Parkinsonism is a very rare complication of phenytoin. The authors experienced a 71-year-old man who presented progressive cognitive decline, postural tremor, bradykinesia and gait disturbance. Laboratory test and brain imaging revealed no abnormality that commonly causes parkinsonism. The only abnormal finding was elevation of serum phenytoin above the therapeutic level. The patient showed marked improvement of symptoms by reduction of phenytoin dosage. Here we report a case of phenytoin induced parkinsonism.
Aged ; Gait ; Humans ; Hypokinesia ; Neuroimaging ; Parkinsonian Disorders ; Phenytoin ; Tremor

Peripheral neuropathy is rarely caused by antiepileptic drugs andmost cases were reported about phenytoin. Here we report carbamazepine- induced peripheral neuropathy, which is a very rare condition and the pathogenesis is not well understood. A 19-year-old man presented with a several-year history of bilateral foot pain and pes planus. He had craniopharyngioma and underwent neurosurgery in 1997 and 2007. He had been prescribed by the general dose (600 mg/day) of carbamazepine since 1998 for the treatment of postoperative epilepsy. His muscle power was normal in all limbs and there were no abnormal sensory symptom and sign. Findings of electrodiagnostic studies were compatible with sensorimotor polyneuropathy with mixed axonotmesis and demyelination. His family history and genetic diagnosis excluded the possibility of hereditary neuropathy. After dose reduction of carbamazepine, his bilateral foot pain has been improved slowly. We report a case of carbamazepine-induced peripheral neuropathy.
Anticonvulsants ; Carbamazepine ; Craniopharyngioma ; Demyelinating Diseases ; Epilepsy ; Extremities ; Flatfoot ; Foot ; Humans ; Muscles ; Neurosurgery ; Peripheral Nervous System Diseases ; Phenytoin ; Polyneuropathies ; Young Adult

Localization of epileptogenic zone in central epilepsy is difficult because of extent and rapidity of ictal spread. Epilepsy surgery in central region is challenging because of the risk of sensorimotor deficitsrelated to excision of eloquent areas. We present a case of 27- year-old woman with a successful surgical treatment for intractable epilepsy from the central region.
Epilepsy ; Female ; Humans

We report a monozygotic twins with temporal lobe epilepsy, almost concordant in the onset time of firt seizure, lateralization and localization of epileptiform discharges. Partial seizures with secondarily generalized seizure occurred 15 days apart. EEG showed frequent spike-slow wave complexes on the right temporal area but the findings of brain MRI were normal in both. Past medical, delivery, developmental and family history were unremarkable. They had no physical and mental handicaps, and any other underlying causes of epilepsy. They have been on monotherapy with seizure free, although follow up EEG showed frequent spike-slow wave complexes after medication. As seizures developed simultaneously, the localization and lateralization of epileptiform discharges were concordant in our monozygotic twins, we suggest that genetic factor might be the most probable etiology of epilepsy in our cases but needs to be elucidated.
Brain ; Electroencephalography ; Epilepsy ; Epilepsy, Temporal Lobe ; Follow-Up Studies ; Humans ; Seizures ; Temporal Lobe ; Twins, Monozygotic

Cefepime is a widely used beta-lactam antibiotic. We first report two cases of cefepime-induced reversible encephalpathy in Korea. Two patients with renal impairment presented stupor while being treated with cefepime for pneumonia, one of whom also developed myoclonus and asterixis. Their electroencephalogram showed triphasic waves despite of normal liver function. After discontinuation of cefepime, they completely recovered with normalization of electroencephalogram. Early recognition of cefepime-induced encephalopathy and immediate withdrawal of cefepime would be important for the prognosis of the patients.
Cephalosporins ; Dyskinesias ; Electroencephalography ; Humans ; Korea ; Liver ; Myoclonus ; Pneumonia ; Prognosis ; Stupor

Different types of aphasia resulting from stroke, as well as their anatomical correlates, are well characterized. In contrast, the literature on ictal aphasia is relatively scant. A 58-year-old woman had 4 times of transient motor aphasia. No other behavioral abnormalities and focal sensorimotor neurological deficits were revealed. Brain MRI showed a small meningioma at the left sphenoid ridge. Electroencephalogram showed occasional sharp waves on the left inferior frontal area. We report a rare case of ictal aphasia associated with meningioma.
Aphasia ; Aphasia, Broca ; Brain ; Electroencephalography ; Female ; Humans ; Meningioma ; Middle Aged ; Stroke

