BACKGROUND AND PURPOSE: Obstructive sleep apnea (OSA) is more severe during rapid eye movement (REM) sleep than during non-REM sleep. We aimed to determine the features of patients with OSA who experience little REM sleep. METHODS: Patients with a chief complaint of sleep-disordered breathing were enrolled. All subjects underwent overnight polysomnography (PSG) and completed questionnaires on sleep quality. Patients were divided into the following three groups according to the proportion of REM sleep detected in overnight PSG: little REM sleep [REM sleep <20% of total sleep time (TST)], normal REM sleep (20–25% of TST), and excessive REM sleep (>25% of TST). Multiple logistic regression analyses were applied to the data. The success rate of continuous positive airway pressure (CPAP) titration was estimated in these groups. RESULTS: The age and body mass index of the patients were 47.9±15.9 years (mean±SD) and 25.2±4.1 kg/m², respectively. The 902 patients comprised 684 (76%) men and 218 (24%) women. The apnea-hypopnea index (AHI) in the little-REM-sleep group was 22.1±24.4 events/hour, which was significantly higher than those in the other two groups (p<0.05). Multiple logistic regression showed that a higher AHI (p<0.001; odds ratio, 1.512; 95% confidence interval, 1.020–1.812) was independently predictive of little REM sleep. The titration success rate was lower in the little-REM-sleep group than in the normal-REM-sleep group (p=0.038). CONCLUSIONS: The AHI is higher and the success rate of CPAP titration is lower in OSA patients with little REM sleep than those with normal REM sleep.
Body Mass Index ; Continuous Positive Airway Pressure ; Female ; Humans ; Logistic Models ; Male ; Odds Ratio ; Polysomnography ; Sleep Apnea Syndromes ; Sleep Apnea, Obstructive* ; Sleep, REM*

BACKGROUND: Semiology of epileptic seizure is very important for diagnosis and treatment. However, little is known about the reliability of the observers' description. This study aims to determine the description reliability of seizures in the aspects of classification and lateralization. METHODS: We recorded 72 patients with habitual seizures during video-EEG monitorings. We, then, compared the ictal behaviors described by frequency observers and those recorded on the videotape to compare the accuracy of the observers' descriptions. Finally, we reviewed which aspects of the informants affected the reliability of the data. RESULTS: The classification of seizures based only on the observer-description was somewhat discordant from the videotape (correct classification: 82%) especially in dividing simple partial from complex partial seizures. Description of many ictal behaviors in presumed complex partial seizure such as oroalimentary automatism, motionless staring, tonic/clonic posture and version was accurate except for the hand automatism. A specified direction by the observer has a very high true positive rate. The accuracy of the description was related to the educational status of the observer. CONCLUSIONS: Semiology description by well-educated observers is may be reliable, but every physician should keep its limitation in mind and judge accordingly.
Automatism ; Classification ; Diagnosis ; Educational Status ; Epilepsy ; Hand ; Humans ; Medical History Taking ; Posture ; Reproducibility of Results ; Seizures ; Videotape Recording

RATIONAELE: Secondary bilateral synchrony(SBS) is not an unusual finding to the EEGers, but its Significance is not well-delineated. We reviewed the clinical EEG, and neuroimaging characteristicts in patients with SBS. METHOD: Patients who were admitted for presurgical evaluation of intractable epilepsy were classified on the basis of video-EEG monitoring, prolonged interictal EEG, MRI, ictal SPECT, PET, and, in a few cases, the surgical results. We analyzed clinical, electrophysiological, and neuroimaging characteristics of patients with SBS by comparing them, with those without SBS. RESULTS: Among 319 patients who were admitted for presurgical epilepsy evaluation, 26 patients had SBS(8.2%). Medial temporal lobe epilepsy was predominant as a whole(140/319, 43.9%), but frontal lobe epilepsy(FLE) was main syndrome in the SBS group(16/26, 61.5%). Multifocal irritative zones were present in 12.5% of FLE with SBS group(2/16) and in 4.8% of FLE without SBS group(2/42). In FLE with SBS group, the location of ictal onset zone was parasaggital in 32%(5/16) and multifocal in 37%(6/16). There was a tendency to develop secondary generalized tonic clonic seizure in FLE with SBS group than in FLE without SBS group. Neuroimaging modalities revealed frontal abnormalities more accurately in FLE with SBS group than in FLE without SBS group. CONCLUSION: Frontal lobe as an epileptogenic zone is an important factor in generating SBS and SBS seems to facilitate seizure spreading to the contralateral hemisphere.
Electroencephalography* ; Epilepsy ; Epilepsy, Temporal Lobe ; Frontal Lobe ; Humans ; Magnetic Resonance Imaging ; Neuroimaging* ; Seizures ; Tomography, Emission-Computed, Single-Photon

