BACKGROUND: Medication adherence (MA) is poor among patients with chronic illnesses, such as those involving the risk factors of stroke. However, the impacts of poor MA on the modifiable risk factors of stroke are not well known. METHODS: We evaluated the MA for the control of hypertension, diabetes, hyperlipidemia, and previous ischemic stroke among consecutive patients with ischemic stroke within 7 days of symptom onset. Nonadherence was defined as taking doctor-prescribed medications for less than 3 weeks during the previous month. Demographic data, risk factor profile, stroke mechanism, and baseline score on the National Institutes of Health Stroke Scale (NIHSS) were compared among patients with nonadherence and those without. RESULTS: Among 1133 patients with at least one medicated risk factor, the rates of nonadherence in hypertension, diabetes, hyperlipidemia, and previous ischemic stroke were 18.5%, 15.3%, 30.3%, and 28.1%, respectively. Overall, 27.4% of patients with more than one risk factor presented nonadherence, with a predilection toward being male (male, 63.9% vs. female, 56.1%, p=0.02) and younger (mean age 64.9 years vs. 66.4 years, p=0.01). Stroke severity according to MA did not differ using either crude analysis (NIHSS score: 5.5+/-5.9 vs. 5.4+/-5.5, p=0.71) or multivariable analysis after log transformation. The prevalence of nonadherence was low for large-artery disease and small-vessel occlusion, and high for cardioembolism. CONCLUSIONS: Prestroke poor MA for the major risk factors was common among patients with chronic illnesses, and was more frequent in younger male patients. Stroke severity was not affected by MA during the month preceding stroke.
Chronic Disease ; Female ; Humans ; Hyperlipidemias ; Hypertension ; Male ; Medication Adherence ; National Institutes of Health (U.S.) ; Prevalence ; Risk Factors ; Stroke

BACKGROUND: The International Restless Legs Scale (IRLS) and the Restless Legs Syndrome Quality of Life questionnaire (RLSQoL) are valid and reliable tools for assessing RLS severity and the impact of RLS on daily life in Western countries. The purpose of this study was to validate the Korean versions of these questionnaires in Korean RLS patients. METHODS: We developed the Korean versions of the IRLS and the RLSQoL. In total, 250 Korean primary RLS patients were included in this study. These questionnaires were used for the initial interview and a subsequent retest approximately 1 month later. The findings were compared with those obtained using the Clinical Global Impression, Short Form 36 Health Survey, and other instruments. The percentage agreement and Cronbach's alpha were calculated for each question, and the validity coefficients were estimated from these statistics. RESULTS: The scores for the Korean versions of the IRLS (range: 0-40) and the RLSQoL (range 0-100) proved reliably consistent (Cronbach's alpha=0.96 and 0.92, respectively) and had good test-retest reliability (intraclass correlation coefficient=0.61-0.85 and 0.61-0.89, respectively). The Korean version of the RLSQoL could be used to distinguish between groups with none, mild, moderate, severe, and very severe symptoms (F=66.10, P<0.0001). The two questionnaires proved to have high reliability and validity coefficients. CONCLUSIONS: The Korean versions of the IRLS and the RLSQoL are valid and reliable tools for assessing RLS severity and the impact of RLS on the daily life of Korean RLS patients.
Health Surveys ; Humans ; Quality of Life ; Surveys and Questionnaires ; Reproducibility of Results ; Restless Legs Syndrome

BACKGROUND: We studied the quality of life (QOL) of patients with restless legs syndrome (RLS) and compared it to that of normal controls and patients with hypertension or diabetes in Korea. METHODS: We developed a Korean version of the Johns Hopkins RLS QOL questionnaire by translating this into Korean and then back into English to check its accuracy. In total, 250 RLS patients were included in this study. The scores of RLS patients were compared with those of 215 normal controls, 196 patients with hypertension, and 185 diabetics. All subjects completed the questionnaires, including the Korean versions of the Short Form 36, Johns Hopkins RLS QOL, Pittsburgh Sleep Quality Index, and the Beck Depression Inventory. The associations between the severity of RLS and the QOL scores were examined using Pearson correlations. RESULTS: The QOL scores were lower in subjects with RLS than in the normal controls and the patients with hypertension or diabetes. More severe RLS symptoms were associated with a lower QOL score. Correlation analysis revealed a significant negative correlation between the severity of RLS symptoms and QOL score (r=-0.702, p<0.001). However, neither the gender of the RLS subjects nor the age at symptom onset (early or late onset) affected the QOL score. The factors most related to QOL score in RLS patients were depression and sleep quality. CONCLUSIONS: We found that Koreans with RLS have a considerably diminished QOL, with this being worse than in Korean subjects with diabetes or hypertension. These findings are comparable with studies conducted in Western countries.
Chronic Disease ; Depression ; Humans ; Hypertension ; Korea ; Quality of Life ; Surveys and Questionnaires ; Restless Legs Syndrome ; Sleep Wake Disorders ; Translating

