PURPOSE: There are few rigorous studies about the side effects of antiepileptic drugs(AEDs) according to age. This study is to analyze differences of the side effects of AEDs in epileptic children according to age. METHODS: Sample are 368 children who had received AEDs for at least 1 month during January 1995 to June 1999. We reviewed their medical records including age, sex, AEDs and side effects, and analyzed these data by X2-test. RESULTS: Side effects were observed in 86(23.4%) of 368 patients. There was no difference in the frequency of overall side effects according to age. But significant differences existed in each side effect(p<0.05). The most common side effect according to age were hematologic side effect(75.0%) under 2 months, gastro intestinal side effect(41.7%) between 2 months and 1 year, CNS side effect(42.1%) between 1 year and 5 years, CNS side effect(41.5%) over 5 years. Hepatotoxicity, the increase of AST/ALT due to valproate, occurred significantly more frequently in children younger than 2 years(p<0.05). Drug eruption and post-carbamazepine leukopenia had no differences according to age. Under 1 year, valproate group had significantly more side effects in CNS. But carbamazepine, phenobarbital, and vigabatrin groups had no differences. CONCLUSION: There was significant difference in the side effects of AEDs among each system according to age. It is recommended to use valproate as monotherapy in children younger than 2 years, and pay more attention to CNS side effect in children older than 1 year.
Anticonvulsants* ; Carbamazepine ; Child* ; Drug Eruptions ; Humans ; Leukopenia ; Medical Records ; Phenobarbital ; Valproic Acid ; Vigabatrin

PURPOSE: The purpose of this study is to estimate the side effects of antiepileptic drug(AED) in children. METHODS: Subjects were 267 children who had received AED for at least 1 month during January 1995 to July 1998. We reviewed their sex, age at start of seizure onset, age at medication, class and number of AED, developmental delay, type and cause of seizure according to the presence of side effect. We analyzed data using Student's t-test and X2-test. RESULTS: Side effects were observed in 61 of 267(22.8%) patients. There were no significant differences in their characteristics according to the presence of side effect. There were 112 episodes of complications in 61 patients. In decreasing order, CNS(38.4%) > digestive(25.9%) > hematologic(22.3%) > skin and connective tissue(7.1%) > others(6.3%). There were 12 episodes in 11 patients who should have been taken off AED due to drug eruption, drowsiness, nausea and so on. Side effects were observed in 16 of 123(6.0%) patients in monotherapy compared with 45 of 144(16.8%) patients in polytherapy, which showed significantly fewer side effects in monotherapy(P<0.05). In monotherapy, mean age at seizure onset and medication start were older(4.63+/-3.83, 5.85+/-3.86 years, respectively) than in polytherapy(2.69+/-3.06, 3.69+/-3.58 years, respectively) (P<0.05). CONCLUSION: In the data, CNS is the most common side effect(43 episodes, 38.4%) and there were significantly fewer side effects in monotherapy compared with polytherapy. Accordingly, we concluded that monotherapy is preferred over polytherapy in reducing the side effects of AED.
Child* ; Drug Eruptions ; Humans ; Nausea ; Seizures ; Skin ; Sleep Stages

BACKGROUND: Control of seizure inducing factors (SIFs) is essential in the management of epilepsy. We suggest that avoiding of SIFs may prevent first attak of seizure in patients with risk factors or family history of epilepsy. We observed SIFs, clinical features associated with SIFs on their first seizure attack in patients diagnosed as epilepsy to help the prevention or management of the childhood epilepsy. SUBJECTS AND METHODS: A retrospective study was undertaken the analysis of 339 epileptic children visited to the pediatric Department of Pusan National University hospital from November, 1992 to July, 1998. RESULTS: 1) The 168 of 339 patients (49.5%) are associated with SIFs on first seizure attack. 2) Mean Age on their first seizure attack in the group with SIFs is 4.08+/-3.63 year-old and without SIFs is 2.80+/-3.34 year-old.3) The factors were febrile state (32.7%), sleepy state (29.0%), acute illness (8.3%), emotional stress (5.8%), fatigue (5.3%), hypoxia (4.7%), during watching TV or playing game (3.5%), head trauma (3.5%), bathing (2.8%), infection of central nervous system (2.3%), sleep deprivation (1.1%), vaccination (0.5%), hyperventilation(0.5%). 4) The types of seizure in patients with SIFs were as following : generalized tonic, clonic, tonic-clonic seiuzre was 140(90.9%), partial seiuzre 14(9.1%). 5) The family history of seizure disorders were not associated with SIFs. And 14(8.3%) of patients with SIFs had developmental delay, 24 (14.0%) of patients without SIFs. 6. Mean duration of control seizure was 1.52+/-2.65 years in the group with SIFs, 0.84+/-1.30 years in the group without SIFs. CONCLUSION: Early detection and education of the possible SIFs in each epileptic patients is considered as an important therapeutic modality in managing the epileptic patients in childhood.
Anoxia ; Baths ; Busan ; Central Nervous System ; Child ; Craniocerebral Trauma ; Education ; Epilepsy* ; Fatigue ; Humans ; Precipitating Factors* ; Retrospective Studies ; Risk Factors ; Seizures* ; Sleep Deprivation ; Stress, Psychological ; Vaccination

