PURPOSE: To evaluate the clinical and electrophysiological characteristics of malformation of cortical development (MCD) with epilepsy. METHOD: We studied clinical and electroencephalographic (EEG) features of 54 childhood epilepsy patients with MCD diagnosed by magnetic resonance imaging (MRI) and pathologic examinations. RESULTS: 1) Bilateral diffuse MCD's were in 5 patients, bilateral focal MCD's were in 8, unilateral diffuse MCD's in 7, and unilateral focal MCD's were noted in 34 patients. 2) Partial seizures were manifested in 35 patients, and 4 of them evolve to infantile spasm (IS), isolated IS was noted in 15 cases, and generalized seizures were noticed in 2 cases 3) Asymmetric EEG backgraound slowing was noted in 30 patients, and 29 patients (96.7%) had MCD's in abnormal side of brain. 4) Polymorphic slowing was noted in 36 patients, and 28 cases (77.8%) had MCD's in those area. 5) Sensitivity of partial epileptiform discharges (ED's) for MCD was 79.6%, but specificity was 68.5%. 6) Localized paroxysmal fast activity was noted in 16 cases (29.6%), and specificity for MCD was 90.7%. 7) Spindle shaped fast activity was noted in 8 patients (14.8%), and its specificity was 100%. 8) Thirty-one cases (57.4%) were intractable to antiepileptic drugs (AED's). Seventeen cases of them were treated by ketogenic diet, and 12 patients (66.7%) were completely controlled. Among 12 cases of surgical resection, 11 patients (91.7%) became seizure free for 6 months to 2 years. 9) In pathologically confirmed cases, EEG sensitivity for MCD lesion was 100%, but sensitivity of MRI was 69.2%. CONCLUSION: EEG is most sensitive diagnostic tool for MCD in childhood epilepsy. and many of intractable epilepsy could be controlled by ketogenic diet and surgery.
Anticonvulsants ; Brain ; Electroencephalography ; Epilepsy* ; Humans ; Infant ; Infant, Newborn ; Ketogenic Diet ; Magnetic Resonance Imaging ; Seizures ; Sensitivity and Specificity ; Spasms, Infantile

BACKGROUND: The recurrent temporal lobe epilepsy induces contralateral cell damage and secondary epileptogenesis in the contralateral hippocampus of rats. This phenomenon is fairly constant and has been used as a model of human temporal lobe epilepsy. It is necessary to understand this patho-mechanism in order to prevent this cell damage. METHODS: We have investigated the patho-mechanism of secondary epileptogenesis by using the rat model injected with kainic acid (KA) into the unilateral hippocampus. KA model shows initial complex partial seizures originating from the limbic structures and following convulsive status epilepticus. Immunohistochemical staining for c-fos expression, TUNEL stain for apoptosis, and hematoxylin-eosin (H-E) stain for morphologic changes were used. RESULTS: In the injected hippocampus, transient activation of c-fos was expressed in the dentate gyrus and CA3 hippocampal area, which were shaded out within 24 hours after the onset of limbic seizure. The stained cell with normal appearance was not observed in the H-E stain after 72 hours due to diffuse cell death. In the contralateral hippocampus, transient expression of c-fos was observed in the dentate gyrus, hilus, CA3, and CA1 area. But the expression of c-fos in the CA3 and CA1 area was sustained to 24 hours. Cell loss was mild in the CA3 and hilus, and mild cell degeneration and shrinkage were observed in the CA1 area. Apoptotic body was expressed in the CA1 area at 72 hours after the onset of seizure. CONCLUSION: These results mean that the area of prolonged expression of c-fos is vulnerable to apoptosis. Also it suggests that the patho-mechanism of ipsilateral hippocampus is an acute cytotoxic edema, whereas the contralateral damage is an apoptosis.
Animals ; Apoptosis ; Cell Death* ; Dentate Gyrus ; Edema ; Epilepsy, Temporal Lobe ; Hippocampus* ; Humans ; In Situ Nick-End Labeling ; Kainic Acid ; Models, Animal ; Neurons* ; Rats* ; Seizures* ; Status Epilepticus