Although the majority of women with epilepsy give birth to healthy children, intrauterine exposure to antiepileptic drugs (AEDs) increases the risk of fetal major congenital malformations (MCMs), a two-to threefold increase in risk with older AEDs. Several prospective pregnancy registries demonstrated a consistent pattern of increased risk for MCMs with valproate (VPA) used as monotherapy, compared to unexposed populations and to other AEDs. Polytherapy likely increases risk for MCMs, but the risk is more pronounced if VPA was included. There are dose-effect relationships in some AEDs and specific MCMs associated with specific AEDs. Dose-dependent risk for MCMs has been demonstrated with VPA above 800 to 1000 mg. Carbamazepine and VPA have been reported to be associated with a significant increase in the risk of spina bifida. For newer AEDs other than lamotrigine, data are still too limited to determine the risks for MCMs. Fetal exposure to AEDs can produce cognitive deficits. VPA and AED polytherapy probably reduces cognitive outcomes and monotherapy exposure to phenytoin or phenobarbital possibly reduces cognitive outcomes. If possible, avoidance of VPA and AED polytharapy during the first trimester should be considered to decrease the risk of MCMs, and avoidance of VPA and AED polytherapy throughout pregnancy should be considered to prevent reduced cognitive outcomes. However these risks must be balanced against potentially grave risks to both mother and fetus posed by seizures. Further studies are needed to compare risks for MCMs and reduced cognitive outcomes of each AEDs at different dosages and combination.
Anticonvulsants ; Carbamazepine ; Child ; Epilepsy ; Female ; Fetus ; Humans ; Mothers ; Parturition ; Phenobarbital ; Phenytoin ; Pregnancy ; Pregnancy Trimester, First ; Registries ; Seizures ; Spinal Dysraphism ; Triazines ; Valproic Acid

BACKGROUND: We studied the accuracy, lateralization criteria of Wada test in patients with temporal lobe epilepsy(TLE). We also evaluated material specific memory and determined the stimulus which can classify best between right and left TLE among four different types of stimuli. METHODS: We examined Wada memory performance in 33 patients(15 left, 18 right) with TLE who underwent surgery and who were good seizure outcome at least 1 year follow-up. Twelve stimuli consited of figures, written words, geometric designs and real objects were presented after Amytal injection. The recognition memory test was performed at 10 minutes after the injection and hemisphere memory performance of each stimulus and total stimuli were obtained by(number of stimuli recognized / number of stimuli presented x 100%). Classification rate, best stimulus for lateralization, and suitable lateralization criteria were determined by discriminant analysis and Chi-square test. Hemispheric memory difference of each stimulus was analyzed by paired-sample Student's t-test in left temporal lobectomy(LTL) and right temporal lobectomy(RTL) groups. RESULTS: No significant difference was observed in pre-Wada memory score and in IQ between LTL and RTL group. The classification rate of Wada test in terms of lateralization by discriminant analysis was 81.82%. The accuracy was 75.8% at 10% and 15% lateralization criteria and was 63.6% and 45.5% at 20% and 25% lateraliza.
Amobarbital ; Classification ; Follow-Up Studies ; Humans ; Memory* ; Seizures ; Temporal Lobe

