OBJECTIVES: The sensitivity and accuracy of thermistor airflow signal has been debated. The purposes of this study were to compare apnea-hypopnea index(AHI) detected from a conventional thermistor signal and a nasal pressure transducer of airflow(NPT), to evaluate the value of NPT for the diagnosis of upper airway resistance syndrome (UARS), and to measure airway pressure fluctuations which produced respiratory arousals in UARS by naso-oro-esophageal manometer catheter. The subjects were 30 patients with obstructive sleep apnea syndrome [mild(540), 10), and 6 UARS patients. Airway resistance arousal in this study was defined as arousals which were not associated with apnea or hypopnea of thermistor signal, but showed significant decrease of nasal airflow pressure just before arousal and a prompt recovery of nasal airflow pressure after arousal, The airway pressure fluctuations were measured during 260 airway resistance arousals observed in 10 patients with OSAS, 2 with UARS. RESULTS: Mean AHIs of patients with OSAS were 33.4 by thermistor and 48.4 by NPT. The AHIs of mild, moderate and severe OSAS group were 10.2, 32.1, 65.4 respectively by thermistor and 23.1, 45.9, 76.4 by NPT. The mean AHI of patients with UARS was 3.2 by tehrmistor and 108 by NPT. The mean AHI of patients with nonspecific arousals was 2.7 by thermistor and 4.4 by NPT. The mean airway pressure changes during resiratory arousals of different groups were 8.7 cmH2O in mild OSAS, 11.4 cmH2O in moderate OSAS, 24.7 cmH2O in severs OSAS and 6.6 cmH2O in UARS. CONCLUSION: The nasal pressure transducer of airflow was more sensitive and accurate for assessing respiratory disturbances of patients with OSAS and was extremely helpful for the diagnosis of UARS without esophageal pressure monitoring. From the results, we would like to propose carefully the NPT diagnostic criteria for sleep disordered breathing as follows : NPT-AHI 5-15->UARS, 15-35->mild OSAS, 35-55->moderate OSAS and >55 ->severe OSAS.
Airway Resistance* ; Apnea ; Arousal ; Catheters ; Diagnosis ; Humans ; Sleep Apnea Syndromes ; Sleep Apnea, Obstructive* ; Transducers, Pressure

Distinguishing epileptic seizure from non-epileptic seizure is a common diagnostic problem. Neurogenic or cardiac syncope can appear similar to atonic and even convulsive seizures. Classic migraine and transient ischemic attacks may also resemble epileptic seizures. Sleep disorders including REM sleep behavior disorder, nocturnal paroxysmal dystonia, and narcolepsy likewise simulate an epileptic seizure. Movement disorders such as paroxysmal dyskinesia can be misinterpreted as epileptic seizures (reflex epilepsy or myoclonic seizures). Psychogenic seizures are often misdiagnosed as an intractable epilepsy. Prior to the definitive diagnosis of epilepsy, possible non-epileptic seizures should be excluded. For the correct decision, a thorough and systematic history taking is important. In addition, EEG, pseudoseizure induction test, head-up tilt test, EKG, sleep studies, and video-EEG monitoring may be necessary. Misdiagnosis of non-epileptic seizures as epilepsy may result in unnecessary anti-epileptic drug use. At the same time, we should let the patients understand what the epilepsy is and that epilepsy is a treatable disease.
Chorea ; Diagnosis ; Diagnostic Errors ; Drug Resistant Epilepsy ; Electrocardiography ; Electroencephalography ; Epilepsy* ; Humans ; Ischemic Attack, Transient ; Linear Energy Transfer ; Migraine with Aura ; Movement Disorders ; Narcolepsy ; Nocturnal Paroxysmal Dystonia ; REM Sleep Behavior Disorder ; Seizures* ; Sleep Wake Disorders ; Syncope

