BACKGROUND AND PURPOSE: Frequently the conventional nerve conduction studies (NCS) with testing usual peripheral nerves did not reveal any abnormalities in patients with early polyneuropathy. Recently Lee and Oh demonstrated that the interdigital sensory nerve conduction studies (NCS) of the foot were very sensitive in detecting early changes of neuropathy. The authors performed the study to see abnormal features of interdigital NCS in early phase of polyneuropathy and to understand the sensitivity of interdigital NCS in making diagnosis of polyneuropathy. METHODS AND MATERIALS: The interdigital NCS of the foot were performed in 19 clinically suspected polyneuropathy with no abnormalities by the conventional NCS (group I), in 7 polyneuropathy with electrophysiological abnormalities by the conventional NCS (group II), and 10 normal controls without clinical or electrophysiological findings of polyneuropathy (group III). The interdigital NCS were done according to the original description of Oh et al ,using the near-nerve needle recording at the level of ankle with averaging technique. The maximal nerve conduction velocity (NCV), the largest negative NCV, the amplitude and the duration of compound nerve action potential (CNAP) were analysed in each recording of I,V digital and I-II, II-III, III-IV, IV-V interdigital nerves of the foot. RESULTS: The abnormal interdigital NCS findings were found in 9 out of 19 patients in group I (47.4% ) , 7 out of 7 patients in group II(100.0%) ,and none in group III.(0.0%). In group I, the most common abnormal findings were no recordable CNAP (77,7%) and the second were the decreased amplitude of CNAP (66.6%). The decreased NCV were found only in one case ( group I-19). The digital or interdigital nerves involvement were symmetrical and the number of involved branches ranged from one to twelve, being averaged to be 7. In group II, the most common abnormalities were no recordable or decreased amplitude of CNAP (85.7 %) and the decreased NCV were found in 1 out of 7. Three out of 7 showed abnormalities in all digital or interdigital nerves and the remaining four showed abnormal findings in at least 4 among 12 digital or interdigital nerves. CONCLUSION: The interdigital NCS with the near nerve needle and averaging technique increased the diagnostic sensitivity in those subjects with clinically suspected polyneuropathy (group I) and the most common abnormal features in the interdigital NCS were the amplitude changes of CNAP. Therefore the authors suggest that the interdigital nerves of the foot are involved earlier in the process of polyneuropathy and the interdigital NCS of the foot might provide enhanced sensitivity for detecting early polyneuropathy.
Action Potentials ; Ankle ; Diagnosis ; Foot* ; Humans ; Needles ; Neural Conduction* ; Peripheral Nerves ; Polyneuropathies*

BACKGROUND: Blepharospasm and apraxia of lid opening (ALO) are nonparalytic causes of involuntary eyelid closure (IEC). Recently Aramideh (1994) divided the IEC into 5 groups by electromyography (EMG) study, and reported that each group had different responses to Botulinum A toxin treatment. Objective : We looked whether clinical observation can match the EMG, and possibly predict the response to Botulinum A toxiu treatment. Method : Based on EMG study of Aramideh (1994), clinically observable characteristics of each group were defined. One of the authors reviewed the videotapes of IEC and applied the above criteria to make the clinical diagnosis. Other author blinded to the clinical information performed 2 channel EMG of levator palpebrae superioris (LP) and orbicularis oculi (00) muscles, and made the EMG diagnosis. Clinical and EMG diagnoses were matched. Results : Twenty five patients (5 men and 20 women) were included in the study. Clinically, 16 were diagnosed as group I (blepharospasm), 1 as group 111(combined blepharospasm and LP motor impersistence), 7 as group tV(combined blepharospasm and involuntary LP inhibition), and 1 as group V(involuntary LP inhibition). There were no patient in group ll (combined dystonic activities of LP and 00). On EMG study, 14 were diagnosed as group 1, 2 as group ll, 1 as group 111, 7 as group IV, and 1 as group V The mismatch between the two diagnoseis occurred between group I and tV in 4 patients, group I and ll in 2, and group I and 111 in 2. Conclusions : Clinical observations are generally correct in predicting EMG diagnosis. Holvever groups with mixed features(ll, 111, and Iv) are difficult to diagnose by clinical observation only. Usefulness of clinical and EMG diagnosis on predicting Botulinum A toxin response will need to be evaluated. Key Words : Involuntary eyelid closure, Blepharospasm, Apraxia of lid opening, Electromyography.
Apraxias ; Blepharospasm ; Botulinum Toxins, Type A ; Diagnosis* ; Electromyography ; Eyelids* ; Humans ; Male ; Muscles ; Videotape Recording

