Valproic acid (VPA) is one of the most commonly used antiepileptic drug, but has many drug-drug interactions. A 58-year-old male under the vegetative state has been well controlled with valproic acid (VPA) monotherapy without seizure attacks during the last 6 months. Pneumonia developed and panipenem-betamipron (PAPM-BP) for acinetobacter baumannii was administered. Seizure attacks recurred after 12 days of initiating PAPM-BP. During the maintenance period of PAPM-BP, serum level of VPA was decreased. After the cessation of PAPM-BP, serum level of VPA increased to the previous level without further seizure attacks. PAPM-BP should be cautiously used together with VPA because of possible drug-drug interaction.
Acinetobacter baumannii ; Humans ; Male ; Middle Aged ; Persistent Vegetative State ; Pneumonia ; Recurrence* ; Seizures* ; Valproic Acid*

Posthypoxic myoclonus is poorly controlled with current treatments. Based on clinical experience, valproate and benzodiazepines have been used to treat myoclonic seizures. Rarely, some antiepileptic drugs may exacerbate myoclonic seizures. Although lamotrigine is controversial for treatment in myoclonic seizures, we experience a case of posthypoxic myoclonus improved with lamotrigine add-on therapy.
Anticonvulsants ; Benzodiazepines ; Myoclonus* ; Seizures ; Valproic Acid

Reversible splenial edema has been often reported in epilepsy patients. Clinical presentation is reported to be silent in general. We experienced a patient with splenial lesion and cognitive dysfunction. A 21-year-old man underwent video-EEG monitoring for preoperative evaluation. He had suffered from viral encephalitis eight years ago and developed chronic drug-resistant epilepsy. After antiepileptic drugs withdrawal, he developed eight episodes of secondarily generalized tonic-clonic seizures for several hours and some seizures were repeated without recovery of consciousness. Majority of ictal EEG onset presumed to originate from the left frontal region. After seizures he had shown disorientation and irritability with gradual recovery. Brain MRI demonstrated a splenial lesion. Though splenial lesion disappeared on follow-up MRI, neuropsychological test demonstrated frontal lobe dysfunction 6 months later compared with that performed just before the video-EEG monitoring. We report a patient with isolated reversible splenial lesion associated with long term dysfunction of frontal lobe.
Anticonvulsants ; Brain ; Consciousness ; Edema ; Electroencephalography ; Encephalitis, Viral ; Epilepsy ; Follow-Up Studies ; Frontal Lobe* ; Humans ; Magnetic Resonance Imaging ; Neuropsychological Tests ; Seizures ; Status Epilepticus* ; Young Adult

BACKGROUND: Clozapine is an "atypical" neuroleptic drug with low affinity at most dopamine receptors, and interact at several other classes of receptors. Although it has less adverse effects, clozapine has profound impact on EEG, and may cause seizures. We retrospectively reviewed medical records and EEGs in patients with clozapine to evaluate the prevalence and risk factors of EEG abnormalities and seizures. METHODS: 163 EEGs of 44 patients and their medical records were reviewed from Jan. 2000 to Jul. 2006. EEG was graded as follows: (0: Normal, 1: Less than 50% of theta waves, 2: More than 50% of theta or less than 50% of delta waves or grade 0/1 plus epileptic discharge, 3: More than 50% of delta waves or grade 2 plus epileptic discharge, and 4: Electroclinical seizure or marked low amplitude EEGs). Relation between the dosage of clozapine and EEG abnormalities, effect of anticonvulsant on seizure prevention were reviewed. RESULTS: Dosage of clozapine and EEG abnormality was closely related (P<.001). 82% (23/28) of the EEGs with less than 100 mg of clozapine were grade 0, whereas 8/83 (9.7%) EEGs were grade 0 with more than 400 mg of clozapine. Epileptic discharges were frequently found when clozapine dosage was 200 mg or more [27/130 EEGs (21%)]. Valproate administration did not prevent EEG deterioration in 4/13 patients as long as clozapine was increased. Although preventive treatment with valproate was done in 11 patients, seizures occurred in 2 patients. CONCLUSIONS: Abnormal EEGs were significantly correlated with dosage of clozapine. Efficacy of valproate can not be determined in the prevention of seizure induced by clozapine.
Clozapine* ; Electroencephalography* ; Humans ; Medical Records ; Prevalence ; Receptors, Dopamine ; Retrospective Studies ; Risk Factors ; Seizures ; Valproic Acid

