Sudden Unexpected Death in Epilepsy (SUDEP) is defined as sudden, unexpected, non-traumatic, and non-drowning death in epilepsy. Postmortem examination must not reveal any anatomical or toxicological causes for SUDEP. The most commonly suggested mechanisms for SUDEP are cardiac abnormalities and apnea, although the cause of SUDEP is still unknown. We experienced a 36 years old male patient with epilepsy who was admitted to emergency room for cardiopulmonary arrest and the death was compatible with SUDEP because of unexpected death without reasonable explanation of cause of death except seizure. There is a possibility of an irreversible cardiac arrest or respiratory arrest by a seizure, which led to death in this case.
Adult ; Apnea ; Autopsy ; Cause of Death ; Emergency Service, Hospital ; Epilepsy* ; Heart Arrest ; Humans ; Male ; Seizures

Glufosinate ammonium (GLA, BASTA(R)), a non-selective herbicide, is widely used in many countries including Korea. The neurological complications of GLA intoxication are manifested as a loss of consciousness, convulsion, or memory impairment. We encountered a 59-year-old male, who was presented to the emergency department 1 hour after orally ingesting GLA. The patient developed mental disturbances, impaired respiration and generalized tonicch ronic seizures. Although the patient was initially treated with lorazepam and phenytoin, the seizures continued to occur. Through continuous infusion of midazolam along with respiratory support, the occurrence of the seizures was controlled. The patient was discharged with no medical and neurological abnormalities except for a shortterm memory loss.
Ammonium Compounds* ; Emergency Service, Hospital ; Humans ; Korea ; Lorazepam ; Male ; Memory ; Memory, Short-Term ; Midazolam ; Middle Aged ; Phenytoin ; Respiration ; Seizures ; Status Epilepticus* ; Unconsciousness

Seizure-associated nose wiping occurs usually during postictal period and is more frequent in temporal than extratemporal lobe epilepsy. The hand used to wipe the nose is highly suggestive of ipsilateral partial seizure onset. We describe a patient with the left mesial temporal lobe epilepsy, who showed ictal nose wiping by the left hand. The hypothetical mechanism remains unknown but may be a response to olfactory aura or increased ictal nasal secretions. In this patient, subtraction ictal SPECT coregistered to MRI (SISCOM) study revealed hyperperfusion mainly in the left temporal lobe, especially amygdala. Our patient may support an important role of amygdala concerned with olfactory system or autonomic activity in provoking nose wiping.
Amygdala ; Epilepsy ; Epilepsy, Temporal Lobe* ; Hand ; Humans ; Magnetic Resonance Imaging ; Nose* ; Seizures ; Temporal Lobe* ; Tomography, Emission-Computed, Single-Photon

Carbamazepine (CBZ) is one of the most commonly used antiepileptic agents. With its potent effects against seizure or neuropathic pain, it also has several undesirable adverse events. CBZ has been known to induce hepatotoxicity because the drug is mainly metabolized through hepatic system, and asymptomatic liver enzyme elevation occurs in 5~10% of patients receiving CBZ. There are several cases of symptomatic hepatitis or hepatic necrosis by CBZ, however, reports of chronic cholangitis associated with CBZ medication are rare. Here, we present a case of chronic recurrent cholangitis by CBZ with pathological evidence.
Anticonvulsants ; Carbamazepine* ; Cholangitis* ; Hepatitis ; Humans ; Liver ; Necrosis ; Neuralgia ; Seizures