STUDY DESIGN: A review of literature including definition, diagnosis and treatment of neuropathic pain. OBJECTIVES: To review and discuss the treatment guideline for neuropathic pain. SUMMARY OF LITERATURE REVIEW: Neuropathic pains are characterized by partial or complete somatosensory change caused by various disorders affecting central and peripheral nervous system, and are especially problematic because of their severity, chronicity and resistance to simple analgesics. MATERIALS AND METHODS: Review of literature. RESULTS: Tricyclic antidepressants and the anticonvulsants gabapentin and pregablin were recommended as first-line treatments for neuropathic pain. Opioid analgesics and tramadol were recommended as second-line treatments that can be considered for first-line use in selected clinical circumstances. Other medications such as dual reuptake inhibitors of both serotonin and norepinephrine would be used in severe cases. More invasive interventions (e.g., spinal cord stimulation) may sometimes be helpful. CONCLUSIONS: Treatment must be individualized for each patient and aggressive, combinatory pharmacotherapy and multidisciplinary approach are recommended for the treatment of neuropathic pain.
Amines ; Analgesics, Opioid ; Anticonvulsants ; Antidepressive Agents, Tricyclic ; Cyclohexanecarboxylic Acids ; gamma-Aminobutyric Acid ; Humans ; Neuralgia ; Norepinephrine ; Peripheral Nervous System ; Serotonin ; Spinal Cord ; Tramadol

Parkinsonism is a clinical syndrome with constellation of resting tremor, rigidity, bradykinesia, and a variety of gait disturbances. Gait disturbances in parkinsonism include short-stepped festination, loss of postural reflexes, and freezing. In certain parkinsonian states such as progressive supranuclear palsy, gait disturbances are very prominent over other clinical signs of parkinsonism in the early stage. However, freezing is usually seen in the late course of parkinsonism. Recently, it has been recognized that some patients have prominent freezing in their early course of the disease, and not much of other parkinsonian signs. The pathologies need to be confirmed, but must be divers based on clinical description of the cases. We report two elderly men who presented with pure freezing. There was minimal short-term memory impairment in the second case, but no other signs of parkinsonism were present. Brief trial of L-dopa did not offer much benefit. Detailed clinical features and laboratory findings will be presented with discussion of the literatures.
Aged ; Freezing ; Gait ; Humans ; Hypokinesia ; Levodopa ; Male ; Memory, Short-Term ; Parkinsonian Disorders ; Pathology ; Reflex ; Supranuclear Palsy, Progressive ; Tremor

No abstract available.
Carbamazepine ; Cataract ; Humans ; Young Adult

PURPOSE: This study examined the morphological characteristics of the thoracic and lumbar vertebrae of normal Koreans and the factors causing breakage of the pedicular wall by measuring the thoracolumbar vertebrae relative to the pedicle screw insertion. MATERIALS AND METHODS: The effect of the pedicle screw shape on the pedicle wall integrity of 56 normal Koreans was examined by performing a computer simulation of the inserting pedicle screws into the pedicle wall by superimposing the graphical images of the screws onto the CT scan images. RESULTS: Because the inner pedicle diameters of the most thoracic vertebrae from T4 to T10 were <5 mm, most pedicles of the thoracic vertebrae were expected to be broken after inserting the 5 mm-diameter cylindrical screws. The pedicles of the thoracic and lumbar vertebrae were classified into 6 groups by performing the cluster analysis using morphometric parameters. Group 1 was labeled "relatively narrow". Group 2 "moderate". Group 3 "wide and angular". Group 4 "severly narrow and short", Group 5 "long", and group 6 "relatively wide and angular". The simulation showed the pedicles of groups 1 and 4 to be too narrow for the 5 mm-diameter cylindrical screws to preserve the pedicular wall integrity. CONCLUSION: The pedicles of the vertebra of Koreans are similar in size to those of Caucasians. Personal morphological characteristics of the pedicles as well as their sizes and levels of the vertebrae are believed to be the significant factors that can cause the breakage of the pedicular wall.

Pure trigeminal motor neuropathy is characterized by trigeminal motor weakness without signs of trigeminal sensory or other cranial nerve involvement. We describe a 63-year-old woman with progressive weakness and atrophy of the left masticatory muscles. She had no sensory disturbance. The diagnosis of pure trigeminal motor neuropathy was made on the basis of clinical and electrophysiologic studies. Magnetic resonance imaging of the brain revealed enhancement of the enlarged mandibular branch of the trigeminal nerve coursing through the left foramen ovale. Our observations suggest that pure trigeminal motor neuropathy can be induced by a tumor.
Atrophy ; Brain ; Cranial Nerves ; Diagnosis ; Female ; Foramen Ovale* ; Humans ; Magnetic Resonance Imaging ; Mandibular Nerve ; Masticatory Muscles ; Middle Aged ; Trigeminal Nerve

Globally, migraine is the third most common disease affecting 1.3 billion people worldwide and the second leading cause of disability. With the recent advances in new drugs and device technology for the treatment of migraine, the Korean Headache Society (KHS) and American Headache Society (AHS) released a new practice guideline on the treatment of migraine in 2019, respectively. They developed their consensus statement after reviewing existing guidelines and recent clinical trials and having discussions with stakeholders. The KHS guideline addresses best practice for preventing migraine with oral treatments including start and stopping strategies. The AHS statement dealt with newer treatments, such as onabotulinumtoxinA, and the recently approved calcitonin gene-related peptide targeting agents, and nonpharmacological treatments such as neuromodulation and biobehavioral therapy for both preventive and acute treatment. In this paper, we will review and summarize updated guideline for migraine treatment.

