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

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

Central pontine myelinolysis(CPM) is rare, with fewer than 30 cases reported in children. It is characterized by demylinated regions throughout the brain and which are most prominent in the pons. The original patients studied were all chronic alcholics, but subsequently the condition has been found in children and in other patients with electrolyte abnormalities, most notably hyponatremia which had been corrected rapidly. CPM symptoms include spastic quadriparesis, pseudobulbar palsy, and acute changes in mental status leading to altered levels of consciousness, coma, or death. This condition was originally thought to be uniformly fatal, but there have been recent reports of survival accompanied by varying degrees of residual neurologic deficit. We experienced a case of central pontine myelinolysis in a 1-year-old girl in 1998. On admission, she had right hemiphegia and developmental delay. She suffered from hyponatremia a year prior to admission. We performed brain MRI and other studies. She was diagnosed with CPM though brain MRI.
Brain ; Child ; Coma ; Consciousness ; Female ; Humans ; Hyponatremia ; Magnetic Resonance Imaging ; Muscle Spasticity ; Myelinolysis, Central Pontine* ; Neurologic Manifestations ; Pons ; Pseudobulbar Palsy ; Quadriplegia

Central pontine myelinolysis(CPM) is rare, with fewer than 30 cases reported in children. It is characterized by demylinated regions throughout the brain and which are most prominent in the pons. The original patients studied were all chronic alcholics, but subsequently the condition has been found in children and in other patients with electrolyte abnormalities, most notably hyponatremia which had been corrected rapidly. CPM symptoms include spastic quadriparesis, pseudobulbar palsy, and acute changes in mental status leading to altered levels of consciousness, coma, or death. This condition was originally thought to be uniformly fatal, but there have been recent reports of survival accompanied by varying degrees of residual neurologic deficit. We experienced a case of central pontine myelinolysis in a 1-year-old girl in 1998. On admission, she had right hemiphegia and developmental delay. She suffered from hyponatremia a year prior to admission. We performed brain MRI and other studies. She was diagnosed with CPM though brain MRI.
Brain ; Child ; Coma ; Consciousness ; Female ; Humans ; Hyponatremia ; Magnetic Resonance Imaging ; Muscle Spasticity ; Myelinolysis, Central Pontine* ; Neurologic Manifestations ; Pons ; Pseudobulbar Palsy ; Quadriplegia

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*

Schwannoma commonly arises from Schwann cells of the neural sheath, and is rare in the groin region. Here, we describe a vaginal schwannoma incidentally detected by magnetic resonance imaging (MRI) in a patient with thigh pain. A 43-year-old woman presented with thigh pain with burning and tingling sensations in the medial aspect of her left thigh. MRI revealed a mass lesion of heterogeneous intensity 5.2 x 5.7 cm in the left vaginal wall. The mass was resected and histology revealed schwannoma.
Adult ; Burns ; Diagnosis* ; Female ; Groin ; Humans ; Magnetic Resonance Imaging ; Neurilemmoma* ; Schwann Cells ; Sensation ; Thigh* ; Vaginal Neoplasms

PURPOSE: Lumbar puncture is an essential and commonly practiced diagnostic tool and post-lumbar puncture headache and post-lumbar puncture back pain are common neurological complications. The aim of this study is to identify the factors that might cause post-lumbar puncture back pain and to reduce those complaints by eliminating the causes. METHODS: From June 5, 2013 to July 29, 2013, we studied 155 patients, male and female between the age 1 and 18,who received diagnostic or therapeutic lumbar puncture at Pusan National University Hospital and Pusan National University Yangsan Hospital. We collected data of variable aspects that may influence post-lumbar puncture back pain, by reviewing the medical records retrospectively. The independent variables were sex, age, symptoms, diagnosis, number of trials to successful lumbar puncture, year of the resident who carried out the procedure, opening pressure of cerebrospinal fluid(CSF), spinal level of punctured site, duration of strict bed rest, and use of sedatives for the procedure. RESULTS: Among the 155 patients whounderwent lumbar puncture, 36 (23.2%) experienced back pain after the procedure. Back pain subsided within 48hours in 24 ofthe 36 patients. Only one patient suffered from post-lumbar puncture back pain for more than 5days. There is no clear causality between the occurrence rate of post-lumbar puncture back pain and the independent variables which includeage, sex, duration of bed rest, symptoms, diagnosis, number of trials, skill, opening pressure, anatomic location, and use of sedatives. CONCLUSION: Back pain was a frequent complication of lumbar puncture. Various factors we expected to influence on the incidence of post-lumbar puncture back pain had no statistical significance. Further studies should be performed to investigate the causes and risk factors of post-lumbar puncture back pain.
Back Pain* ; Bed Rest ; Busan ; Child* ; Diagnosis ; Female ; Gyeongsangnam-do ; Humans ; Hypnotics and Sedatives ; Incidence ; Male ; Medical Records ; Post-Dural Puncture Headache ; Punctures* ; Retrospective Studies ; Risk Factors ; Spinal Puncture

Endometrial cancer is the most common malignancy of the female genital tract. The cancer spreads by direct extension, transtubal dissemination, lymphatic dissemination, and/or by hematogenous spread, usually results in lung metastasis, but may less commonly involve liver, brain, and bone. Here, we describe a patient with stage IA endometrial cancer who developed liver recurrence 17 months after surgery.
Brain ; Endometrial Neoplasms ; Female ; Humans ; Liver ; Lung ; Neoplasm Metastasis ; Recurrence