Although oxcarbazepine (OXC)-induced hyponatremia is usually asymptomatic, it can lead to serious complications. We reports two cases of symptomatic hyponatremia induced by OXC. First case was 39-year-old female with partial epilepsy who developed the exceeding tiredness, headache, and seizures under OXC with a serum sodium level of 121 mEq/L. After the discontinuation of OXC, serum sodium was normalized and the clinical symptoms disappeared. Second case was 48-year-old female with partial epilepsy who complained of the fluctuating tiredness and fatigability, and then eventually developed seizures after OXC was increased in dosage. At that time, serum sodium was 121 mEq/L. She remained asymptomatic with normal level of serum sodium even if OXC was maintained with topiramate. Our cases may suggest that symptomatic hyponatremia is not rare unlike the results from previous studies. Therefore, clinician should be alert to mild symptoms such as headache, lethargy, and tiredness in patients treated with OXC.
Adult ; Epilepsies, Partial ; Female ; Headache ; Humans ; Hyponatremia* ; Lethargy ; Middle Aged ; Seizures ; Sodium

No abstract available.
Electroencephalography*

Radiation-induced neuropathy is a rare but well recognized clinical entity although peripheral nerves are considered to be relatively resistant to irradiation. We report three patients with radiation-induced lumbosacral plexopathy, whose characteristic clinical and electrophysiological features can be summarized as follows: 1) 55-58 year old women who were previously treated with radiotherapy for uterine cervix carcinoma: 2) the latent period is to 10 from 13 years: 3)predominantly motor involvement with slowly progressive paraparesis, asymmetrical onset and worse in distal muscle group: 4) painless at onset, with variable degree of sensorv changes: 5)decreased or absent knee and ankle jerks :6)axonal damage in electrophysiologic study: 7)frequent myokymic discharges. Myokymic discharges occur in bursts at regular rate of 0.1 to 8 Hz. In myokymic bursts with more spikes, interburst interval is longer but interspike Interval is shorter.
Ankle ; Cervix Uteri ; Female ; Humans ; Knee ; Paraparesis ; Peripheral Nerves ; Radiotherapy

Kleine-Levin syndrome (KLS) is characterized by recurring episodes of hypersomnia, megaphagia, and abnormal behavior. We report two cases of KLS. Two boys, aged 18 (case 1) and 17 (case 2), had recurrent episodes of hyper-somnolence with compulsive eating or drinking and hypersexuality for several years. HLA-DR typing was HLA-DR3 and 13 in case 1 and HLA-DR4 and 10 in case 2. Case 1 showed hypersomnia with early onset of REM sleep on MSLT and frequent frontal intermittent rhythmic delta activity on EEG. Both cases showed no abnormalities on brain MRI. HLA-DR typing facilitates differentiation between KLS and narcolepsy by the absence of HLA-DR2.
Brain ; Disorders of Excessive Somnolence ; Drinking ; Eating ; Electroencephalography ; HLA-DR Antigens ; HLA-DR2 Antigen ; HLA-DR3 Antigen ; HLA-DR4 Antigen ; Kleine-Levin Syndrome* ; Magnetic Resonance Imaging ; Narcolepsy ; Sleep, REM

Although there are some reports of neuromyelitis optica or Guillain-Barre syndrome in patients with tuberculosis, the combined peripheral and central demyelination associated with tuberculosis has not yet been reported. We report a 43 year-old man with active pulmonary tuberculosis presenting with Guillain-Barre syndrome, bilateral optic neuritis, and multiple central nervous system white matter lesions on MRI. Our case suggests that tuberculosis may be associated with the combined peripheral and central demyelination.
Adult ; Central Nervous System ; Demyelinating Diseases* ; Guillain-Barre Syndrome ; Humans ; Magnetic Resonance Imaging ; Neuromyelitis Optica ; Optic Neuritis ; Tuberculosis ; Tuberculosis, Pulmonary*

A physician faced with a patient who has an episodic disorder should determine whether the episode in question is indeed a seizure in the first place. If so, he or she should characterize its pattern and other characteristics, and finally, should delineate the underlying cause. Epilepsy is primarily a diagnosis based on a history and the initial assessment is based largely on the clinical history, especially on an accurate description of the event in question. The EEG, MRI, and routine blood tests should be included in the initial diagnostic workup. The EEG is undoubtedly the most sensitive, indeed indispensable, tool for the diagnosis of epilepsy, however, it must be used in conjunction with clinical data. A proportion of epileptic patients have a perfectly normal interictal EEG. Furthermore, a small number of healthy persons show paroxysmal EEG abnormalities. MRI is the most important diagnostic tool for the detection of structural abnormalities underlying epilepsy. Some patients may later need protracted video-EEG monitoring for the diagnosis of epilepsy. The conditions most likely to simulate a seizure are syncope and transient ischemic attacks. There is a rise in serum creatine kinase and serum prolactin levels after the seizure, which findings could be used in emergency room to assist in distinguishing seizures from syncope or pseudo-seizures.
Creatine Kinase ; Diagnosis* ; Electroencephalography ; Emergency Service, Hospital ; Epilepsy* ; Hematologic Tests ; Humans ; Ischemic Attack, Transient ; Magnetic Resonance Imaging ; Prolactin ; Seizures ; Syncope

