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

Methyl bromide is presently used as a fumigant for insects in soil, grains or fruit in storage or transport. It is a neurotoxic agent and has been responsible a number of deaths or acute poisonings among occupationally exposed persons. We report 2 patients, who had worked fumigation warehouse, presented with seizures and altered mental state. The serum concentrations of bromide were elevated 32.9 and 42.5 mg/l, respectively. Brain MRI showed bilateral symmetric high signal intensities in the splenium of corpus callosum, the globus pallidus, the quadrigeminal plate, the periaqueductal gray matter, the red nucleus, the substantia nigra, the medial lemniscus, the pontine tegmentum, the dentate nucleus, and the medulla. There was no brain lesion in the other patient. Appropriate and supervised handling of the chemical and regular education to workers are important to avoid the risk of methyl bromide poisoning.
Brain ; Edible Grain ; Cerebellar Nuclei ; Corpus Callosum ; Education ; Fruit ; Fumigation ; Globus Pallidus ; Humans ; Insects ; Magnetic Resonance Imaging ; Occupations ; Periaqueductal Gray ; Poisoning ; Red Nucleus ; Seizures* ; Soil ; Substantia Nigra ; Tectum Mesencephali

PURPOSE: This study is to evaluate the efficacy and safety of vagus nerve stimulation (VNS) in intractable childhood onset epilepsy by reviewing our experiences. MEHTHOD: Involved in the study are five patients who underwent VNS from July 23th, 1999 and had been followed up over 12 months. We reviewed data prospectively collected with a focus on clinical features, therapeutic outcomes and safety, developmental progress, and EEG findings. RESULTS: Three patients were classified as Lennox-Gastaut syndrome. One patient of the two remaining patients had gelastic seizure caused by hypothalamic harmatoma, while the other patient had partial seizure with secondary generalization. Among the 5 patients, one patient showed a seizure frequency reduction rate of about 50% from baseline in 3 months after VNS implantation and more than 90% in 12 months, 2 patients of about 50% in 3 months and of about 75% in 12 months, but the other two patients didn't show any change in seizure frequency. Side effects such as hoarseness, dyspnea during sleep and wound infection could be controlled simply through the adjustment of output current or wound revision. However, efficacy in cognitive function and EEG findings was not satisfactory. CONCLUSIONS: VNS might be an effective adjunctive therapy for intractable childhood epilepsy and transient side effects can be controlled without discontinuation of VNS therapy.
Dyspnea ; Electroencephalography ; Epilepsy* ; Generalization (Psychology) ; Hoarseness ; Humans ; Prospective Studies ; Seizures ; Vagus Nerve Stimulation* ; Vagus Nerve* ; Wound Infection ; Wounds and Injuries

PURPOSE: To compare the reliability of lateralization between seizure semiology and ictal scalp EEG findings in mesial temporal lobe epilepsy (MTLE) patients, and to examine the advantage of the combined use of these two methods. METHODS: We independently reviewed the ictal scalp EEG recordings and clinical seizure semiology of 243 seizures recorded in 58 consecutive MTLE patients. All patients were seizure-free for at least 1 year postoperatively. Each seizure was lateralized on the basis of ictal semiology and ictal scalp EEG patterns according to strictly defined criteria, respectively. Individual patients were also lateralized based on these data. RESULTS: Seizure semiology analysis lateralized 64.6 % of seizures and 82.8 % of patients. Ictal scalp EEG analysis lateralized 74.5% of seizures and 74.1% of patients. Combination of the information from the two methods allowed for lateralization in a greater portion of both seizures (79.8%) and patients (89.7%). CONCLUSION: This study suggests that combination of ictal scalp EEG findings and seizure semiology improves the lateralization of individual seizures and patients. Therefore, it is worth lateralizing with standardized combined ictal EEG and semiology analysis for noninvasive presurgical evaluation in TLE patients.
Electroencephalography* ; Epilepsy, Temporal Lobe* ; Humans ; Scalp* ; Seizures* ; Temporal Lobe*