Anticonvulsants* ; Pharmacogenetics*

Epilepsy* ; Genetics*

A 29-year-old man with schizophrenia was admitted to the emergency department in a stupor following the first generalized tonicclonic seizure. He had drunk about 1.5 L of Coke and 2 L of water each day for 1 week without eating any other food. A laboratory evaluation revealed severe hyponatremia (110 mEq/L), and we diagnosed a hyponatremia-induced seizure. As polydipsia and hyponatremia are not uncommon in schizophrenics, hyponatremia-induced seizure should be included in the causes of seizure in schizophrenics.
Adult ; Coke ; Eating ; Emergency Service, Hospital ; Humans ; Hyponatremia ; Polydipsia* ; Schizophrenia ; Seizures* ; Stupor ; Water

PURPOSE: To identify cognitive effects of lamotrigine (LTG) compared with valproate (VPA) in epilepsy patients after 1 year of treatment. METHODS: Cognitive tests and subjective complaints of 22 patients with LTG monotherapy (50-200 mg/day) were retrospectively compared with those of 22 patients with VPA monotherapy (500-1300 mg/day) at 1 year of medication. RESULTS: LTG group did not show any significant difference in the performance of cognitive tests compared with VPA group. The incidence of cognitive complaints between two drugs were also not different. Both groups showed a better performance of list learning and Trail Making Test type A after antiepileptic drug medication. CONCLUSION: The impact of LTG and VPA monotherapy on cognitive functioning is similar. Both drugs may not be harmful or rather slightly beneficial for cognitive functions.
Cognition ; Epilepsy* ; Humans ; Incidence ; Learning ; Retrospective Studies ; Trail Making Test ; Valproic Acid*

BACKGROUND: Although stroke is one of the most frequent causes of seizures in adulthood, there has been constant controversy concerning risk factors and prognosis of poststroke seizures. This study was performed to investigate clinical manifestations, risk factors and prognosis in patients with poststroke seizures (PSS). METHODS: A total of 2048 patients with cerebral infarction were recruited for this study. Patients with PSS were reviewed retrospectively regarding stroke subtype, etiology, lesion location, and functional disability of the stroke as well as seizure types, treatment and recurrence rate. Patients with traumatic or hemorrhagic brain lesion or a history of previous seizures were excluded. RESULTS: PSS developed in 4.2% of ischemic stroke patients (85/2048; 46 men and 39 women, mean age 65.4 years). PSS developed within one week of stroke onset in 18.8% (16/85) whereas after one week in 81.2% (69/85). PSS was more common in patients with cortical lesions than subcortical lesions (15.1% and 0.8%; p=0.076). Status epilepticus more frequently manifested in early onset seizures compared to late onset seizures (31.3% and 10.1%; p=0.029). Seizure recurrence was observed in 44.3% of PSS patients, mostly due to poor compliance to treatment or due to inadequate drug treatment. Only 7.1% of PSS patients were drug resistant and all of these patients had late onset seizures. CONCLUSION: Seizures after ischemic infarction developed more commonly after one week of stroke onset, and in patients with cortical lesions. Seizure recurrence occurred in about half of the patients, and the rate of drug resistance was higher in late onset seizures.
Brain ; Cerebral Infarction* ; Compliance ; Drug Resistance ; Female ; Humans ; Infarction ; Male ; Prognosis* ; Recurrence ; Retrospective Studies ; Risk Factors ; Seizures* ; Status Epilepticus ; Stroke