Ophthalmoplegia without ataxia has various etiologies. An atypical Miller Fisher syndrome implies an ophthalmoplegia without ataxia, areflexia or both. The presence of anti-GQ1b antibody supports the diagnosis of an atypical Miller Fisher syndrome. A 4-year-old Russian girl visited our hospital because of acute bilateral abducens nerve palsy and mydriasis. Although the muscle power of extremities was normal and she didn't show an ataxia, the deep tendon reflex of both knees and ankles was absent. The results of nerve conduction study and cerebrospinal fluid analysis were normal. Magnetic resonance imaging (MRI) showed an enhancement of the bilateral abducens nerve. The anti-Gq1b antibody titer was elevated. The diagnosis of atypical Miller Fisher syndrome was made and a therapy with intravenous immunoglobulins led to the clinical recovery. We report a girl with atypical Miller Fisher syndrome with acute bilateral abducens nerve palsy and mydriasis, diagnosed by of anti-GQ1b antibody positivity.
Abducens Nerve ; Abducens Nerve Diseases* ; Ankle ; Ataxia ; Cerebrospinal Fluid ; Child, Preschool ; Diagnosis ; Extremities ; Female ; Humans ; Immunoglobulins, Intravenous ; Knee ; Magnetic Resonance Imaging ; Miller Fisher Syndrome ; Mydriasis* ; Neural Conduction ; Ophthalmoplegia ; Reflex, Stretch

Duchenne muscular dystrophy (DMD) is the most common and severe form of childhood muscular dystrophy. Females are affected in rare cases because of its' X-linked, recessive inheritance. A small number of female DMD carriers have muscle weakness to some extent. A healthy 8-month-old girl was brought to our tertiary center because of the elevated serum liver enzyme (aspartate aminotransferase (AST): 986 IU/mL, alanine aminotransferase (ALT): 1,126 IU/mL), that was first noted 1 month ago when she was hospitalized for an acute respiratory infection. Follow-up her serum liver enzyme, AST and ALT level remained increased to 613 and 1,049 IU/mL, respectively without serologic evidence of viral hepatitis. Serum creatinine kinase (CK) level was highly elevated to 5,245 U/L. She showed normal development. Pseudohypertrophy of bilateral calf muscle was not observed, and Gowers' sign was not seen because of her young age. Electromyography and cardiac echocardiography showed no abnormal findings. A multiplex ligation-dependent probe amplification confirmed the heterozygote deletion mutation of DMD gene in exon 10-17. The result of karyotyping was normal 46,XX. She was diagnosed as an asymptomatic DMD carrier. Female carriers are usually asymptomatic but may have an elevated serum CK and/or mild calf hypertrophy. A girl with persistent elevated liver enzyme and CK level should be evaluated for the neuromuscular disease including DMD, despite her normal motor activity.
Alanine Transaminase ; Creatinine ; Echocardiography ; Electromyography ; Exons ; Female ; Follow-Up Studies ; Hepatitis ; Heterozygote ; Humans ; Hypertrophy ; Infant* ; Karyotyping ; Liver ; Motor Activity ; Multiplex Polymerase Chain Reaction ; Muscle Weakness ; Muscular Dystrophies ; Muscular Dystrophy, Duchenne* ; Neuromuscular Diseases ; Phosphotransferases ; Sequence Deletion ; Wills

