To evaluate the intractability of partial epileptic patients by variables, the author studied 113 patients (uncontrolled: 45, controlled: 68) who were admitted to the Department of Neurology, College of Medicine, Yeungnam University from January, 1991 to August, 1993. The results were as follows. The items related to complex partial seizures, multiple seizure types and a histories of status epilepticus or clusters of seizures were significantly associated with drug-refractoriness (p<0.01). A high frequency of seizures before evaluation was associated with a poor outcome(p<0.01). The presences of known etiology of seizures, neurologic abnormalities and psychiatric disturbance were associated with limited treatment responses(p<0.01, p<0.05, p<0.01). An abnormal EEG findings such as background slowing, focal slowing, epileptiform discharges or secondarily bilateral synchrony were statistically significant (p<0.01). Age at onset, sex, distribution of epileptic foci, duration of seizure before evaluation, family history and abnormal neuroradiologic findings were not statistically significant. By these results, it was suggested that having at least four factors of the above variables were associated with limited treatment response.
Electroencephalography ; Epilepsies, Partial* ; Humans ; Neurology ; Risk Factors ; Seizures ; Status Epilepticus

BACKGROUND AND PURPOSE: This study was undertaken to compare the sensitivity of the Repetitive Nerve Stimulation Test (RNST) between the upper and lower extremity muscles in myasthenia gravis(MG) patients. MATERIALS AND METHODS: The study population consisted of 20 normal persons(control group) and 10 MG patients(MG group). Using Stalberg's method. RNST was systemically performed in orbicularis oculi muscle. upper extremity muscles(flexor carpi ulnaris. abductor digiti quinti), and lower extremity muscles(tibialis anterior. extensor digitorum brevis. vastus medialis). RESULTS: There were statistical differences of decremental response(mean+/-SD) in orbicularis oculi and upper extremity muscles between the control and MG groups(p<0.05 or p<0.01). However, there was no statistical difference of decremental response(mean+/-SD) to RNST in lower extremity muscles between the control and MG groups. There were highersensitivity in orbicularis oculi and upper extremity muscles than lower extremity muscles. Although positive reponse were detected in the lower extremity muscles, the positive response rates of lower extremity muscles were lower than o.oculi and upper extremity muscles. CONCLUSIONS: When the response rates of RNST in facial and upper extremity muscles are normal, may not be required RNST in lower extremity muscles.
Humans ; Lower Extremity* ; Muscles* ; Myasthenia Gravis* ; Upper Extremity

BACKGROUND: It is well known that non-rapid eye movement(NREM) sleep activates the occurrence of interictal epileptiform discharges(IED) in many epileptic syndromes. We performed this study to assess the effect of NREM sleep on IED in epileptic patients with organic brain lesions. MATERIALS AND METHODS: We analyzed awake and sleep electroencephalopathy(EEG) recorded simultaneously after partial sleep deprivation in 50 patients. We calculated the awake and sleep spike index (ASI and SSI, spikes/epoch), and the percentage increase of ASI and SSI during sleep. RESULTS: In the 50 patients, the IEDs were recorded exclusively during the awake state in 1 (2%) patient, and during the sleep state in 13(26%) patients. The SSI was higher in 44 (88%) patients, and the ASI was higher in 5 (10%) patients. The mean ASI and the SSI in patients with organic brain lesions were 0.058+/-0.121 and 0.148+/-0.187, and it was 0.081+/-0.150 and 0.174 +/-0.226 in patients without organic brain lesions. There were significant increases in the spike index (P<0.05) during NREM sleep in both groups (n=36), but no significant difference in the percent increase of spike index (P>0.05). CONCLUSION: The IEDs were activated significantly during NREM sleep both in patients with and without organic brain lesions, but there were no differences in the degree of activation in both groups. The activating effect of NREM sleep was not correlated with clinical factors such as, frequent nocturnal seizures, frequent generalized tonic clonic seizures, type of epilepsy and taking anticonvulsants. We conclude that the routine EEG used to evaluate epileptiform discharges in epileptic patients should include sleep recordings after partial sleep deprivation.
Anticonvulsants ; Brain ; Electroencephalography* ; Epilepsy ; Humans ; Seizures ; Sleep Deprivation

BACKGROUND: Carpal tunnel syndrome (CTS) is the most common mononeuropathy encountered in clinical practice. When performing routine diagnostic nerve conduction studies (NCS) in patients with CTS, we sometimes happen to be confronted with patients who have no definite electrophysiological evidence of CTS. We therefore evaluated the diag-nostic sensitivities of several parameters in NCS for CTS patients. METHODS: We analyzed 187 patients (262 hands) who were diagnosed with CTS clinically and electrophysiologically for the past 4 years in this hospital. RESULTS: Significant abnormal findings of nerve conduction velocity (NCV) were noted in the palm to wrist (P-W) seg-ment( 98.5%), thumb-wrist (I-W) segment (97.3%), distoproximal ratio in the third finger (95.0%), and the terminal latency (71.4%) of the median nerve. There were no statistical differences in the abnormal NCVs between the male and female groups. The sensitivity of each compartment parameters were obtained in the female groups and statistical dif-ferences were found in the sensory NCV of the P-W segment and compound nerve action potential (CNAP) amplitude of the I-W segments in patients between the ages of 40 and 60. The sensory NCV of the P-W segment was especially more significant in this age group. There were statistical differences in the amplitude of the index finger to wrist (F-W) and P-W segments between the denervated electromyography group and normal group (p < 0.05). CONCLUSIONS: In clini-cally suspected CTS, the most sensitive tests were the sensory NCV of the P-W segment, I-W segment, and distoproxi-mal ratio in the third finger. Therefore, the sensory NCV of the P-W segment should be performed first. If the results of this test are unremarkable, then, the next tests should include the sensory NCV of the I-W segment and the distoproxi-mal ratio should be performed before ruling out the diagnosis of CTS.
Action Potentials ; Carpal Tunnel Syndrome* ; Diagnosis ; Electromyography ; Female ; Fingers ; Humans ; Male ; Median Nerve ; Mononeuropathies ; Neural Conduction ; Wrist