PURPOSE: Alcohol related seizures (ARS) are common problems in community. We reviewed the clinical characteristics of ARS in chronic alcoholics and evaluated the predictors of delirium tremens and recurrence of seizures. METHODS: We thoroughly reviewed all medical records of patients with alcohol related seizures at admission and some outpatient records for follow-up data. For the patients who had been lost during follow-up, telephone interviews were performed. We described the clinical characteristics of ARS during admission and analyzed the correlation between initial findings of ARS. RESULTS: Forty eight patients with ARS were admitted and followup data were available in 33 patients by out-patient records or telephone interviews. Forty-four patients were male and the mean age was 47.4+/-10.4 years old. Nine out of 33 patients became completely abstinent after discharge. Ten out of 24 current drinkers developed recurrent seizures and 20 out of 48 patients developed delirium tremens (DT) during admission. The number of seizures and age ofpatients were significantly related with DT. Patients with much weekly- consumption of alcohol were prone to develop recurrent seizures. CONCLUSIONS:These results suggest that careful attention should be paid to the patients with older age and multiple seizures at each event about the development of DT and to the patients with much weekly-consumption of alcohol about the recurrence of seizures during follow-up.
Alcohol Withdrawal Delirium ; Alcoholics ; Follow-Up Studies ; Humans ; Interviews as Topic ; Male ; Medical Records ; Outpatients ; Recurrence ; Seizures

The definition of refractory status epilepticus (RSE) is the state of epilepticus that persists for longer than 60 minutes despite an adequate dose of benzodiazepine and an antiepileptic drug. Topiramate is a broad-spectrum antiepileptic drug used as a monotherapy as well as an adjunctive therapy in the treatment of epilepsy. We encountered a 32-month-old girl with RSE, who showed spastic quadriplegia, hydrocephalus and a previous history of 3 times recurrence of status epilepticus in the presence of global development. Although the girl was treated with lorazepam, phenytoin, phenobarbital and even with midazolam, seizure lasted for more than 60 minutes. Through pentobarbital coma, seizure was controlled clinically on the state of EEG. However, it recurred. Therefore, the patient was treated with an overdose amount of topiramate (10 mg/kg/day) by nasogastric tube without titration as an add-on therapy and then treated with a reduced amount of topiramate (4 mg/kg/day). Finally, the seizure became controlled.
Benzodiazepines ; Child, Preschool ; Coma ; Electroencephalography ; Epilepsy ; Female ; Humans ; Hydrocephalus ; Lorazepam ; Midazolam ; Pentobarbital ; Phenobarbital ; Phenytoin ; Quadriplegia ; Recurrence ; Seizures ; Status Epilepticus*

Insulinoma with hyperproinsulinemia and normal serum insulin level is a rare disease. Because of the neuroglycopenic symptoms, the initial diagnosis tends to be made as epilepsy or as psychosis. A 43-year-old man was admitted to our hospital because of recurrent confusional episodes. Symptoms are intermittent and consist of staring, confusion, amnesia, and bizarre behavior. Vital signs during the episode were normal but the serum glucose level was 27 mg/dl. The serum level of insulin during the episode was lower than normal and those of proinsulin and growth hormone were higher than normal. Solitary pancreatic mass was found by abdominal CT, measuring 15 mm in diameter. Pathologic evaluation showed islet cell tumor. This suggests that the serum level of proinsulin should be checked when insulinoma with neuroglycopenic symptom is suspected.
Adenoma, Islet Cell ; Adult ; Amnesia ; Blood Glucose ; Diagnosis ; Epilepsy ; Growth Hormone ; Humans ; Insulin ; Insulinoma* ; Proinsulin ; Psychotic Disorders ; Rare Diseases ; Seizures* ; Tomography, X-Ray Computed ; Vital Signs

Idiopathic hypertrophic pachymeningitis is a clinical disorder caused by a localized or diffuse thickening of the dura mater, with an associated chronic inflammation. This can be diagnosed when there is no evidence of other etiologies such as trauma, infection, tumors, and Wegener's disease. Clinical manifestations are chronic headache with or without neurological manifestations such as cranial nerve palsies, cerebellar ataxia, neuro-ophthalmologic complications, and rarely clinical seizures. We described a patient with simple partial seizures with focal sensory and motor symptoms in the right hand as an initial and the only clinical manifestation, accompanied by a tumor-like lesion in the left parietal convexity on brain MRI. The patient underwent a lesionectomy, and the seizures have been well controlled so far without immunosuppressant treatment.
Brain ; Cerebellar Ataxia ; Cranial Nerve Diseases ; Dura Mater ; Epilepsies, Partial ; Hand ; Headache Disorders ; Humans ; Inflammation ; Magnetic Resonance Imaging ; Meningitis* ; Neurologic Manifestations ; Rabeprazole ; Seizures*