trevathan E, Murphy CC, Yeargin-Allsopp M : Prevalence and descriptive epidemiology of Lennox-Gastaut syndrome among Atlanta children. Epilepsia, 38:1283-1288, 1997. https://doi.org/10.1111/j.1528-1157.1997.tb00065.x
  15. Jellinger KA : A clinical guide to epileptic syndromes and their treatment based on the new ILAE diagnostic scheme. Eur J Neurol, 10:338-339, 2003.
  16. Sanders BJ, Weddell JA, Dodge NN : Managing patients who have seizure disorders: dental and medical issues. J Am Dent Assoc, 126:1641-1647, 1995. https://doi.org/10.14219/jada.archive.1995.0112
  17. Trevathan E : Infantile spasms and Lennox-Gastaut syndrome. J Child Neurol, 2:9-22, 2002.
  18. Majola MP, McFadyen ML, Laher MH, et al. : Factors influencing phenytoin-induced gingival enlargement. J Clin Periodontol, 27:506-512, 2000. https://doi.org/10.1034/j.1600-051x.2000.027007506.x