Neuropathic pain is defined as pain arising as a direct consequence of a lesion or disease affecting the somatosensory system either at the peripheral or central level. In most cases, neuropathic pain is associated with poor general health and has a problem of suboptimal response to medical treatment. This review will discuss the neurologic and non-neurologic conditions that cause neuropathic pain and the results of epidemiologic studies on neuropathic pain.Current Concepts: Epidemiology would be a useful clinical tool for designing management and prevention strategies for various neuropathic pain syndromes. Validated neuropathic pain screening questionnaires are widely used as useful tools for the epidemiologic study of neuropathic pain. There are also validated Korean versions of these questionnaires. The overall prevalence of neuropathic pain was estimated at 6.9-10%. Common neuropathic pain syndromes include diabetic neuropathy, herpes zoster, and trigeminal neuralgia. In addition, neuropathic pain can also occur in central nervous system disorders such as spinal cord injury or stroke, and other conditions like cancerous diseases, intervertebral disc disease, and joint diseases.Discussion and Conclusion: Neuropathic pain does not respond well to medical treatment, which leaves both patients and physicians are less satisfied with such treatments. Therefore, physicians must identify the causes of the pain, explain them to the patient, and proceed with the treatment together with patients.

Neuropathic pain is defined as pain arising as a direct consequence of a lesion or disease affecting the somatosensory system either at the peripheral or central level. In most cases, neuropathic pain is associated with poor general health and has a problem of suboptimal response to medical treatment. This review will discuss the neurologic and non-neurologic conditions that cause neuropathic pain and the results of epidemiologic studies on neuropathic pain.Current Concepts: Epidemiology would be a useful clinical tool for designing management and prevention strategies for various neuropathic pain syndromes. Validated neuropathic pain screening questionnaires are widely used as useful tools for the epidemiologic study of neuropathic pain. There are also validated Korean versions of these questionnaires. The overall prevalence of neuropathic pain was estimated at 6.9-10%. Common neuropathic pain syndromes include diabetic neuropathy, herpes zoster, and trigeminal neuralgia. In addition, neuropathic pain can also occur in central nervous system disorders such as spinal cord injury or stroke, and other conditions like cancerous diseases, intervertebral disc disease, and joint diseases.Discussion and Conclusion: Neuropathic pain does not respond well to medical treatment, which leaves both patients and physicians are less satisfied with such treatments. Therefore, physicians must identify the causes of the pain, explain them to the patient, and proceed with the treatment together with patients.

This retrospective series compries 268 patients who underwent curative resection of colorectal cancer at the department of surgery, Ewha womans university hospital,from January 1990 to December 1995,and the results obtained were summerized as follows. 1) The sex ratio of male to female was 1.6:1 and peak age group was the 6th decade(29.1%). 2) The most common location of tumor was the rectum (61.2%) and the sigmoid colon (19.8%),ascending colon (11.6%) were followed.3) In the right colon cancer,the most frequent symptoms were abdominal pain and palpable mass. In the left colon,bowel habit change and bloody stool were the most common symptoms. 4) In 119 cases (49.4%) of total cases,the duration of the symptoms prior to admission was below 3 months. 5) The preoperative CEA level was less than 5ng/ml in 147 cases (56.8%). 6) The Modified Dukes stage C2 was noted in 40.3%,B2 in 30.2%,B1 in 11.9%,D in 7.5%,A in 5.2%,and C1 in 4.9%. 7) The Histologic type of cancer was adenocarcinoma in 98.9%,squamous cell cancer in 0.7%,and leiomyosarcoma in 0.4%. 8) Rectal cancer was treated with abdominoperineal resection in 111 cases (41.4%),low.anterior resection in 53 case (19.8%). 9) The Postoperative complications were devepoled in 15.3 % of total cases and the most frequent one was wound infection (39.0%).10) Pelvic cavity was the frequent metastatic site,within 3 year after operation. 11) The 3 year survival rates of 152 patients from 1990 to 1992 were 88.8% in B1, 85.3% in B2, 77.7% in C1,and 50.8% in C2 stages.
Abdominal Pain ; Adenocarcinoma ; Colon ; Colon, Sigmoid ; Colorectal Neoplasms* ; Female ; Humans ; Leiomyosarcoma ; Male ; Postoperative Complications ; Rectal Neoplasms ; Rectum ; Retrospective Studies ; Sex Ratio ; Survival Rate ; Wound Infection