OBJECTIVE & BACKGROUND: There have been reports on the lateralizing value of temporal lobe interictal epileptiform discharge(IED), yet it is a matter of debate till now. We studied our patients focusing on the degree of lateralization by which accurate lateralization was possible and also on the significance of bisynchronous IED(BIED) in the lateralization of temporal lobe epilepsy. METHOD: Fifty two patients were included in the study who were diagnosed as having medial temporal lobe epilepsy through video-EEG monitoring and brain MRI. Twenty four hour sleep-deprived interictal scalp EEG was checked for all of them. After that, we counted the number of independent IED(IIED) and BIED originating from anterior temporal areas. Then we tried to find a reasonable degree of IED above which correct lateralization of epileptogenic area was possible by using brain MRI as a standard. We also tried to find a significance of BIED in the lateralization of temporal lobe epilepsy by comparing the result excluding patients with BIED to that includig patients with BIED. RESULT: Lateralization of IED was over 80% accurate if the cutoff point was set at 70% and patients with BIED were included, but nearly 100% accurate of the cutoff point was set at 80% and patients with BIED were excluded. CONCLUSION: Influence of BIED on the accuracy of lateralization by IED is significant, and if the lateralization of IED is over 80% in patients with no BIED, the chance of true lateralization is very high.
Brain ; Electroencephalography ; Epilepsy, Temporal Lobe* ; Humans ; Magnetic Resonance Imaging ; Scalp ; Temporal Lobe*

Distinct from migraine with aura or hemiplegic migraine, a rare clinical entity of migraine-like headache, transient focal neurologic deficit and CSF pleocytosis (HaNDL) has been known. Although the etiology or pathogenesis is unknown, possibility of viral infection or inflammation has been suggested. We report a 25-year-old man diagnosed as HaNDL with literature review. (J Korean Neurol Assoc 19(3):302~304, 2001)
Adult ; Aphasia ; Headache* ; Humans ; Inflammation ; Leukocytosis* ; Migraine Disorders ; Migraine with Aura ; Neurologic Manifestations*

No abstract available.
Amnesia, Transient Global* ; Humans ; Writing*

BACKGROUND AND PURPOSE: Chronic simulated snoring was induced in rabbits to determine the impact of snoring on the development of atherosclerosis. METHODS: The pressure wave of induced snoring at the carotid bifurcation of rabbits was acquired by gently pressing the airway. This wave was then simulated using custom-made mechanical devices. Twelve rabbits were used in this study, seven of which were assigned to the experimental group and the remaining five formed the control group. All of the rabbits were raised on a 1% high-cholesterol diet. Either working or sham devices were positioned at the ventral center of the neck in each rabbit. At the end of a 2-month observation period, all of the rabbits were sacrificed by perfusion fixation, the carotid arteries harvested, and the carotid atherosclerosis histology reviewed. RESULTS: All of the rabbits survived to the end of the experimental period. Blood sampling revealed the presence of hypercholesterolemia in both groups, with no significant difference between them. The presence and degree of atherosclerosis did not differ significantly between the groups. CONCLUSIONS: The findings of this study show the feasibility of making a chronic simulated snoring rabbit model. However, the causative role of snoring in carotid atherosclerosis was not detected in this animal study.
Animals ; Atherosclerosis ; Carotid Arteries ; Carotid Artery Diseases* ; Diet ; Hypercholesterolemia ; Neck ; Perfusion ; Rabbits* ; Snoring*