BACKGROUND & OBJECTIVES: We tried to investigate the impact of prolonged KD on liver, and their recovery in rats. METHOD: KD was administered to 25 male Sprague-Dawley rats, while 25 control rats were fed with standard rodent chow. Liver function and serum lipids were evaluated in 3, 5, 7, 9 and 11 weeks of KD group and RD group. To evaluate the recovery of liver function, regular diet (RD) was provided after the 3 weeks of KD and liver function and hyperlipidemia were evaluated in 1, 3, 5, 7, and 9 weeks (25rats). Plasma ALT (Alanine aminotransferase), AST (Aspartate aminotransferase), HDL-cholesterol, total cholesterol and triglycerides were measured in all rats. Liver was stained with Oil Red O and analysed with Visus image analysis system. RESULTS: Liver enzymes and serum lipids were markedly elevated in KD group and were partly correlated with the duration of KD. But these abnormal liver enzymes and lipids were rapidly normalized between 1 to 3 weeks after KD cessation. Liver weight/body weight ratio was smaller in KD rats in spite of visible fatty liver. Oil Red O stain showed that the longer period of KD causes more lipids in liver. During the recovery stage, liver lipids started to decreases 1 week after the RD and normalized 4 to 5 weeks afterwards. CONCLUSION: Although the KD has impact on liver in most rats, abnormal liver function, hyperlipidemia, and fatty liver induced by certain period of KD were reliably normalized within short duration of regular diet.
Animals ; Cholesterol ; Diet ; Fatty Liver ; Humans ; Hyperlipidemias ; Ketogenic Diet* ; Liver ; Male ; Plasma ; Rats* ; Rats, Sprague-Dawley ; Rodentia ; Triglycerides

PURPOSE: Frontal lobe epilepsy is difficult to be managed with medical or surgical treatment. So the authors analyzed and reviewed the clinical results of the frontal lobe epilepsy patients who underwent surgical treatment. METHODS: From 1996 to 2004, Thirty-nine patients were treated surgically. The authors reviewed retrospectively the radiological, clinical and pathological data of the patients. The surgical outcome was classified using Engel's classification. RESULTS: The mean follow-up period is 70.5 (+/-29.7) months. The preoperative MR image was normal in 19 cases and abnormal in 20 cases. There were 11 encephalomalacias, 4 cortical dysplasias and 5 brain tumors. The postoperative pathological finding was normal in 5 cases and abnormal finding in 34. There were 20 cortical dysplasias, 4 encephalomalacias, 3 gliosises, 2 fibrous scars, 2 cavernous malformations, 1 dysembryoplastic neuroepithelial tumor, 1 paragonimiasis and 1 venous thrombosis. The postoperative surgical outcomes were as follows: Class I, 41%; Class II, 25.6%; Class III, 20.5%; Class IV, 12.8%. CONCLUSIONS: The surgical outcomes of frontal lobe epilepsy have improved, compared with previous series. The pathological abnormality was observed in large portion of the frontal lobe epilepsy patients.
Brain Neoplasms ; Cicatrix ; Classification ; Encephalomalacia ; Epilepsy ; Epilepsy, Frontal Lobe* ; Follow-Up Studies ; Frontal Lobe* ; Gliosis ; Humans ; Malformations of Cortical Development ; Neoplasms, Neuroepithelial ; Paragonimiasis ; Retrospective Studies ; Venous Thrombosis

Epilepsy is one of the most common neurological problems in pregnancy. For the majority of women, pregnancy proceeds without any apparent difficulties but there is growing evidence of an increased risk of major malformations and later cognitive problems in children exposed to antiepileptic drugs in utero. Updated evidence from several prospective pregnancy registries suggests an increased risk of major malformations with valproic acid compared with other antiepileptic drugs, becoming more evident as doses exceed 1,000 mg/day. The effects of polytherapy appear to carry greater risks compared with monotherapy. Limited data exist for the newer AEDs except for lamotrigine. Although most women with epilepsy have no change in seizure frequency, seizures, especially generalized tonic-clonic seizures can produce adverse effects on mother and fetus. Data about the risk associated with seizures in pregnancy are limited. The pregnancy registry will be performed in Korea to assess the relative risk of major congenital malformation from in utero exposure to antiepileptic drug and to analyze seizure control and treatment in pregnant women with epilepsy.
Anticonvulsants* ; Child ; Epilepsy ; Female ; Fetus ; Humans ; Korea ; Mothers ; Pregnancy* ; Pregnant Women ; Registries ; Seizures* ; Valproic Acid

Neonatal electroencephalogram (EEG) is a useful and sensitive tool to evaluate the degree of neurological insult in neonate. However, Clinical significances of its compositions is still explored, and it often causes physician a difficulty in interpretation of neonatal EEG. The most important factor in interpreting neonatal EEG is to consider a gestational age of the patient. All preterm and term neonates physiologically show ontogenic maturations in background activity of the EEG. Continuity, symmetry, and synchronicity are three major determinants of this ontogenic maturations. In neonatal period, some physiological sharp transients are easily misunderstood as epileptiform discharges unless physician have sufficient experiences of neonatal EEG. Background abnormalities are relative and indirect indicators for neonatal seizure in case of absence of electrical signature, however, video-EEG monitoring is recently much more recommended due to its uncertainty. In conclusion, neonatal EEG is useful in evaluating gestational age of patient, the degree of neurological insult, and detecting neonatal seizure. However, neonatal EEG is an independent and complicated domain of pediatric EEG so that its interpretation requires special efforts to physicians.
Electroencephalography* ; Gestational Age ; Humans ; Infant, Newborn ; Seizures ; Uncertainty

