No abstract available.
Stroke*

To consider current concepts of epilepsy further, the brief review begins with a discussion of what is epilepsy, discribes multifactorial nature of epileptic disorders, and ends with a presentation of current classifications. A combination of the standard antiepielptic drugs(AEDs) may be necessary to treat intractable seizures, but no studies have been done to indicate an optimal combination. The new AEDs provide alternative choices, but questions remain about the optimal timing and manner of administration. AEDs selection must individualized, no drug of choice can be named for all patients.
Anticonvulsants* ; Classification ; Epilepsy* ; Humans ; Seizures

The knowledge about nutritional, toxic, and metabolic causes of dementia is particularly important, because they may be reversible. Central pontine myelinolysis(CPM) is one of these causes. CPM is a well known but rare metabolic disease of unknown etiology linked to overly aggressive correction of hyponatremia. We report a 74-year-old woman who developed disorientation, memory disturbance, and behavioral problem following intensive care unit management for pneumonia. Mini-mental status examination-Korean version(MMSE-K) study revealed severe cognitive dysfunction. Brain magnetic resonance imaging showed changes consistent with CPM and extrapontine myelinolysis. After supportive care, patient's clinical status was significantly improved. We suggest that a metabolic problem such as CPM should be considered in the diagnosis of acute or subacute cognitive deterioration in elderly patients.
Aged ; Brain ; Dementia ; Diagnosis ; Female ; Humans ; Hyponatremia ; Intensive Care Units ; Magnetic Resonance Imaging ; Memory ; Metabolic Diseases ; Myelinolysis, Central Pontine* ; Pneumonia ; Problem Behavior

Current treatment strategies for levodopa-induced psychosis in advanced Parkinson's disease have had limited success. Reduction or discontinuation of levodopa and coadministration with dopamine-blocking neuroleptics may attenuate the psychotic symptoms, but these strategies are associated with worsening of parkinsonian symptoms. Administration of 5-HT3 receptor antagonist ; ondansetron, a newer strategy to attenuate psychosis of Parkinson' disease without motor deterioration was introduced. A 41-year-old young-onset male, who was diagnosed as Parkinson's disease 7 years ago, was treated with levodopa therapy, and had levodopa-induced psychosis(delusion, hallucination, paranoid, insomnia). After trial of ondansetron, he showed improvement in the Brief Psychiatric Rating Scale(from 21 points to 9 points) in spite of increasing the dosage of levodopa. With ondansetron, we could increase the dosage of levodopa without psychotic complications(esp, hallucination), and he showed improvement in the motor fluctuation.
Adult ; Antipsychotic Agents ; Hallucinations ; Humans ; Levodopa ; Male ; Ondansetron ; Parkinson Disease ; Psychotic Disorders* ; Receptors, Serotonin, 5-HT3

No abstract available.
Blood Platelets* ; Monoamine Oxidase* ; Selegiline*

Korea health care system and public welfare system have been changed slowly and developed step by step. It makes efforts to promote the welfare of the people, but does not provide good benefits for geriatric patients. In 2008, it was incompletely set up the long term care system in Korea. And the Law on Long-Term Care Insurance for Elderly was officially announced in Nov. 2011 and the law for dementia, Dementia Management Act, was drafted in Feb. 2012. Though there were many laws, the concept of long-term care hospital and geriatric care facility is still obscure. In long-term care hospital, there are big expansion of the number of beds and institutions in Korea. Over a half of the patients in long-term care hospitals are suffered from mixed neurological diseases. Especially, dementia is the comorbid state with other chronic geriatric diseases. In view of the aging population, the role of neurologist will continue to grow. So neurologists need more special training for the needed skills and competencies, and the specific care settings program in long-term care hospital. In this review, the history and current state of long-term care hospital, related laws, and the role of neurologist will be discussed.
Aged ; Aging ; Delivery of Health Care ; Dementia ; Humans ; Insurance, Long-Term Care ; Jurisprudence ; Korea ; Long-Term Care*