PURPOSE: This study was aimed to investigate the psychiatric manifestations in children with epilepsy and the associations with seizure-related variables. METHODS: The Korean version of the Child Behavior Checklist (K-CBCL) and the ADHD Rating Scale (K-ARS) were used to assess the psychopathology of 78 children with epilepsy (39 boys, mean age: 9.8+/-3.26 years-old) and 78 healthy comparisons matched for age and sex. RESULTS: Compared with healthy comparisons, children with epilepsy showed differences in the social, school, total competence scale, withdrawn, somatic complaints, social problems, thought, attention problems, aggressive behavior, internalizing and externalizing problem, and total behavior problem scores in the K-CBCL. Significant differences in the social, school, total competence scale, withdrawn, social problems, attention, and total behavior problem scales were found between groups in clinical spectrum and nonclinical spectrum. The inattentive, hyperactive/impulsive, and total scores of the K-ARS between groups were significantly different. In addition, the total scores of the K-ARS between subjects in clinical spectrum and nonclinical spectrum were different. The more the number of antiepileptic drugs, the higher significance of the score for aggressive behavior, sex problem, somatic complaints in the K-CBCL, and the inattentive scales in the K-ARS. In addition, the withdrawn, anxious/depressed and somatic complaints in the K-CBCL were correlated with sex, onset age and seizure type, respectively. CONCLUSIONS: Children with epilepsy may experience more various and serious psychiatric problems than healthy children. Responsiveness to antiepileptic drugs and seizure itself can be risk factors of psychiatric manifestations in epileptic children.
Age of Onset ; Anticonvulsants ; Checklist ; Child Behavior ; Child* ; Epilepsy* ; Humans ; Mental Competency ; Psychopathology ; Risk Factors* ; Seizures* ; Sexual Behavior ; Social Problems ; Weights and Measures

BACKGROUND: Folic acid has been frequently used for hyperhomocyesteinemia in various diseases and decreases the level of homocysteine. OBJECTIVES: To assess the effect of folic acid in the level of homocysteine in epilepsy patients, and to analyze factors affecting its responsiveness and the difference of its efficacy according to methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism. METHODS: Total 75 epilepsy patients with antiepileptic drugs (AEDs) therapy were included. 41 patients had normal level of homocysteine and 34 patients with hyperhomocysteinemia (> or =12 micro mol/ ) were supplemented with folic acid for 1 year. Thirty-four patients with hyperhomocyteinemia were divided into two groups according to the responsiveness of homocysteine to folic acid; decrease group (DG) and non-decrease group (NDG). RESULTS: The level of homocysteine in patients with hyperhomocysteinemia was significantly decreased after administration of folic acid, comparing with patients with normal level. DG was younger and had more male gender, shorter duration of seizure, and initial higher homocysteine level, compared to NDG (p<0.05). Patients with mutant type of MTHFR (CT+TT) had more decreased homocysteine level after supplement of folic acid, but had more increased homocysteine level without supplement of folic acid. Comparing between MTHFR genotypes, TT type had the most decreased homocysteine level than others, but there was no significance. CONCLUSION: Folic acid is useful treatment of hyperhomocysteinemia in epilepsy patients and the supplement of folic acid might be considered in patients with mutant type of MTHFR regardless of homocysteine level. The effect of folic acid supplement is greater in younger age, male sex, shorter duration of seizure, and initial higher homocysteine level.
Anticonvulsants ; Epilepsy* ; Folic Acid* ; Genotype ; Homocysteine* ; Humans ; Hyperhomocysteinemia ; Male ; Methylenetetrahydrofolate Reductase (NADPH2) ; Seizures

PURPOSE: This prospective, open-label study evaluated the efficacy and safety of adjunctive levetiracetam (LEV) in Korean adults with uncontrolled partial epilepsy. METHODS: A total of 100 patients whose partial seizures were inadequately controlled on their current antiepileptic drugs were enrolled and received LEV (1000-3000 mg/day). Seizure count and adverse events (AEs) were recorded by patients. Global evaluation scale (GES) and quality of life (QOLIE-31) were also evaluated. Additionally effectiveness over 1-year follow-up was investigated. RESULTS: Ninety-two patients completed the short-term 16-week trial. The median percent reduction in weekly seizure frequency over the treatment period was 43.2%. The > or =50% and > or =75% responder rates were 45.4% and 36.1%, respectively. Seizure freedom was observed in 17 patients throughout the initial 16-week treatment period. On investigator's GES, 81 patients were considered improved, with 41 patients showing marked improvement. Most QOLIE-31 scales improved significantly. At the end of the trial, 79 chose to continue follow-up treatment with LEV. At the follow-up visit (ranging 60 to 81 weeks), 64 patients were still taking LEV; during the last 16 weeks, 65.6% of patients had > or =50% reduction, 50.0% had > or =75% reduction, and 35.9% had a 100% reduction. Seven patients showed continuous seizure freedom from the initiation of LEV treatment. During the entire treatment period, LEV was withdrawn in 36 patients; due to lack of efficacy in 22, AEs in six, both in three, other reasons in five. CONCLUSION: Adjunctive LEV therapy in patients with refractory partial epilepsy was effective and well-tolerated, as evidenced by the high seizure freedom and retention rates in both the short-term trial and the long-term follow-up.
Adult ; Anticonvulsants ; Epilepsies, Partial* ; Epilepsy ; Follow-Up Studies* ; Freedom ; Humans ; Prospective Studies ; Quality of Life ; Seizures ; Weights and Measures