BACKGROUND: The repetitive nerve stimulation (RNS) test is a useful tool in the evaluation of neuromuscular transmission disorders. In our laboratory, we frequently use Oh's method, which tests 5 kinds of muscles (flexor carpi ulnaris (FCU), abductor digiti quinti (ADQ), orbicularis oculi, nasalis and trapezius) with 3 kinds of low rate stimulation (LRS) and high rate stimulation (HRS). This method has the advantage of high sensitivity, but is time consuming and painful to patients. So, we tried to reestablish the stage of RNS to overcome this problem and to create a useful test. METHODS: We analyzed RNS data from 369 patients, retrospectively. The number of patients with myasthenia gravis (MG) was 357 and the number with myasthenic syndrome was 12. We compared the sensitivity of individual muscle as well as individual stimulation rate. And we analyzed the results of MG and myasthenic syndrome to verify the usefulness of HRS. RESULTS: The sensitivity of RNS (LRS) was 69.7% in MG (generalized symptom 86.4%, only ocular symptom 40.3%). The sensitivity was higher with 3 pps and 5 pps than with 2 pps, while the exclusion of 2 pps did not affect the sensitivity. We found only 3 cases (1.0%) with post-tetanic exhaustion (PTE) in MG patients with negative results on LRS. The distributions of resting CMAP and post-exercise CMAP were different between MG and myasthenic syndrome. In most cases of myasthenic syndrome, the resting CMAP of ADQ and FCU was below 4.0 mV and post-exercise CMAP of ADQ and FCU was above 50%. CONCLUSIONS: LRS may be done with only 3 and 5 pps, and HRS of the ulnar nerve was helpful only if there was a suspicion of myasthenic syndrome (resting CMAP<4.0 mV or post-exercise CMAP>50%, in ADQ & FCU) or a borderline decremental response in LRS.
Humans ; Muscles ; Myasthenia Gravis* ; Neuromuscular Junction Diseases ; Retrospective Studies ; Ulnar Nerve

Basal temporal language area (BTLA), demonstrated by electric stimulation of the cortex in epilepsy patients rarely cause significant language problems after it resection. Recently, we experienced a patient who developed severe language deficits after the resection of BTLA. To characterize the language function of BTLA we compared the language characteristics in our patient with those of the previously reported characteristics of BTLA observed by either its resection or electrical stimulation. The BTLA was thought to play a major function in access to naming pool and in the comprehension partly through Wernicke's area. Also the visually associated language function, reading aloud and reading comprehension were known to be more damaged than visually unassociated function. Previous studies showed that BTLA identified by electrical stimulations in patients with epilepsy was usually found to be clinically insignificant for only minor and transient ]anguage deficits being noticed after its surgical resection with only rare exceptions. Our patient developed severe language deficits which lasted for at least several weeks after the resection of the epileptogenic lesion located in the BTLA. She had a calcified granuloma in inferior temporal gyrus and the WADA test in this patient revealed a strongly lateralized language and memory function to the resected temporal lobe. The precise neural mechanisms of severe language deficits found in this patient in unclear, however, our experience suggest that BTLA is involved in the language function to a significant degree at least in some patients. Further prospective investigations to preoperatively identify the patient group at risk of developing severe language deficits after the resection of BTLA are needed.
Comprehension ; Electric Stimulation ; Epilepsy ; Granuloma ; Humans ; Memory ; Temporal Lobe

Basal temporal language area (BTLA), demonstrated by electric stimulation of the cortex in epilepsy patients rarely cause significant language problems after it resection. Recently, we experienced a patient who developed severe language deficits after the resection of BTLA. To characterize the language function of BTLA we compared the language characteristics in our patient with those of the previously reported characteristics of BTLA observed by either its resection or electrical stimulation. The BTLA was thought to play a major function in access to naming pool and in the comprehension partly through Wernicke's area. Also the visually associated language function, reading aloud and reading comprehension were known to be more damaged than visually unassociated function. Previous studies showed that BTLA identified by electrical stimulations in patients with epilepsy was usually found to be clinically insignificant for only minor and transient ]anguage deficits being noticed after its surgical resection with only rare exceptions. Our patient developed severe language deficits which lasted for at least several weeks after the resection of the epileptogenic lesion located in the BTLA. She had a calcified granuloma in inferior temporal gyrus and the WADA test in this patient revealed a strongly lateralized language and memory function to the resected temporal lobe. The precise neural mechanisms of severe language deficits found in this patient in unclear, however, our experience suggest that BTLA is involved in the language function to a significant degree at least in some patients. Further prospective investigations to preoperatively identify the patient group at risk of developing severe language deficits after the resection of BTLA are needed.
Comprehension ; Electric Stimulation ; Epilepsy ; Granuloma ; Humans ; Memory ; Temporal Lobe