BACKGROUNDS: The inflammatory reaction after cerebral ischemia involving adhesion molecules aggravates neurologic deficit. This study aimed to study the change of plasma level of the adhesion molecules after acute cerebral ischemia. METHODS: Nineteen patients with acute cerebral infarction and ten control subjects without a history of cerebrovascular disease were included in this study. The patient groups were subgrouped into large artery atherosclerosis and small artery occlusion groups according to TOAST classification. Plasma levels of sP-selectin, sE-selectin, sICAM-1 and sVCAM-1 were measured within 24 hours and in 6 to 8 days after acute ischemic infarction. RESULTS: The plasma level of sP-selectin was elevated in acute stroke patients within 24 hours and in 6 to 8 days after stroke onset compared with control group(p<0.05). But plasma levels of sE-selectin, sICAM-1 and sVCAM-1 were not different from those of control group. The plasma level of sP-selectin was significantly elevated in large artery artherosclerosis group compared with control group. CONCLUSION: This study suggest that P-selectin actively involves in inflammatory process after acute ischemic stroke, especially associated with atherosclerosis.
Arteries ; Atherosclerosis ; Brain Ischemia ; Cerebral Infarction ; Classification ; Humans ; Infarction ; Neurologic Manifestations ; P-Selectin ; Plasma* ; Stroke*

There has been quite a number of research regarding the role of dopamine in epilepsy and it has been still very controversial, In this study, the effect of dopaminergic deafferentation on kainic acid induced seizures was evaluated with behavioral study and molecular biologic method. We produced unilateral dopaminergic deafferentation via injection of 6-hydroxydopamine at the location of right substantia nigra in the Spague- Dawley rats (250-300gm) using the stereotaxic technique under pentobarbital anesthesia. Four weeks after this procedure, kainic acid (10m9/kg) was injected into the peritoneal cavity for induction of seizures. Observations of seizure pattern and mRNA expression of c-fos, dynorphin and enkephalin were obtained in the lesion group and were compared with those in the non-lesion group in terms of behavior characteristics and in situ hybridization histochemistry. In behavior study, the results demonstrated that more severe seizure patterns (rearing, falling, tonic-clonic seizure and status epilepticus) and more fast seizure evolution time(from onset to stage V) in the lesion group than those in the non-lesion group, which may indicated statistically significant (16.21+/-12.84 min. vs 35.88+/-16.55 min., p(0.05) The results of in situ hybridization revealed that the expression of c-fos, dynorphin and enkephalin mRNAs in certain areas of brain was higher in the lesion group than that in non-lesion group; c-fos in cerebral cortex, dynorphin in dentate gyrus, enkephalin in the entorhinal cortex and amygdala nuclei. Although the lesion was unilateral, the mRNA expression patterns appeared symmetrical shape. The characteristic behavior and molecular biologic study results are suggested that the dopamine may plays a important role in control of kainic acid induced seizures.
Amygdala ; Anesthesia ; Animals ; Brain ; Cerebral Cortex ; Dentate Gyrus ; Dopamine ; Dynorphins ; Enkephalins ; Entorhinal Cortex ; Epilepsy ; In Situ Hybridization ; Kainic Acid* ; Oxidopamine ; Pentobarbital ; Peritoneal Cavity ; Rats* ; RNA, Messenger ; Seizures* ; Stereotaxic Techniques ; Substantia Nigra

No abstract available.
Contraceptives, Oral* ; Female ; Humans

Huntington's disease is an autosomal dominant neurodegenerative disorder that usually begins in mid-life and is characterized by a progression of involuntary choreiform movements, personality change, and dementia. 4 specific unstable trinucleotide (CAG) repeat expansion in a gene on the short arm of chromosome 4 was recently identified as the pathogenic mutation for this disease. We have analysed the CAG expansion in peripheral leukocyte from a woman suspected with Huntington's disease and her family. A 40-year-old woman visited for the 6 years history of progressing intractable involuntary hyperkinetic movement and antagonistic personality. She showed bilateral caudate nucleus atrophy with mild enlargement of both frontal horn at brain MRI and showed the decrement of glucose metabolism in both basal ganglia at 18F-FDG PET scan. We also studied about the clinical manifestations of her family. Her younger brother also showed mild cognitive impairment and dysarthria. She and her relatives (n = 6) were tested for the existence of high risk allele of Huntington's disease by polymerase chain reaction method. The high risk allele (above 40 CAG repeat) in the 1715 gene was confirmed in 6 persons including the patient. The CAG repeat variance was 46 to 54. Only one person showed the normal range of CAG repeat.
Adult ; Alleles ; Animals ; Arm ; Atrophy ; Basal Ganglia ; Brain ; Caudate Nucleus ; Chorea ; Chromosomes, Human, Pair 4 ; Dementia ; Diagnosis* ; Dysarthria ; Female ; Fluorodeoxyglucose F18 ; Genes, vif ; Glucose ; Horns ; Humans ; Huntington Disease* ; Hyperkinesis ; Leukocytes ; Magnetic Resonance Imaging ; Metabolism ; Mild Cognitive Impairment ; Neurodegenerative Diseases ; Polymerase Chain Reaction* ; Positron-Emission Tomography ; Reference Values ; Siblings