PURPOSE: To investigate the regional and temporal patterns of Bcl-2, Bim, and caspase-3 expression in rat hippocampus after kainic acid (KA)-induced seizures, and to determine whether valproic acid (VA) has the neuroprotective effect on hippocampal apoptotic cell death. METHODS: Thirty five male Sprague-Dawley rats were used. KA (20 mg/kg) was injected once intraperitoneally in the experimental group, and 15 rats were immediately treated with repeated subcutaneous injections of VA. The brain was extracted at 4, 24, and 72 hours after KA injection. Immunohistochemical staining was conducted to assess the degree of Bcl-2, Bim, and caspase-3 expression at each hippocampal region. To investigate the effect of VA on apoptotic cell death, the expression degrees of Bcl-2, Bim, and caspase-3 were compared. RESULTS: Bcl-2 expression started to increase 4 hours after KA injection at CA3 and CA4 regions, and lasted up to 72 hours. Bim expression was increased at CA2 and CA3 regions 4 and 24 hours after KA injection. Caspase-3 expression was increased at all regions of hippocampus 4 hours after the injection, and lasted up to 72 hours. The expressions of Bcl-2, Bim, and caspase-3 were not different between KA-injected group and KA and VA-injected group. CONCLUSION: Although the present study was unable to confirm the neuroprotective effect of VA on KA-induced apoptotic cell death, this study showed that KA-induced seizures increased the expression of Bcl-2, Bim, and caspase-3. These results suggest that apoptotic cell death mechanism, such as the activation of cell death-regulating proteins Bcl-2, Bim, and caspase-3, involves in the KA-induced neuronal death.
Animals ; Brain ; Caspase 3* ; Cell Death ; Hippocampus* ; Humans ; Injections, Subcutaneous ; Kainic Acid ; Male ; Neurons ; Neuroprotective Agents ; Rats* ; Rats, Sprague-Dawley ; Seizures* ; Valproic Acid*

BACKGROUND: The internet has a great amount of medical information for patients, but because no standards exist regarding the publication of medical literature on the internet, the quality of the internet information is quite variable. The purpose of our study was to assess the content and ethics of information on epilepsy, which is available on the Korean internet. METHODS: The search word "epilepsy" or "seizure" was entered into the five most commonly utilized Korean internet search engines. The web sites were divided into the higher or lower rank site on the basis of popularity ranking, and then evaluated by using both ethic and content value scales. The comparison between two groups was analyzed. RESULTS: Twenty eight epilepsy web sites were identified and divided into two equal groups. The average scores of ethic and content value scales were below half of the total score in the higher rank group as well as the lower. The score of higher rank group was not different statistically to that of lower rank group in both value scales. In addition, the score in the epilepsy specialists group was not higher than that in the non-specialists as well. DISCUSSION: The internet is easily accessible source of medical information including epilepsy. Moreover, because lots of epileptic patients are using the web for obtaining the information, the web information should be standardized. The results of our study show that clinicians should not recommend the epilepsy web site as a source of information for epileptic patients unless the epilepsy websites have been evaluated and assessed.
Epilepsy ; Ethics ; Humans ; Internet ; Publications ; Search Engine ; Specialization ; Weights and Measures

Magnetoencephalography (MEG) and magnetic source imaging (MSI) are becoming increasingly important modalities in the functional neuroimaging of children. MEG is the magnetic equivalent of electroencephalography (EEG) and is thus capable of noninvasively characterizing neuronal activity on a millisecond time scale. MSI combines this functional information provided by MEG with the high anatomic detail of conventional magnetic resonance imagings. Considerable effort is placed on analyzing the configuration and number of spike waves by MEG that relate to a primary epileptiform discharge. Such MEG spike clusters are corroborated now by intraoperative invasive subdural grid monitoring that show good correlation in the majority of cases. Another important role of MEG relates to the mapping of critical regions of brain function using known paradigms for speech, motor, sensory, visual, and auditory brain cortex. In this review, I would introduce the background of MEG, data acquisition and analysis, and clinical application of MEG in children with epilepsy.
Brain ; Child* ; Electroencephalography ; Epilepsy ; Functional Neuroimaging ; Humans ; Magnetoencephalography* ; Neurons