Objectives: Functional dyspepsia is one of the most common functional gastrointestinal disorders. We aimed to investigate the relationship between obstructive sleep apnea (OSA) and functional dyspepsia in patients with the complaint of sleep-disordered breathing. Methods: We prospectively recruited patients who visited the institute for the evaluation of sleep-disordered breathing. All patients underwent overnight polysomnography and submitted their responses to sleep questionnaires. A validated Korean version of the Rome III criteria was used to estimate functional dyspepsia. Functional dyspepsia was classified into two subtypes of epigastric pain syndrome and postprandial distress syndrome. Results: Out of 130 subjects with sleep disturbances, a total of 79 patients (60 men, 19 women) were enrolled. The mean (±standard deviation) age was 46.9±13.4 years. Functional dyspepsia was diagnosed in 8 (10%) patients. Patients with functional dyspepsia showed significantly higher values of Stanford Sleepiness Scale, the proportion of N1 sleep, arousal index, and apnea-hypopnea index compared to patients without functional dyspepsia (p=0.018, p=0.021, p=0.041, and p=0.039, respectively). With respect to OSA severity, 12% of patients with moderate OSA and 22% patients with severe OSA had functional dyspepsia. Severe OSA was significantly associated with a higher proportion of postprandial distress syndrome (p=0.030). Conclusions Our patients with snoring or OSA revealed that functional dyspepsia is associated with more severe daytime sleepiness and apnea-hypopnea index compared to those without functional dyspepsia. In addition, postprandial distress syndrome was a prevalent subtype of functional dyspepsia in patients with severe OSA.

BACKGROUND AND PURPOSE: Restless legs syndrome (RLS) is a sleep disorder that frequently occurs in dialysis patients, which disturbs the sleep and reduces the quality of life. The aim of this study was to determine the risk factors for RLS in dialysis patients. METHODS: Patients who visited any of four outpatient dialysis clinics between September 2005 and May 2006 were included in this study. The diagnosis of RLS and the severity assessment were made using the criteria described by the International Restless Legs Syndrome Study Group. We collected basic demographic data, clinical information, and laboratory findings, and then analyzed their association with various aspects of RLS using univariate and multivariate analyses. RESULTS: RLS was present in 46 (28.0%) of 164 dialysis patients. We found no significant risk factor for inducing RLS. The predialysis serum blood urea nitrogen (BUN) level in the dialysis patients with RLS was significantly correlated with RLS symptom severity. CONCLUSIONS: Predialysis BUN is related to RLS symptom severity. Further studies on the underlying mechanism are needed.
Blood Urea Nitrogen ; Dialysis ; Humans ; Multivariate Analysis ; Outpatients ; Quality of Life ; Renal Dialysis ; Restless Legs Syndrome ; Risk Factors

We tried to investigate the incidence and the clinical profile of intractable epilepsy with hippocampal atrophy and ictal onset zones located in areas other than the hippocampus (extra-medial-temporal epilepsy; EMTE). We included patients who had hippocampal atrophy confirmed by MRI but with extra-medial-temporal ictal onset zones as verified by invasive intracranial electrodes or video-EEG monitoring. The case histories, interictal EEG, ictal semiology, other MRI findings in addition to hippocampal atrophy, and results of ictal SPECT and PET scans were evaluated. Results were compared with those of surgically proven medial temporal lobe epilepsy with hippocampal atrophy recruited during the same period. 8.5% of the intractable epilepsy patients with hippocampal atrophy had extra-medial temporal epileptogenic zones. A history of encephalitis and hemiconvulsion-hemiparesis were significantly common in the EMTE group. Most of the interictal EEGs of EMTE patients showed extratemporal irritative zones. MRI, ictal SPECT, and FDG-PET seemed to be helpful at localizing the true epileptogenic zones. The predominant EMTE seizure type was focal motor seizure with secondary generalization. Some portion of intractable epilepsy patients with hippocampal atrophy had extra-medial-temporal epileptogenic foci and careful analysis of semiology and neuroimagings could yield clues to correct diagnosis.
Adult ; Atrophy ; Electroencephalography ; Epilepsy/physiopathology ; Epilepsy/epidemiology* ; Epilepsy/diagnosis ; Epilepsy, Temporal Lobe/epidemiology ; Hippocampus/pathology* ; Human ; Incidence ; Magnetic Resonance Imaging ; Retrospective Studies ; Tomography, Emission-Computed ; Tomography, Emission-Computed, Single-Photon