Konvülziyonlar ve Kanıta Dayalı Tedavi Bakım Uygulamaları
Özet
Günümüzde görülme sıklığı azalsa da, özellikle hemodiyaliz işlemi nedeniyle oluşan hemodinamik ve biyokimyasal değişikliklere bağlı olarak, hala azımsanmayacak oranda hastada nöbet aktivitesi gözlenmektedir. Üremik ensefalopati, diyaliz dengesizliği sendromu, diyalize bağlı hemodinamik instabilite, alüminyumla ilişkili diyaliz demansı, hava embolisi, hipoglisemi, elektrolit bozuklukları, çeşitli ilaç etkileri hemodiyaliz uygulanan hastalarda öne çıkan nöbet nedenlerindendir. Nöbetler hemodiyaliz işlemi sırasında oluşabileceği gibi, işlemden hemen sonra da ortaya çıkabilir. Diyaliz işlemi sırasında nöbet aktivitesi oluşursa diyalizin hemen durdurulması ve nöbet geçiren herhangi bir hastada uygulanan yaklaşımların uygulanması gerekir. Nöbetlerin önlenmesi ve tedavi başarısı için nöbeti tetikleyen faktörlerin bilinmesi ve giderilmesi önceliklidir.
Referanslar
Mauritz M, Hirsch LJ, Camfield P, et al. Acute symptomatic seizures: An educational, evidence-based review. Epileptic Disorders. 2022; 24(1), 26-49. https://doi.org/10.1684/epd.2021.1376
Gungor O, Aydin Z, Inci A, Oguz EG, Arici M. Seizures in patients with kidney diseases: a neglected problem?. Nephrol Dial Transplant. 2023;38(2):291-299. doi:10.1093/ndt/gfab283
Títoff V, Moury HN, Títoff IB, et al. Seizures, Antiepileptic Drugs, and CKD. Am J Kidney Dis. 2019;73(1):90-101. doi:10.1053/j.ajkd.2018.03.021.
Murali S, Shenoy SV, Prabhu RA, et al. Hypertensive emergency and seizures during haemodialysis. BMJ Case Rep. 2021;14(9):e242471. doi:10.1136/bcr-2021-242471
Kelly DM, Clarkson MR, Cronin S. Neurological consults on the renal unit. Pract Neurol. 2017;17(2):104-112. doi:10.1136/practneurol-2016-001538.
Wu HHL, Wang CCY, Chhetri SK, et al. Seizures and chronic kidney disease: An in-depth review. Adv Neuro. 2023;2(2): 314. https://doi.org/10.36922/an.314
Gibson BA. Brief Review of a New Antibiotic: Meropenem-vaborbactam. Sr Care Pharm. 2019;34(3):187-191.
Habas E, Habas A, Farfar K, Habas E, Rayani A. Disequilibrium syndrome in hemodialysis patients; narrative review. Turk J Nephrol. 2025;34(2):79-85.
Greenberg KI, Choi MJ. Hemodialysis Emergencies: Core Curriculum 2021. Am J Kidney Dis. 2021;77(5):796-809. doi: 10.1053/j.ajkd.2020.11.024.
Bhandari, Binita. and Saketram Komanduri. “Dialysis Disequilibrium Syndrome.” StatPearls, StatPearls Publishing, 29 May 2023.
Mistry K. Dialysis disequilibrium syndrome prevention and management. Int J Nephrol Renovasc Dis. 2019;30;12:69-77. doi: 10.2147/IJNRD.S165925.
Raina R, Davenport A, Warady B, et al. Dialysis disequilibrium syndrome (DDS) in pediatric patients on dialysis: systematic review and clinical practice recommendations. Pediatr Nephrol. 2022 Feb;37(2):263-274. doi: 10.1007/s00467-021-05242-1. Epub 2021 Oct 5. PMID: 34609583.
Triplett JD, Kutlubaev MA, Kermode AG, et al. Posterior reversible encephalopathy syndrome (PRES): diagnosis and management Practical Neurology 2022;22:183-189.
Karimi Z, Raeisi Shahraki H, Mohammadian-Hafshejani A. The effect of erythropoiesis-stimulating agents on systolic and diastolic blood pressure in hemodialysis patients: A systematic review and meta-analysis of clinical trials. Med Clin (Barc). 2024;162(10):e43-e51. doi:10.1016/j.medcli.2024.01.004
Karimi Z, Raeisi Shahraki H, Mohammadian-Hafshejani A. Investigating the relationship between erythropoiesis-stimulating agents and mortality in hemodialysis patients: A systematic review and meta-analysis. PLoS One. 2023;18(11):e0293980. doi:10.1371/journal.pone.0293980
Saha M, Allon M. Diagnosis, Treatment, and Prevention of Hemodialysis Emergencies. Clin J Am Soc Nephrol. 2017;12(2):357-369. doi:10.2215/CJN.05260516
Sahutoglu T, Sakaci T, Hasbal NB, et al. Air embolism following removal of hemodialysis catheter. Hemodial Int 2017; 21: 29–34.
Bryliński Ł, Kostelecka K, Woliński F, et al. Aluminium in the Human Brain: Routes of Penetration, Toxicity, and Resulting Complications. Int J Mol Sci. 2023;24(8):7228. doi:10.3390/ijms24087228
Wolfgram DF, Szabo A, Murray AM, Whittle J. Risk of dementia in peritoneal dialysis patients compared with hemodialysis patients. Perit Dial Int. 2015;35(2):189-198. doi:10.3747/pdi.2014.00213
Sazgar M. Kidney Disease and Epilepsy. J Stroke Cerebrovasc Dis. 2021;30(9):105651. doi:10.1016/j.jstrokecerebrovasdis.2021.105651
Besha A, Adamu Y, Mulugeta H, et al. Evidence-based guideline on management of status epilepticus in adult intensive care unit in resource-limited settings: a review article. Ann Med Surg (Lond). 2023 Apr 17;85(6):2714-2720. doi: 10.1097/MS9.0000000000000625. PMID: 37363462; PMCID: PMC10289780.
Marsico O, Pascarella A, Cutellè R, et al. Anti-seizure medications in patients with renal failure undergoing dialysis: how to manage?. Expert Rev Clin Pharmacol. 2025;18(7):471-483. doi:10.1080/17512433.2025.2531109.
Mora Rodríguez KA, Benbadis SR. Managing Antiepileptic Medication in Dialysis Patients. Curr Treat Options Neurol. 2018;20(11):45. doi:10.1007/s11940-018-0530-5
Sawhney H, Gill SS. Renal transplant recipient seizure practical management. World J Nephrol. 2020; 30;9(1):1-8. doi: 10.5527/wjn.v9.i1.1. PMID: 32742951; PMCID: PMC7360523.
Mahmoud SH, Zhou XY, Ahmed SN. Managing the patient with epilepsy and renal impairment. Seizure. 2020;10;76:143-152. doi: 10.1016/j.seizure.2020.02.006.
Wylie T, Sandhu DS, Murr NI. Status Epilepticus. [Updated 2023 May 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430686/
Adrogué HJ, Tucker BM, Madias NE. Diagnosis and Management of Hyponatremia: A Review. JAMA. 2022;328(3):280-291. doi:10.1001/jama.2022.11176
