PURPOSE: The aim of this study was to evaluate the efficacy and safety of levetiracetam in children younger than 4 years with intractable epilepsy. METHODS: A retrospective analysis of pediatric epilepsy patients was performed. Data were obtained from the medical records of 30 patients (male 19, female 11) with intractable epilepsy, who were treated with levetiracetam. RESULTS: Seizure types were partial in 18, and generalized in 12. Fifteen patients had symptomatic etiologies. The median age of the patients at the time of levetiracetam administration was 26 months old (range: 4-47 months). The median starting dose was 13 mg/kg/ day, and the median maintenance dose was 52 mg/kg/day (range: 10-123 mg/kg/day). Ten (10/30, 33%) patients experienced more than 50% reduction in seizure frequency, and 4 (4/30, 13%) partial epilepsy patients became seizure-free. Eight partial epilepsy patients (44%) had more than 50% seizure reduction, while 2 patients (17%) with generalized epilepsy did. All of patients with infantile spasms and Lennox-Gastaut syndrome except one, had less than 50% reduction in seizure frequency. Adverse events reported in 8 patients (27%), included lethargy, behavioral problems, sleep disturbance, and seizure aggravation. CONCLUSIONS:Levetiracetam is effective in children aged 4 years or less with intractable epilepsy, and also seems to be safe to use in this age group.
Aged ; Anticonvulsants ; Child ; Child, Preschool ; Epilepsies, Partial ; Epilepsy ; Epilepsy, Generalized ; Female ; Humans ; Infant ; Infant, Newborn ; Intellectual Disability ; Lethargy ; Medical Records ; Piracetam ; Retrospective Studies ; Seizures ; Spasms, Infantile

A 29-year-old man with schizophrenia was admitted to the emergency department in a stupor following the first generalized tonicclonic seizure. He had drunk about 1.5 L of Coke and 2 L of water each day for 1 week without eating any other food. A laboratory evaluation revealed severe hyponatremia (110 mEq/L), and we diagnosed a hyponatremia-induced seizure. As polydipsia and hyponatremia are not uncommon in schizophrenics, hyponatremia-induced seizure should be included in the causes of seizure in schizophrenics.
Adult ; Coke ; Eating ; Emergency Service, Hospital ; Humans ; Hyponatremia ; Polydipsia* ; Schizophrenia ; Seizures* ; Stupor ; Water

PURPOSE: To identify cognitive effects of lamotrigine (LTG) compared with valproate (VPA) in epilepsy patients after 1 year of treatment. METHODS: Cognitive tests and subjective complaints of 22 patients with LTG monotherapy (50-200 mg/day) were retrospectively compared with those of 22 patients with VPA monotherapy (500-1300 mg/day) at 1 year of medication. RESULTS: LTG group did not show any significant difference in the performance of cognitive tests compared with VPA group. The incidence of cognitive complaints between two drugs were also not different. Both groups showed a better performance of list learning and Trail Making Test type A after antiepileptic drug medication. CONCLUSION: The impact of LTG and VPA monotherapy on cognitive functioning is similar. Both drugs may not be harmful or rather slightly beneficial for cognitive functions.
Cognition ; Epilepsy* ; Humans ; Incidence ; Learning ; Retrospective Studies ; Trail Making Test ; Valproic Acid*

BACKGROUND: Although stroke is one of the most frequent causes of seizures in adulthood, there has been constant controversy concerning risk factors and prognosis of poststroke seizures. This study was performed to investigate clinical manifestations, risk factors and prognosis in patients with poststroke seizures (PSS). METHODS: A total of 2048 patients with cerebral infarction were recruited for this study. Patients with PSS were reviewed retrospectively regarding stroke subtype, etiology, lesion location, and functional disability of the stroke as well as seizure types, treatment and recurrence rate. Patients with traumatic or hemorrhagic brain lesion or a history of previous seizures were excluded. RESULTS: PSS developed in 4.2% of ischemic stroke patients (85/2048; 46 men and 39 women, mean age 65.4 years). PSS developed within one week of stroke onset in 18.8% (16/85) whereas after one week in 81.2% (69/85). PSS was more common in patients with cortical lesions than subcortical lesions (15.1% and 0.8%; p=0.076). Status epilepticus more frequently manifested in early onset seizures compared to late onset seizures (31.3% and 10.1%; p=0.029). Seizure recurrence was observed in 44.3% of PSS patients, mostly due to poor compliance to treatment or due to inadequate drug treatment. Only 7.1% of PSS patients were drug resistant and all of these patients had late onset seizures. CONCLUSION: Seizures after ischemic infarction developed more commonly after one week of stroke onset, and in patients with cortical lesions. Seizure recurrence occurred in about half of the patients, and the rate of drug resistance was higher in late onset seizures.
Brain ; Cerebral Infarction* ; Compliance ; Drug Resistance ; Female ; Humans ; Infarction ; Male ; Prognosis* ; Recurrence ; Retrospective Studies ; Risk Factors ; Seizures* ; Status Epilepticus ; Stroke