Transient conduction block and its sequential changes have been rarely reported in human vasculitic neuropathy We performed serial nerve conduction studies during initial stage of nerve infarction in a patient with Churg-Strauss syndrome, who had acute ulnar nerve palsy 2 days before admission. At second day after the ulnar nerve palsy, the motor conduction block was detected in the segment between 12.5cm and 15cm above the ulnar groove; the amplitude of the compound muscle action potentials (CMAP) obtained with stimulation at 12 5cm above the ulnar groove was 7.4mV and that at 15cm was 0. 6mV. At fifth day, the motor conduction block disappeared and the amplitude of the CMAP obtained with stimulation at the site just distal to that segment reduced to 0. 6mV. The amplitude of the compound nerve action potentials (CNAP) of the finger-wrist segment was normal at admission but became unevokable at eighth day. The CNAP of the mixed nerve of the wrist-toelbow segment also gradually decreased and became similar with the amplitude of the wrist-to-axilla segment at twelfth day. These findings suggest that transient conduction block may be present in the metal stage of vasculitic neuropathy and that CMAP become unevokable earlier than CNAP.
Action Potentials ; Churg-Strauss Syndrome* ; Humans ; Infarction ; Neural Conduction ; Ulnar Neuropathies

We report a case of non-traumatic rhabdomyolysis after overdose of doxylamine succinate. A 22-year-old woman with reactive depression had an overdose of doxylamine with suicidal intent. She had decreased mental state, confusion, convulsion, vomiting, tachycardia, pupil dilatation, and ocular flutter. Serum creatine phosphokinase concentra-tion was 6,752 IU/L initially, increased to maximum (165,590 IU/L) at the third day, and then rapidly decreased and returned to normal 2 weeks after intoxication. Acute renal failure occurred but was resolved without hemodialysis. Rhabdomyolysis associated with renal failure is a rare but serious complication after doxylamine overdose.
Acute Kidney Injury ; Adjustment Disorders ; Creatine Kinase ; Dilatation ; Doxylamine* ; Female ; Humans ; Pupil ; Renal Dialysis ; Renal Insufficiency ; Rhabdomyolysis* ; Seizures ; Succinic Acid ; Tachycardia ; Vomiting ; Young Adult

Periodic alternating nystagmus is a rare form of horizontal jerk nystagmus characterized by a periodical reversal in the direction of nystagmus. It implies a cerebellar disorder or lesions involving the vestibulocerebellar connections. We report a patient with an acquired form of periodic alternating nystagmus associated with meningoencephalitis. Its waveform characteristics were demonstrated by a video-nystagmogram. The brainstem lesions in our patient were thought to be responsible for her nystagmus.
Baclofen ; Brain Stem ; Cerebellar Diseases ; Humans ; Meningoencephalitis ; Nystagmus, Pathologic*

People with epilepsy are at increased risk of cognitive impairment as a result of multiple factors:the underlying etiology of epilepsy, the effects of seizures themselves, and the central nervous system effects of antiepileptic drugs (AEDs). Cognitive effects of AEDs are of special concern because AEDs are the major therapeutic modality for seizures. All commonly used AEDs have some effect on cognitive function. The risk of AEDs cognitive adverse effects is increased with polypharmacy and at higher dosages and higher AED blood levels. Also children and the elderly are especially vulnerable to adverse effects on cognition. The most common AED cognitive effects include psychomotor slowing, reduced vigilance, and impairments in memory. This review focuses on studies of the cognitive effects of the new AEDs, and in particular on studies that compare cognitive effects of the old and new drugs. The available evidence is insufficient to support definite conclusions about the cognitive effects of the new AEDs. Neuropsychological testing has been the major method of objectively examining cognitive function related to the use of AEDs but a number of methodological problems blur the results. However, some of the new AEDs appear to produce fewer adverse cognitive effects than the old AEDs. Lamotrigine, for which a relatively large number of studies are available, has demonstrated a favorable cognitive profile overall, both in volunteers and in patients with epilepsy. Oxcarbazepine appears not to affect cognitive function in healthy volunteers or adults with newly diagnosed epilepsy. Gabapentin, tiagabine, and vigabatrin also have shown few cognitive effects compared with placebo. Although dose and titration speed may be confounding factors in some of the studies of topiramate, there is clear evidence that this agent does affect cognitive function, with specific effects on attention and verbal function. Additional studies are needed to delineate fully the relative effects of all the new AEDs to each other and to the older AEDs.
Adult ; Aged ; Anticonvulsants* ; Central Nervous System ; Child ; Cognition ; Epilepsy ; Healthy Volunteers ; Humans ; Memory ; Neuropsychological Tests ; Polypharmacy ; Seizures ; Vigabatrin ; Volunteers