The present study was designed to identify the sequential electrophysiological findings ant to determine the prognostic values of electrophysiological and clinical pararneters in patients with Guillain-Barre syndrome (GBS). Severely affected 42 subjects (Grade D,E). Who fulfilled the diagnostic criteria of GBS were selected. Twentynine patients were followed up at least 6 months (range 6-24 months) from the onset of neurologic syrnptorns. We analyzed 83 electrodiagnostic studies from 42 subjects. The sequential electrophysiological abnorrnalities were most marked at 3-4 weeks after the onset. At that time the most significant change was a decrease of CMAP amplitude. By stepwise discriminant analysis of several electrophysiological parameters, the three variables, of CMAP amplitude, distal conduction velocity; and F-wave latency were deterrnined to be significant pararneters. The accuracy of predicting the prognosis at 6 months was 82. 8%, when the classification functions were applied. Nlerefore the findings of early electrophysiological studies would be irnportant in understanding the serial pathophysiological changes and assessing the clinical outcorne of Guillain-Barre syndrorne.
Ants ; Classification ; Guillain-Barre Syndrome* ; Humans ; Prognosis

Three patients with complex partial seizures had dysembryoplastic neuroepithelial tumor (DNET) in temporal lobe. In all cases, longterm video-EEG monitoring showed epileptogenic focus in left temporal lobe where small mass lesion was located. For further seizure localization and functional mapping, subdural grids were placed on left temporal lobe including lesions. Lateral temporal lobectomy with lesionectomy was performed in two cases. Lateral temporal lobe resection and amygdalohippocampectomy was done in one case. The pathological findings of all lesions were characterized by intracortical location, multiple nodular architecture, foci of dysplastic cortical disorganization and the presence of a specific glioneuronal element. All patients have been seizure free.
Epilepsy, Temporal Lobe* ; Humans ; Neoplasms, Neuroepithelial* ; Seizures ; Temporal Lobe*

Epilepsy surgery can be a safe, effective treatment for individuals with intractable partial epilepsy. There is increasing evidence that brain abnormalities in focal epilepsy are not restricted to a single area. The longstanding debate around the relationship between structural lesions and the epileptic zone remains unresolved. Patients with DNT (dysembryoplastic neuroepithelial tumor), which is an essentially benign tumor, can be cured by epilepsy surgery-oriented approach. Cortical dysplasia is frequently associated with DNT and seems to contribute to epileptogenic activity of DNT. Surgical treatment should be aimed at removal of the associated cortical dysplasia as well as DNT itself for ideal treatment of the disease. Simple lesionectomy of cavernous angioma would relieve seizures significantly, but not always. The concept of epilepsy surgery needs to be recruited in the treatment of cavernous angioma with seizures because diffusion of hemosiderin into the surrounding brain tissue and formation of cortical scars can make epileptogenic areas. Cortical dysplasia is a highly epileptogenic lesion constituting an important cause of medically intractable epilepsy and surgery is a treatment of choice in a selected group of patients. Identification and complete resection of the lesion and ictal onset zone are necessary to achieve a good surgical results. Intractable epilepsy accompanied by benign brain lesions can be treated surgically using the entire armamentarium of presurgical investigations. Deliberate resective procedures aimed at complete removal of dysplastic tissue and epiletogenically active areas on and around the lesion ensure excellent seizure control without permanent neurologic deficit.
Brain* ; Cicatrix ; Diffusion ; Epilepsies, Partial ; Epilepsy* ; Hemangioma, Cavernous ; Hemosiderin ; Humans ; Malformations of Cortical Development ; Neurologic Manifestations ; Seizures

No abstract available.
Humans ; Hypercholesterolemia*

Primary hypothyroidism can result in reactive enlargement of the pituitary gland which is indistinguishable from primary pituitary lesions in clinical presentation and on magnetic resonance imaging. A 17-year-old girl came to the hospital due to short stature, general weakness and galac-torrhea. The magnetic resonance imaging (MRI) study showed pitutary enlargement. The hormone study showed hyperprolactinemia, decreased basal growth hormone level and primary hypothyroi-dism. By thyroid replacement therapy only, mass was successfully regressed on follow up MRI after 4 months, and growth acceleration could be achieved.
Acceleration ; Adolescent ; Female ; Follow-Up Studies ; Growth Hormone ; Humans ; Hyperplasia* ; Hyperprolactinemia ; Hypothyroidism* ; Magnetic Resonance Imaging ; Pituitary Gland ; Thyroid Gland