PURPOSE: The majority of patients with idiopathic generalized epilepsy (IGE) are controlled by an antiepileptic drug when appropriately selected. So far, valproate is regarded as the first-line treatment for IGE. Also, it is postulated that lamotrigine and topiramate may have efficacy in IGE but there are a few evidence to support the usage. We examined the remission rates of seizures on valproate, lamotrigine, topiramate and factors predicting the outcome. METHODS: We reviewed the patients who diagnosed as IGE in pediatric neurology clinics in Asan Medical Center from March, 1995 to August, 2005. The patients with childhood absence epilepsy and patients without generalized spike and slow waves in EEG were excluded. Data were collected retrospectively on demographics, seizure types, antiepileptic drug treatment details, and remission rates. RESULTS: 64 of 80 patients had achieved one year period of remission by monotherapy with following drugs: Valproate (73.7% of 38 patients), lamotrigine (72.4% of 29 patients) or topiramate (83.3% of 18 patients). Among patients who failed to achieve remission by monotherapy, the combination of the drugs showed a remission rate of 72.7% (8/11 patients). Factors such as age, sex, family history, and history of febrile convulsions did not affect the remission rates. The existence of photoparoxysmal responses or focal epileptiform discharges, and syndrome diagnoses also couldn't be the predictive factors as well. CONCLUSIONS: As in adult patients with IGE, topiramate and lamotrigine as well as valproate can be used as the most effective anti-epileptic drugs in children with IGE without significant side effect.
Adult ; Child ; Chungcheongnam-do ; Demography ; Diagnosis ; Electroencephalography ; Epilepsy, Absence ; Epilepsy, Generalized* ; Humans ; Immunoglobulin E ; Neurology ; Retrospective Studies ; Seizures ; Seizures, Febrile ; Valproic Acid*

PURPOSE: Children with epilepsy tend to experience more emotional problems compared with healthy controls. The objective of this study was to elucidate the clinical factors influencing the quality of life in children and adolescents with epilepsy. We also evaluated preliminary findings concerning relationships between family factors and child emotional problems. METHODS: Subjects were 90 epilepsy patients aged between 6 and 17 years (mean 12.2+/-3.3 years) and their parents. Parents filled up the Impact of Childhood Illness Scale (ICIS). We compared the differences across patient groups according to the clinical factors such as seizure frequency, epilepsy types and duration, mono- or polytherapy, etc. RESULTS: ICIS subscore for treatment was higher when patients took more than one antiepileptic drugs (p=0.032), and when they still had poor seizure control (p=0.054) by regression analysis. Subscores for treatment, children, parents, and family were analyzed in each clinical factor. CONCLUSION: Epilepsy patients in childhood and adolescent ages have significant impacts on their quality of life and as well as on the family if they are on polytherapy or have poorly controlled seizures.
Adolescent* ; Anticonvulsants ; Child* ; Epilepsy* ; Humans ; Parents ; Quality of Life* ; Seizures

PURPOSE: The routine electroencephalography is a pivotal diagnostic study in the evaluation of patients with seizure disorders, but often proves incomplete. Video-Electroencephalographic Monitoring (VEM) is an important diagnostic innovation for intractable epilepsy. We performed this study to evaluate clinical indications and efficacies of VEM in childhood epilepsy. METHODS: The study group consisted of 231 children under the age of 15 year, admitted to the Asan Medical Center for VEM from November 1995 to February 2005. We classified the group on the basis of reasons for admission and did analyze the EEG, the change of diagnosis, treatment modality, and seizure control. RESULTS: Eighty seven (38%) patients underwent VEM for the exact classification of seizure types in patients who have epilepsy (Group I), 95 (41%) for presurgical evaluation (Group II) and 49 (21%) to confirm the diagnosis of a seizure disorder (Group III). The diagnosis was altered after VEM in 111 (48%) cases. The treatment modality was altered after VEM in 161 (70%) patients. In Group I, 53 (61%) had a changed treatment plan, 32 of whom had changes in antiepileptic drug and 7 underwent ketogenic diet. In Group II the treatment modality was changed in 82 (86%) cases, 68 of whom had done epileptic surgery and 6 had done VNS. In Group III, 26 (53%) changed the treatment modality. After VEM study, eventually 149 (65%) patients received changed modality of treatment and 91 (61%) patients of them showed improvement in the seizure control. CONCLUSIONS: VEM showed a high yield in changing diagnosis and management of childhood epilepsy in our study, and we confirmed it is effectively used in the treatment of the intractable childhood epilepsy.
Child ; Chungcheongnam-do ; Classification ; Diagnosis* ; Electroencephalography ; Epilepsy* ; Humans ; Ketogenic Diet ; Seizures