Extramedullary relapse of childhood acute lymphoblastic leukemia (ALL) occurs most commonly in the central nervous system or in the testes. Isolated relapse on chest wall as a soft tissue mass is extremely rare in children with ALL. We experenced a 12-year-old girl who developed an isolated relapse on chest wall during the treatment for ALL. She had a pain and protruding mass on right anterior chest wall 6 months after the initial diagnosis of ALL. Imaging study revealed an 5 7 cm sized soft tissue mass on the right chest wall. Histopathologic examination revealed infiltrates composed of immature lymphoblasts with morphology identical with that of previous bone marrow aspiration. Studies on bone marrow and cerebrospinal fluid were negative for disease at this time. The patient was treated with 3,000 cGy of local irradiation in 10 fractions and systemic chemotherapy with ifosfamide and etoposide. The mass size decreased markedly, but she has been suffering from development of multiple mass in other site and recurrent pleural effusion.
Bone Marrow ; Central Nervous System ; Cerebrospinal Fluid ; Child ; Diagnosis ; Drug Therapy ; Etoposide ; Female ; Humans ; Ifosfamide ; Pleural Effusion ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Recurrence* ; Testis ; Thoracic Wall* ; Thorax*

Behcet's disease consists of a triad of relapsing inflammatory disease of the eye (iridocyclitis) with painful and recurrent oral and genital ulcerations. Arthritis, thrombophlebitis, neurologic abnormalities, fever, and colitis are associated clinical manifestations. The disease affects predominantly young adults and is very rare in children, especially those under 10 years of age. The proportion of Behcet's colitis in Behcet's disease is about 12%. Ulcerations are localized or diffuse, with the majority occuring in the ileocecal region. Extension to the serosal surface may result in perforation. The frequent complaints are abdominal pain, nausea, vomiting, diarrhea, hematochezia, loss of appetite, loss of weight gain, distention and palpable abdominal mass. The disease is complicated by intestinal obstruction, perforation, fistula formation, abscess formation and hemorrhage. We experienced a case of Behcet's colitis in a 9-year-old boy showing symptoms of abdominal pain, tenderness, and diarrhea. Thus, we report a case of Behcet's colitis with brief review of related literatures.
Abdominal Pain ; Abscess ; Appetite ; Arthritis ; Child* ; Colitis* ; Diarrhea ; Fever ; Fistula ; Gastrointestinal Hemorrhage ; Hemorrhage ; Humans ; Intestinal Obstruction ; Male ; Nausea ; Thrombophlebitis ; Ulcer ; Vomiting ; Weight Gain ; Young Adult

In this paper, a new superimposition scheme using a computer vision system was proposed with pairs of skull and ante-mortem photographs, which were already identified through other tests and DNA fingerprints at the Korea National Institute of Scientific Investigation. In this computer vision system, an unidentified skull was caught by video-camcoder with the MPEG and the other ante-mortem photograph was scanned by scanner. These two images were processed and superimposed using pixel processing. This recognition of individual identifications by anatomical references can be performed on the two superimposed images for many big cases like as Guam KAL accident in 1997.
Artificial Intelligence ; DNA Fingerprinting ; Guam ; Korea ; Skull

Malignant transformation of a mature cystic teratoma (MCT) is an uncommon complication. The most common form of malignant transformation of a MCT is squamous cell carcinoma, representing 75% of malignant transformations. The frequency of malignant transformation of MCT to adenocarcinoma is just 6.8%. To the best of our knowledge, no case of para-aortic lymph node metastasis in mucinous adenocarcinoma arising from MCT has been reported before. The prognosis of malignant transformation of the MCT is very poor. Here, we report an unusual case of a 41-year-old woman with mucinous adenocarcinoma arising from MCT with para-aortic lymph node metastasis.
Adenocarcinoma ; Adenocarcinoma, Mucinous ; Adult ; Carcinoma, Squamous Cell ; Cystadenocarcinoma, Mucinous ; Female ; Humans ; Lymph Nodes ; Mucins ; Neoplasm Metastasis ; Prognosis ; Teratoma

Malignant transformation of a mature cystic teratoma (MCT) is an uncommon complication. The most common form of malignant transformation of a MCT is squamous cell carcinoma, representing 75% of malignant transformations. The frequency of malignant transformation of MCT to adenocarcinoma is just 6.8%. To the best of our knowledge, no case of para-aortic lymph node metastasis in mucinous adenocarcinoma arising from MCT has been reported before. The prognosis of malignant transformation of the MCT is very poor. Here, we report an unusual case of a 41-year-old woman with mucinous adenocarcinoma arising from MCT with para-aortic lymph node metastasis.
Adenocarcinoma ; Adenocarcinoma, Mucinous ; Adult ; Carcinoma, Squamous Cell ; Cystadenocarcinoma, Mucinous ; Female ; Humans ; Lymph Nodes ; Mucins ; Neoplasm Metastasis ; Prognosis ; Teratoma