PURPOSE: The majority of patients with idiopathic generalized epilepsy (IGE) are controlled by an antiepileptic drug when appropriately selected. So far, valproate is regarded as the first-line treatment for IGE. Also, it is postulated that lamotrigine and topiramate may have efficacy in IGE but there are a few evidence to support the usage. We examined the remission rates of seizures on valproate, lamotrigine, topiramate and factors predicting the outcome. METHODS: We reviewed the patients who diagnosed as IGE in pediatric neurology clinics in Asan Medical Center from March, 1995 to August, 2005. The patients with childhood absence epilepsy and patients without generalized spike and slow waves in EEG were excluded. Data were collected retrospectively on demographics, seizure types, antiepileptic drug treatment details, and remission rates. RESULTS: 64 of 80 patients had achieved one year period of remission by monotherapy with following drugs: Valproate (73.7% of 38 patients), lamotrigine (72.4% of 29 patients) or topiramate (83.3% of 18 patients). Among patients who failed to achieve remission by monotherapy, the combination of the drugs showed a remission rate of 72.7% (8/11 patients). Factors such as age, sex, family history, and history of febrile convulsions did not affect the remission rates. The existence of photoparoxysmal responses or focal epileptiform discharges, and syndrome diagnoses also couldn't be the predictive factors as well. CONCLUSIONS: As in adult patients with IGE, topiramate and lamotrigine as well as valproate can be used as the most effective anti-epileptic drugs in children with IGE without significant side effect.
Adult ; Child ; Chungcheongnam-do ; Demography ; Diagnosis ; Electroencephalography ; Epilepsy, Absence ; Epilepsy, Generalized* ; Humans ; Immunoglobulin E ; Neurology ; Retrospective Studies ; Seizures ; Seizures, Febrile ; Valproic Acid*

PURPOSE: Children with epilepsy tend to experience more emotional problems compared with healthy controls. The objective of this study was to elucidate the clinical factors influencing the quality of life in children and adolescents with epilepsy. We also evaluated preliminary findings concerning relationships between family factors and child emotional problems. METHODS: Subjects were 90 epilepsy patients aged between 6 and 17 years (mean 12.2+/-3.3 years) and their parents. Parents filled up the Impact of Childhood Illness Scale (ICIS). We compared the differences across patient groups according to the clinical factors such as seizure frequency, epilepsy types and duration, mono- or polytherapy, etc. RESULTS: ICIS subscore for treatment was higher when patients took more than one antiepileptic drugs (p=0.032), and when they still had poor seizure control (p=0.054) by regression analysis. Subscores for treatment, children, parents, and family were analyzed in each clinical factor. CONCLUSION: Epilepsy patients in childhood and adolescent ages have significant impacts on their quality of life and as well as on the family if they are on polytherapy or have poorly controlled seizures.
Adolescent* ; Anticonvulsants ; Child* ; Epilepsy* ; Humans ; Parents ; Quality of Life* ; Seizures

PURPOSE: The routine electroencephalography is a pivotal diagnostic study in the evaluation of patients with seizure disorders, but often proves incomplete. Video-Electroencephalographic Monitoring (VEM) is an important diagnostic innovation for intractable epilepsy. We performed this study to evaluate clinical indications and efficacies of VEM in childhood epilepsy. METHODS: The study group consisted of 231 children under the age of 15 year, admitted to the Asan Medical Center for VEM from November 1995 to February 2005. We classified the group on the basis of reasons for admission and did analyze the EEG, the change of diagnosis, treatment modality, and seizure control. RESULTS: Eighty seven (38%) patients underwent VEM for the exact classification of seizure types in patients who have epilepsy (Group I), 95 (41%) for presurgical evaluation (Group II) and 49 (21%) to confirm the diagnosis of a seizure disorder (Group III). The diagnosis was altered after VEM in 111 (48%) cases. The treatment modality was altered after VEM in 161 (70%) patients. In Group I, 53 (61%) had a changed treatment plan, 32 of whom had changes in antiepileptic drug and 7 underwent ketogenic diet. In Group II the treatment modality was changed in 82 (86%) cases, 68 of whom had done epileptic surgery and 6 had done VNS. In Group III, 26 (53%) changed the treatment modality. After VEM study, eventually 149 (65%) patients received changed modality of treatment and 91 (61%) patients of them showed improvement in the seizure control. CONCLUSIONS: VEM showed a high yield in changing diagnosis and management of childhood epilepsy in our study, and we confirmed it is effectively used in the treatment of the intractable childhood epilepsy.
Child ; Chungcheongnam-do ; Classification ; Diagnosis* ; Electroencephalography ; Epilepsy* ; Humans ; Ketogenic Diet ; Seizures