INTRODUCTION: Magnetic resonance imaging has demonstrated reversible peri-ictal MRI changes suggestive of hemodynamic changes or cytotoxic edema. We were to investigate the dynamic peri-ictal MRI changes in patients with seizures. METHODS: We retrospectively reviewed the medical records, electroencephalography, and initial and follow-up MRI of 5 patients with single seizure or status epilepticus. We analyzed the patterns and locations of MRI abnormalities and their relationship with characteristics of seizures. RESULTS: Two patients with complex partial seizures (CPS) and versive or unilateral tonic seizures showed high signal changes in frontal cortex on T2-weighted (T2WI), fluid attenuated inversion recovery (FLAIR) and DWI. Three patients had MRI changes in mesial temporal structures including hippocampus after single generalized tonic-clinic seizure without encephalitic features clinically. One patient had multiple signal abnormalities in the left temporo-parietal, mesial temporal, insular cortices and thalamus on T2WI and FLAIR after frequent CPS. All of the lesions disappeared or resolved partially on the follow-up MRI. CONCLUSION: Our results showed that variable MRI changes in peri-ictal phase are possible at cortical as well as at subcortical areas. The dynamic MRI changes can be associated even in patients with single clinical seizure, suggesting that these changes are not related to the seizure frequency.
Edema ; Electroencephalography ; Epilepsy ; Follow-Up Studies ; Hemodynamics ; Hippocampus ; Humans ; Magnetic Resonance Imaging* ; Medical Records ; Retrospective Studies ; Seizures* ; Status Epilepticus ; Thalamus

OBJECTIVE: Using functional magnetic resonance imaging, cerebral language areas were determined during a series of language tasks in normal strong right-handed subjects. METHODS: Twelve normal right-handed volunteers were examined on a 1.5T MR unit. Language task paradigms included two phonological tasks involving meaningless letters and sentences, and four semantic tasks using different types of words. Each language task was examined using a separate scan consisted of three blocks separated by rest periods. BOLD (blood oxygenation level dependent) signals during language tasks were compared using 24 sec alternating rest periods during which subjects concentrated on a plus symbol. After preprocessing and statistically analyzing individual data, group analysis (p<0.001, k=50) was performed using SPM99 software. RESULTS: Meaningless letter reading was more efficient than sentence reading, in terms of delineating brain regions related to phonological processing, we found significant regions in the left inferior frontal gyrus (IFG), left thalamus, bilateral cingulate gyri, right anterior superior temporal gyrus (STG), right IFG, and left inferior parietal lobule (IPL). During semantic tasks, left IFG, left posterior middle temporal gyrus, left IPL, bilateral medial frontal gyrus, right posterior STG, right parahippocampal, and fusiform gyri were found to be activated. CONCLUSION: During the two phonological tasks, normal strongly right-handed people more actively used the left IFG, right anterior temporal lobe, and right IFG than during semantic processing, whereas during the four semantic tasks, these subjects more actively used the bilateral posterior temporal and right medial temporal lobes.
Brain ; Magnetic Resonance Imaging* ; Oxygen ; Rabeprazole ; Semantics* ; Temporal Lobe ; Thalamus ; Volunteers

PURPOSE: To evaluate the cerebral hemodynamic changes during interictal period in patients with epilepsy, we investigated changes in cerebral blood flow velocities by transcranial Doppler sonography (TCD). METHODS: Blood flow velocities and pulsatility indecies were measured in both anterior cerebral arteries, middle cerebral arteries, posterior cerebral arteries, internal carotid arteries, and basilar artery using TCD in 21 patients with epilepsy and 21 age and sex matched normal adults. We also evaluated the effects of seizure type, seizure frequency, EEG findings, and anticonvulsant medication on cerebral blood flow velocities. RESULTS: The blood flow velocities of cerebral arteries were decreased in patients, but the pulsatility indecies weren't different. Cerebral blood flow velocities were influenced by seizure type, EEG findings, or anticonvulsant medication. CONCLUSION: Our study demonstrates that cerebral blood flow velocities might be decreased during interictal period in patients with epilepsy, and suggests that TCD is an useful method for the investigation of the cerebral hemodynamic changes in epilepsy.
Adult ; Anterior Cerebral Artery ; Basilar Artery ; Blood Flow Velocity ; Carotid Artery, Internal ; Cerebral Arteries ; Electroencephalography ; Epilepsy* ; Hemodynamics ; Humans ; Middle Cerebral Artery ; Posterior Cerebral Artery ; Seizures ; Ultrasonography, Doppler, Transcranial