BACKGROUND AND PURPOSE: Frovatriptan is a selective 5-HT1B/1D agonist with a long duration of action and a low incidence of side effects. Although several placebo-controlled trials have documented the clinical efficacy and safety of frovatriptan in adults with migraine, this drug has not previously been studied in Asian including Korean patients. METHODS: In this double-blind multicenter trial, 229 patients with migraine were randomized to receive frovatriptan 2.5 mg or placebo upon the occurrence of a moderate-to-severe migraine. The primary outcome was the 2-hour headache response rate. RESULTS: Frovatriptan significantly increased the 2-hour headache response rate compared with placebo (52.9% vs. 34.0%, p=0.004). The headache response rates at 4, 6, and 12 hours were significantly higher in the frovatriptan group than in the placebo group, as was the pain-free rate at 2 hours (19.0% vs. 5.7%, p=0.004), 4 hours (40.7% vs. 23.0%, p=0.006), and 6 hours (56.1% vs. 34.0%, p=0.002). The median time to a headache response was significantly shorter in the frovatriptan group than in the placebo group (2.00 hours vs. 3.50 hours, p<0.001). The use of rescue medications was more common in the placebo group (p=0.005). Chest tightness associated with triptan was infrequent (2.5%), mild, and transient. CONCLUSIONS: These results demonstrate that 2.5-mg frovatriptan is effective and well tolerated in Korean migraineurs for acute treatment of migraine attacks.
Adult ; Asian Continental Ancestry Group ; Carbazoles ; Headache ; Humans ; Incidence ; Migraine Disorders ; Oxalates ; Thorax ; Tryptamines

BACKGROUND: With the aid of high-resolution MRI, the identification of neuronal migration disorder(NMDs) is increasing and NMDs are considered as one of the major causes of extrahippocampal epilepsy. However, MRI has some limitatons in detecting small cortical lesion of NMDs. We have studied the diagnostic value and findings of brain SPECT and PET in the patients with NMDs. METHODS: Nineteen NMD patient with intrac table and partial epilepsy were studied. Diagnosis of NMDs was based on neuroimaging and pathology. Proton, Tl and T2-weighted axial, saggital and coronal MR image were obtained by 1.5 Tesla unit. Interictal and ictal SPFCT and PET imagings were performed with 99mTc-HMPAO and 18F-fluorodeoxyglucose. RESULT: Focal cortical dysplasia (FCD) and schizencephaly were detected in 4 patients, heterotopias in 3(one with 3 isolated lesions and one with bilateral temporal lobe lesions), polymicrogyria in 3, hemi-megalencephaly in 2, pachygyria in 2, forme fruste of tuberculous sclerosis(FFTS) in 1. Heterotopia was also combined with other lesions as schizencephaly, FFS and pachygyria. The MRI detected the lesions in 14 patients(73.7%). Of the 5 patients without definite abnormalities on MRI, 3 had focal polymicrogyda and 2 had FCD on pathologic examination. The interictal SPECT revealed abnormalities in 9 of 12 patients(75.0%), but could not detect 2 FCDs and one heterotopia. The ictal SPECT detected the lesions in all 11 patients. PET showed the compatible abnormalities in 17 patients(89.5%), but there was no abnormal finding in 2(1 with FCD and 1 with heterotopia). The abnormal lesions in PET were more extensive than those in MRI in the 8 patients with focal NMDs. Heterotopia showed cortical gray matter activity on PET in 6 out of 11 lesions. All other NMDs showed hypometabolism or metabolic detect in the interictal SPECT and PET. CONCLUSION: Functional imaging as SPECT & PET may be more selective than MRI to detect focal cortical lesions in NMD. NMDs show, variable metabolic pattern on functional imagings and in general the derangement in the functional imaging is more widespread than the lesions detected by MRI. We recommend the functional neuroimaging in the patients who are suspected to have partial seizure of neocortical origin and have no abnormal findings on brain MRI.
Brain ; Diagnosis ; Epilepsies, Partial ; Epilepsy ; Functional Neuroimaging ; Humans ; Lissencephaly ; Magnetic Resonance Imaging* ; Malformations of Cortical Development ; Neuroimaging ; Neuronal Migration Disorders* ; Neurons* ; Pathology ; Protons ; Seizures ; Technetium Tc 99m Exametazime ; Temporal Lobe ; Tomography, Emission-Computed, Single-Photon*