BACKGROUND: The detection of the phase reversal of somatosensory evoked potentials (SEP) has been well known to be a safe and reproducible method for defining the sensorimotor cortex. Brain stimulation (BS) has also been used to identify functional loci. The two tests, however have not to be compared in the cortical localization of the sensorimotor cortex yet. METHODS: We recorded the cortical potentials to median nerve stimulation from subdural grids which were in the frontoparietal areas of 12 epilepsy patients. After looking for phase reversals, we compared positive motor and sensory responses by brain stimulation from each electrode. In addition, the maximal amplitude areas of precentral positivity (max-P20) and postcentral negativity (max-N20) were analyzed, which were then compared with BS results. RESULTS: All patients showed phase reversals (average:4.7+1.61) on cortical SEP to median nerve stimulation. The electrodes before the phase reversal line had positive motor responses in 75% among electrodes with positive motor responses. The electrodes after the phase reversal line had positive sensory responses in 88.9% among electrodes with positive sensory responses. The maximal amplitude areas were recorded within a 2cm distance to the central sulcus. Max-P20's were located on the areas where BS showed a finger in 5 patients, hand in 3, forearm in 2, and tongue motor response in 2. Max-N20's were recorded on the areas where BS revealed a hand in 4 patients, forearm in 1, and undetected sensory responses in 7. CONCLUSIONS: These results suggest that SEP is different from BS in the functional localization of the perirolandic area. Thus, combined functional evaluation of the periolandic area by SEP as well as by BS is helpful in assessing sensorimotor functions.
Brain* ; Electrodes ; Epilepsy* ; Evoked Potentials, Somatosensory* ; Fingers ; Forearm ; Hand ; Humans ; Median Nerve ; Tongue

No abstract available.
Appendicitis* ; Barium* ; Enema*

BACKGROUND: Intractable partial epilepsy is the most frequent manifestation in cortical dysplasia (CD). The surgical removal of the epileptogenic focus in CD is the main therapeutic option for achieving seizure control. However, it is dif-ficult to predict surgical outcome by current diagnostic methods. We investigated 35 subjects with intractable epilepsy due to CD, in order to know the relationship the extent of lesion in a magnetic resonance imaging (MRI), the epilepto-genic foci in invasive electroencephalography (IEEG), pathologic grading, and surgical outcome. METHODS: We reviewed clinical findings (the seizure history, MRI), IEEG findings (interictal and ictal EEG), pathologic findings and surgical outcomes retrospectively and compared them. All the patients ranged in age from 2 to 45 years (mean: 21.8+10.8years). The time of their seizure onset ranged from 6 months to 31 years (mean:9.4+6.6years). The postopera-tive follow-up period ranged from 7 to 45months (mean:26+14months). RESULTS: Regarding MRI findings, the lesions were focal (within one lobe) in 10, diffuse (more than one lobe) in 7, and no abnormalities in 18 subjects. The ictal onset zones of ictal IEEG had one focus in 18, two in 7, three in 7, and four in 3 subjects. The area of focus was focal in 15, regional in 14, lobar in 4, and in diffuse areas in 2 subjects. Pathologic grading revealed mild in 18, moderate in 5, and severe changes in 13 subjects. Their surgical outcomes were: Engel's class I in 20, class II in 7, class III in 6, and class IV in 2 subjects. The relationships among clinical features, IEEG, regarding pathology and surgical outcomes, revealed that severe pathologic grading had a significant correlation with earlier ictal onset zones (p=0.003), and diffuse MRI lesions. Diffuse ictal onset zones had poor surgical outcomes (p<0.010). CONCLUSIONS: Cortical dysplasia may have a diverse pattern of epileptogenic foci in MRI and IEEG. The earlier the seizure onset is, the severe pathologic grading becomes. When the lesions in MRI as well as the ictal onet zones in IEEG were diffuse, the surgical outcome was poor.
Electroencephalography* ; Epilepsies, Partial ; Epilepsy* ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging* ; Malformations of Cortical Development* ; Pathology ; Retrospective Studies ; Seizures