The author studied 20 healthy adults (20 hands) as a control and 30 patients (40 hands) with carpal tunnel syndrome to evaluate the clinical usefulness of measuring nerve conduction velocity after wrist flexion in diagnosis of carpal tunnel syndrome. The median nerve conduction velocity over wrist to finger segment was measured before and after wrist flexion for 1, 2 and 5 minutes, using belly-tendon method for motor nerve distal latency (MNDL) and antidromic method for sensory nerve conduction velocity (SNCV). The results were as follows: 1. In control group, MNDL increased in 1 hand and SNCV decreased in 2 hands after wrist flexion. In patient group, MNDL increased in 2 hands and SNCV decreased in 3 hands after wrist flexion. 2. In both control and patient group, there were no significant changes in mean values of SNCV and MNDL between before and after wrist flexion. 3. Phalen's wrist flexion test was positive in 5 percent of control and 60 percent of patient group. 4. Tinel's sign was present in 10 percent of control and 33 percent of patient group.
Adult ; Carpal Tunnel Syndrome* ; Diagnosis ; Fingers ; Hand ; Humans ; Median Nerve ; Methods ; Neural Conduction* ; Wrist*

A 59 year-old woman who had suffered daily headaches was diagnosed with leptomeningeal metastasis. Leptomeningeal metastasis is uncommon but devastating form of metastatic spread. Cerebral venous thrombosis is a disease sometimes associated with systemic cancer. Rarely, cerebral sinus occlusion accompanies leptomeningeal cancer. We report a patient who had cerebral sinus thrombosis and leptomeningeal metastasis.
Female ; Headache ; Humans ; Middle Aged ; Neoplasm Metastasis* ; Sinus Thrombosis, Intracranial ; Venous Thrombosis*

We experinced 2 cases of reversible leukoencephalopathy, caused by 5-Fluorouracil derivatives(carmoful), presenting as akinetic mutism. Each patient was diagnosed as colon cancer and stomach cancer respectively and received operations. Their outcome was good without metastatic evidences, and carmoful was started orally 400mg in 1 case and 600mg in the other. Their clinical pictures were akinetic mutism, one and two months after the administration of carmoful. There were no metastatic lesions in the brain CT but bilaterally symmetric diffuse low densities of cerebral whites matter, predominantly in the frontal area, were noted. Carmoful was discontinued and replaced by conservative treatment. One and two months later, their clinical symptoms improved without specific treatment. Follow up brain CT was done in case 2, which revealed attenuation of the previous low densities.
Akinetic Mutism* ; Brain ; Colonic Neoplasms ; Fluorouracil* ; Follow-Up Studies ; Humans ; Leukoencephalopathies* ; Stomach Neoplasms

The Neuropsychiatric complications in acute viral hepatitis are uncommon. Despite the wide spread occurrence of this disease. Various complications of central and peripheral nervous involvement may arise during the course of viral hepatitis. Encephalitis, meningitis, neuritis, myelitis and mental disturbances such as depression, euphoria and insomnia complicating viral hepatitis has been reported several literatures. Also, bilateral facial nerve palsy is seen very infrequently in clinical practice and has an annual incidence of approximately 0.01% per total facial nerve palsy. The isolated cranial nerve palsy, especially facial nerve. Complicated by viral hepatitis has been suggested very rarely. This combination of bilateral facial nerve palsy and viral hepatitis B seems to be two phases of same disease. However, there were no such reports in Korea until now. Therefore, We present a case of bilateral peipheral facial nerve palsy associated with acute viral hepatitis type B.
Cranial Nerve Diseases ; Depression ; Encephalitis ; Euphoria ; Facial Nerve ; Hepatitis B ; Hepatitis* ; Incidence ; Korea ; Meningitis ; Myelitis ; Neuritis ; Paralysis ; Sleep Initiation and Maintenance Disorders

Transient ischemic attacks or embolic strokes caused by the cardiac myxoma are very rare in its freguency. To detect cardiac myxoma, as a source of cerebral embolism originating from the heart, has a great significance because of the occurrence and recurrence of the possible stroke can be prevented by surgical procedure. We present a patient who showed typical clinical symptoms and signs of the left atrial myxoma which was subsequently diagnosed by 2-dimensional real time echocardiography and confirmed by sugery. Following the successful removal of the left atrial myxoma, now, the patient is in stable neurological condition.
Echocardiography ; Heart ; Humans ; Intracranial Embolism* ; Ischemic Attack, Transient ; Myxoma* ; Recurrence ; Stroke

The lesion of the global aphasia often involves both Broca's and Wernicke's speech area, and is shown as broad lesion in the Brain CT However, practically there were several reports about the Brain CT findings of the global aphasia, which suggested atypical patterns that did not involve both language centers, simultaneously. Therefore we subdivided the patterns of Brain CT finding of the 17 global aphasic patients into 4 subtypes according to whether or not the cortical language area was involved. We obtained the following results; 1. Type A : Involvement of the both language areas : 9 cases (53%) 2. Type B : Involvement of only Broca's area with sparing of Wernicke's area : 3 cases(17%) 3. Type C : Involvement of only Wernicke's area with sparing of Broca's area : 1 case (6%) 4. Type D : Involvement only of subcortical area with sparing of cortical language areas : 4 cases (24%).
Aphasia ; Brain* ; Humans