We report 3 cases of recurrent acute disseminated encephalomyelitis (ADEM) known as multiphasic disseminated encephalomyelitis (MDEM). The 3 cases presented with fever, headache, neck stiffness, abdominal pain, seizure and decreased mentality as well as focal neurologic deficits, which showed relatively good steroid responsiveness. Brain MRI revealed variable sized, multifocal, subcortical white matter lesions with gray matter involvement. The CSF study showed mild pleocytosis with negative oligoclonal band.
Abdominal Pain ; Brain ; Encephalomyelitis* ; Encephalomyelitis, Acute Disseminated ; Fever ; Headache ; Leukocytosis ; Magnetic Resonance Imaging ; Neck ; Neurologic Manifestations ; Seizures

A 74-year old woman presented with partial and secondarily generalized status epilepticus lasted for 11 days. Initially her seizures consisted of only unformed visual hallucination, which progressed to formed hallucinations, and then memory disturbance and GTCs. During the period of recurrent formed visual hallucinations, T2-weighted brain MRI revealed high signal intensities in the left occipital lobe. After intravenous phenytoin loading, she did not develop any further GTCs but visual hallucinations persisted. Follow-up MRI performed after complete recovery of seizures showed complete recovery of the previous focal lesions, however, 1H-MRS showed a significant decrease of NAA in the recovered area. These features suggested the neuronal loss in the area of seizure focus, despite the complete recovery of transient focal abnormalities in MRI. This case provides a supportive evidence of neuronal damage even in focal status epilepticus, which stress the importance of early treatment and EEG confirmation of the complete seizure control after the disappearance of clinically obvious seizures.
Aged ; Brain ; Electroencephalography ; Female ; Follow-Up Studies ; Hallucinations ; Humans ; Magnetic Resonance Imaging ; Memory ; Neurons* ; Occipital Lobe* ; Phenytoin ; Seizures ; Status Epilepticus*

Wada test has been used as the presurgical evaluation method of memory function in epileptic patient. We report experiences with selective posterior cerebral artery sodium amytal test in two intractable temporal lobe epilepsy patients who showed poor performance in conventional Wada test for the presurgical evaluation. Our procedure consisted of injection of sodium amytal via a microcatheter into the P1 distal segment of the posterior cerebral artery and verbal and visual memory test before and after the injection. We also performed Tc-99m ECD SPECT during the procedure. In one patient showed good memory function during the procedure so operation was performed. But the other patient showed poor memory function so we discharged him without operation.
Amobarbital* ; Epilepsy, Temporal Lobe* ; Humans ; Memory ; Posterior Cerebral Artery* ; Sodium* ; Temporal Lobe* ; Tomography, Emission-Computed, Single-Photon

BACKGROUND: Charcot-Marie-Tooth (CMT) disease is pathologically divided into the following two types: demyelinating type and axonal type. This study aimed to analyze the results of the electrophysiological studies of CMT1A and to reevaluate the clinical significance of nerve conduction studies (NCS). METHODS: The subjects of the study were 18 patients with genetically confirmed CMT1A during the period of 1995. 1.-2004. 8. The NCS data from 22 family members of the patients were also included. The nerve conduction velocities, conduction blocks and compound muscle action potentials were analyzed. RESULTS: The subjects were composed of 19 males and 21 females. The mean NCV was 21.70 m/s in the median nerve, and the conduction block was observed in 13 patients (32.5%). The NCV was uniformly slow. The intrafamilial variation of NCVs between parents and their children were analyzed in 30 patients from 11 families. The mean velocity was 24.44+/-3.67 m/s in parents and 19.53+/-5.37m/s in their children. CONCLUSIONS: The CMT1A showed the slowness in NCV, one of the characteristics of demyelinating neuropathy, and this slowing had a uniform pattern. Nerve conduction block was also frequently observed, the pattern of which was diffuse without dispersion, and non segmental. Because the NCV of the children tended to be slower than that of the parents, CMT1A may not be a simple progressive disease. The onset and progression of CMT1A may be determined by other genetic and environmental factors.
Action Potentials ; Axons ; Child ; Female ; Humans ; Male ; Median Nerve ; Neural Conduction ; Parents