BACKGROUND: The interpretation of Wada memory test is various in different epilepsy centers. Four types of Wada memory score (WMS) were defined by four different criteria to determine the best WMS in predicting postsurgical memory outcome. METHODS: Twenty temporal lobe epilepsy patients underwent Wada test before surgery and pre- and post-operative neuropsychological tests. WMS was obtained by four ways; including 1) total stimulating items, 2) items presented between one and two minutes after amobarbital injection, 3) items presented before ipsilateral EEG slowing decreased to 50%, 4) items presented until EEG slowing disappeared. Wada memory asymmetry index (WAI) was determined by [(WMS of normal side ? WMS of epileptic side)/their mean]. Logical and visual memory tests were performed before and after operation. Neuropsychological asymmetry index (NPAI) was defined as [(postsurgical score ? Presurgical score)/their mean]. Spearman correlation coefficients were obtained between WAIs and NPAIs. RESULTS: WAIs obtained by method 2) and 3) showed relatively good correlation with NPAIs. Visual memory outcome was correlated with WMS better than logical memory both in non-dominant and dominant hemisphere epilepsy groups. The lateralizing value of memory dominance in non-dominant hemisphere epilepsy group was greater than that of dominant group. CONCLUSIONS: Early presented stimuli during Wada test had a better predictive value of postoperative memory outcome.
Amobarbital ; Electroencephalography ; Epilepsy ; Epilepsy, Temporal Lobe ; Humans ; Logic ; Memory* ; Neuropsychological Tests

BACKGROUND: Many children with acute infanti]e hemiplegia (AIH) develop epilepsy later. Epilepsy associated with AIH has been generally thought to be medical]y intractable and difficult to be treated surgically. We report 15 patients with intractable epilepsy associated with AIH, 10 of whom received surgery. METHODS: All patients underwent comprehensive presurgical evaluation, including video-EEG monitoring, MRI, PET, interictal and ictal SPECT. RESULTS:The onset of AIH was at mean age of 19 months, accompanied by hyperpyrexia and repeated convulsion. Subsequent epilepsy started at mean age of 11 years, which could be subdivided by mesial temporal lobe epilepsy (MTLE) in 8 patients (53%) and neocortical or multifocal epilepsy in 7 patients (47%). The mean age of onset of AIH was earlier in MTLE group and the mean age of onset of subsequent epilepsy was earlier in neocortlcal group, although not significant statistically. The patients demonstrated variable spectrums of abnormalities on EEG, MRI, PET, and SPECT, but neocortica] group tended to show more widespread abnormalities than MTLE group. Surgery was performed in 7 of 8 in MTLE group and 3 of 7 in neocortica] group, and the outcome was excellent in MTLE group. CONCLUSION: Epilepsy associated with AIH showed two distinct subtypes; MTLE and neocortical/multifoca] epilepsy. Because the surgical outcome in selected cases with well-localized epileptogenic zone was excellent, careful clinical consideration and presurgical evaluation will be needed for management planning and to avoid unnecessary hemispherectomy.
Adult* ; Age of Onset ; Child ; Electroencephalography ; Epilepsy* ; Epilepsy, Temporal Lobe ; Hemiplegia* ; Hemispherectomy ; Humans ; Magnetic Resonance Imaging ; Seizures ; Tomography, Emission-Computed, Single-Photon

BACKGROUND: Persistent auras after temporal lobectomy may be bothersome to the patients even though they are seizure free. But most authors specifically are concerned about the seizure outcome itself. The aim of the present study was to investigate which factors are related to persistent auras in patients with temporal lobe epilepsy(TLE) after temporal lobectomy. METHODS: We have retrospectively analysed many factors in 38 TLE patients with aura. All patients underwent anterior temporal lobectomy with amygdalo-hippocampectomy. Twenty three patients were seizure and aura free (completely seizure-free) and 15 patients had persistent auras(persistent auras) in spite of seizure-free. Characteristics of auras, past medical history, presence of secondary GTC, seizure frequency, age of surgery, age of onset, duration of habitual seizure, ictal EEG pattern, and pre- and postoperative MRI findings were compared between group with completely seizure-free and group with persistent aura. RESULTS: Characteristics of aura, past medical history, presence of secondary GTC, seizure frequency, ictal EEG pattern, age of onset, and age of surgery had no statistical differences between both groups. Seizure duration of group with persistent aura seemed to be longer than that of group with completely seizure-free(13.6 years vs 17.0 years, median test, p=0.10) and remained hippocampus in postsurgical MRI seemed to be related to persistent auras(Fisher's exact test, p=0.06). CONCLUSIONS: We found that there were suggestive differences in seizure duration and remained hippocampus between the two groups.
Age of Onset ; Anterior Temporal Lobectomy ; Electroencephalography ; Epilepsy* ; Epilepsy, Temporal Lobe ; Hippocampus ; Humans ; Magnetic Resonance Imaging ; Prognosis ; Retrospective Studies ; Seizures ; Temporal Lobe