The gamma knife radiosurgery (GKS) is a safe and effective neurosurgical approach in the treatment of arteriovenous malformation (AVM). Seizures after GKS are rarely reported, but epilepsia partialis continua (EPC) has not been reported yet. We report a patient with EPC accompanied with cerebral edema after GKS in AVM. A 50-year-old man was admitted for EPC, dysarthria and monoparesis 20 days after GKS due to AVM. Brain MRI showed increased cerebral edema around AVM in the left premotor area. Symptoms were relieved by IV dexamethasone and antiepileptic drugs (AEDs). 15 weeks later, EPC recurred and aphasia and right hemiplegia were rapidly aggravated. The follow up brain MRI showed markedly increased cerebral edema compared with previous MRI. EPC was well controlled by AEDs, but aphasia and hemiplegia were not responsive to IV dexamethasone until trying oral prednisolon. We think that cerebral edema induced by EPC, as a complication of GKR, might aggravate hemiparesis.
Anticonvulsants ; Aphasia ; Arteriovenous Malformations ; Brain ; Brain Edema ; Dexamethasone ; Dysarthria ; Epilepsia Partialis Continua* ; Follow-Up Studies ; Hemiplegia ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Paresis ; Radiosurgery* ; Seizures

PURPOSE: In the pediatric patients who have medically intractable epilepsy the callosotomy is useful to prevent the propagation of seizure from one hemisphere to the other. The indications of callosotomy are drop attack, life threatening primarily or secondarily generalized seizure, medically refractory mixed seizure types such as Lennox-Gastaut syndrome. In addition, the retarded children are not contraindicated. The anterior callosotomy is used to perform to control medically intractable epilepsy which is believed to have some advantages to total callosotomy. But, we propose that the anterior callosotomy does not seem to be superior to total callosotomy for the prevention of the propagation of seizure or complication. We describe a series of 21 patients with medically intractable epilepsy who underwent total callosotomy in one stage. METHODS: The diagnoses in these patients included Lennox-Gastaut syndrome, atonic seizure, infantile hemiplegia, and no obvious solitary seizure focus on chronic video/EEG monitoring to characterize seizures, electrographic activity, and postictal behaviors. Preoperatively 16 patients suffered from disabling drop attacks or intense head drop seizures which caused frequent physical injuries. Other types of seizures are 12 generalized tonic-clonic seizures, 7 complex partial seizures, 1 absence seizure, and 7 myoclonic seizures. Male:Female=14:7, Age: 2-22 years (Mean: 9.4 years). The follow-up period ranged from 0.8 to 3.8 years (median 2.4 years). Seizure outcome, parental assessment of daily function, and parental satisfaction with outcome were assessed postoperatively. RESULTS: Drop attacks disappeared completely during the entire follow-up period in 13 patients and decreased to less than 10% of baseline in five. The corpus callosum of the one patient were not completely sectioned in Diffusion Tensor Image, tractography. Other types of seizures resolved completely in 14 patients and decreased in 7. 2 patients experienced a transient disconnection syndrome, but completely resolved within four weeks. Overall daily function improved and parents were satisfied with the surgical outcome in all patients except three who experienced recurrent of drop attacks after operation. There was no sign of significant and persistent neurological deficits in any case. CONCLUSION: Results of total callosotomy in patients with medically intractable epilepsy with diffuse epileptic foci were favorable in most cases. The procedure was particularly effective against drop attacks causing physical injuries and impaired quality of life in these patients.
Child ; Corpus Callosum ; Diagnosis ; Diffusion ; Epilepsy* ; Epilepsy, Absence ; Follow-Up Studies ; Head ; Hemiplegia ; Humans ; Parents ; Quality of Life ; Seizures ; Syncope