BACKGROUND: To evaluate the efficacy and safety of topiramate (TPM) as add-on therapy in medically intractable partial epilepsies. METHODS: This study was a multicenter double-blind placebo-controlled randomized parallel group trial consisting of 12 weeks of baseline phase, 10 weeks of titration phase, and 8 weeks of maintenance phase. The primary efficacy variable was the median seizure frequency reduction rate(MSFRR) and the other efficacy variables included responder rate, seizure free rate, and global evaluations by the patient and the physician. The patient should have partial epilepsies refractory to the maximally tolerable doses of one to two antiepileptic drugs(AEDs) and should have at least two or more episodes of clinical seizures every 4 weeks during the baseline phase. The target dose of study drugs was 600mg/day. The study drug was started at the initial dose of 50mg/day and increased by 50mg/day every week until 400mg/day was reached. Thereafter, the dose was increased by 100mg weekly over next two weeks. RESULTS: A total of 177 patients were randomized into TPM group(n=91) and placebo (PLC) group (n=86). Baseline median seizure frequencies were 5.60 episodes/4 weeks in TPM group and 5.59 episodes/4 weeks in PLC group. Among those who were randomized, 158 patients (TPM: 78 patients, PLC: 80 patients) were available for efficacy measurement by intention-to-treat analysis. The MSFRR was 63.6% for TPM and 17.9% for PLC, which was highly in favor of TPM (p=0.0001). The responder rate was 59.0% for TPM and 23.8% for PLC (p=0.001). Thirteen of 78 patients (16.7%) taking TPM became seizure free compared to 2 of 80 patients (2.5%) taking PLC (p=0.004). The global evaluation by the patient and the physician greatly favored TPM (p=0.001, p=0.001). The incidence of adverse events(AE) was higher in TPM(81.3%) than PLC (48.9%) with CNS-related AE being the most frequent. Among individual AE, anorexia (20.9%) and abdominal pain or discomfort (20.9%) were the most common AE in TPM group. AE precipitated early drop out in 7 patients taking TPM (7.6%) and 3 patients taking PLC(3.5%). No serious AE were observed. CONCLUSIONS: TPM was highly effective and safe as add-on therapy in medically intractable partial epilepsies. Slower titration of TPM seems to decrease the drop-out rate but the incidence of AE was still high. The AE profile of TPM in Asians was different from that in Caucasians.
Abdominal Pain ; Anorexia ; Asian Continental Ancestry Group ; Epilepsies, Partial* ; Humans ; Incidence ; Seizures

BACKGROUND: Estrogen deficiency is linked to cardiovascular disease (CVD) and osteoporosis in women. Ovarian hormones are also presumed to play a key role in Alzheimer's disease (AD). This study was designed to investigate the clinical evidences of estrogen deficiency and therapeutic efficacy of hormone replacement (HRT) in women with AD. METHODS: Clinical tests indicative of ovarian insufficiency were performed in 44 female patients with AD (age: 49-81: 68.0+1.2, Mean+SEM). Out of 40 patients treated with HRT, 16 completed one-year follow-ups. Modification of risk factors for CVD and changes in bone mineral density with HRT were assessed. Periodic MMSE was performed to evaluate changes in cognitive function under HRT. RESULTS: All the patients except two were postmenopausal, and years since menopause were 18.2+1.8. Six patients had early menopause. Hypertension was detected in 9 patients, and one had history of CVD. Prevalence of osteoporosis at lumbar vertebrae or femur neck and that of fragility fracture were 57% and 39%, respectively. Sixteen patiens who completed one-year HRT were analyzed separately: HRT reduced significantly blood levels of total cholesterol, Lp(a), and glucose and increased HDL-cholesterol. HRT also prevented bone loss at both lumbar spine and femur neck. MMSE scores at 3, 6, and 12 months of HRT revealed no significant decline compared with baseline score. CONCLUSIONS: Female AD is late problem after menopause, and frequently associated with osteoporosis. In addition to beneficial modification of risk factors for CVD and prevention of further bone loss, HRT might inhibit cognitive decline assessed by MMSE in AD.
Alzheimer Disease* ; Bone Density ; Cardiovascular Diseases ; Cholesterol ; Dementia ; Estrogens ; Female ; Femur Neck ; Follow-Up Studies ; Glucose ; Hormone Replacement Therapy* ; Humans ; Hypertension ; Lumbar Vertebrae ; Menopause ; Osteoporosis ; Prevalence ; Risk Factors ; Spine