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

PURPOSE: The ictal perfusion patterns of cerebellum and basal ganglia have not been systematically investigated in patients with temporal lobe epilepsy (TLE). Their ictal perfusion patterns were analyzed in relation with temporal lobe and frontal lobe hyperperfusion during TLE seizures using SPECT subtraction. MATERIALS AND METHODS: Thirty-three TLE patients had interictal and ictal SPECT, video-EEG monitoring, SPGR MRI, and SPECT subtraction with MRI co-registration. RESULTS: The vermian cerebellar hyperperfusion (CH) was observed in 26 patients (78.8%) and hemispheric CH in 25 (75.8%). Compared to the side of epileptogenic temporal lobe, there were seven ipsilateral hemispheric CH (28.0%), fifteen contralateral hemispheric CH (60.0%) and three bilateral hemispheric CH (12.0%). CH was more frequently observed in patients with additional frontal hyperperfusion (14/15, 93.3%) than in patients without frontal hyperperfusion (11/18, 61.1%). The basal ganglia hyperperfusion (BGH) was seen in 11 of the 15 patients with frontotemporal hyperperfusion (73.3%) and 11 of the 18 with temporal hyperperfusion only (61.1%). In 17 patients with unilateral BGH, contralateral CH to the BGH was observed in 14 (82.5%) and ipsilateral CH to BGH in 2 (11.8%) and bilateral CH in 1 (5.9%). CONCLUSION: The cerebellar hyperperfusion and basal ganglia hyperperfusion during seizures of TLE can be contralateral, ipsilateral or bilateral to the seizure focus. The presence of additional frontal or basal ganglia hyperperfusion was more frequently associated with contralateral hemispheric CH to their sides. However, temporal lobe hyperperfusion appears to be related with both ipsilateral and contralateral hemispheric CH.
Basal Ganglia* ; Cerebellum* ; Epilepsy, Temporal Lobe* ; Frontal Lobe ; Humans ; Magnetic Resonance Imaging ; Perfusion ; Seizures ; Temporal Lobe* ; Tomography, Emission-Computed, Single-Photon

BACKGROUND: Neocortical temporal lobe epilepsy (NTLE) appears to have different characteristics in clinical and electrophysiological aspects from mesial temporal lobe epilepsy (MTLE). Many semiological studies on TLE have been performed. We investigated ictal EEG patterns to differentiate NTLE from MTLE. METHODS: One hundred twenty nine scalp ictal EEG recordings came from 27 pathologically proven TLE patients were analyzed by 1) frequency of ictal discharge at EEG seizure onset (alpha, beta, theta & delta), 2) distribution patterns of ictal EEG onset (diffuse, lateralized & regionalized), 3) electrode of maximum amplitude at initial regionalized portion of ictal EEG, and 4) mesial to lateral and anterior to posterior amplitude ratio of ictal discharges in temporal electrodes. RESULTS: One hundred seven seizures came from MTLE (23 patients) and twenty-two seizures from NTLE (4 patients). Ictal EEG onset with delta wave was observed more frequently in MTLE (42.7%) than in NTLE (14.3%), but beta wave onset was noted more frequently in NTLE (14.3%) than MTLE (0%). Initial ictal EEG discharges were lateralized on ipsilateral hemisphere in 22.0% of MTLE and in 28.6% of NTLE, regionalized over ipsilateral temporal region in 36.6% and 23.8% respectively, and showed diffuse nonlateralized onset in 41.5% of MTLE and 47.6% of NTLE. Both TLE groups revealed most often their maximum negativity of ictal EEG onset at sphenoidal electrode (MTLE: 59.3%, NTLE: 42.8%). Mesial to lateral amplitude ratio of ictal EEG was significantly larger in MTLE group than NTLE group. The amplitude ratio of anterior to posterior temporal electrodes was greater in NTLE group than in MTLE group. CONCLUSION: Delta frequency of ictal onset EEG is more suggestive of MTLE while beta frequency may suggest NTLE. Initial ictal EEG patterns with their maximum on sphenoidal electrode do not differentiate MTLE from NTLE. NTLE has wide vertical and narrow horizontal electrical field, but MTLE has wide horizontal and narrow vertical electrical field.
Electrodes ; Electroencephalography* ; Epilepsy, Temporal Lobe* ; Humans ; Scalp ; Seizures ; Temporal Lobe*

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

BACKGROUND: Diet and weight concerns are commonplace and almost accepted features of life for girls during adolescence. Until recently, younger age groups haue largely been ignored, as these concerns were thought to be a product of pubertal development and sexual maturity. Girls under the age of fifteen therefore, have been assumed to be free of the pressures experienced by adult women. However, this belief is now hard to sustain. The object of the present study was to investigate the self-perception and body shape satisfaction in different weight categories of boys and girls aged 12-years old in Korea. METHODS: In May, 1995, one hundred and sixty seven boys and one hundred and twenty girls from two schools in Seoul completed assessments of body-esteem, self-esteem, body shape preference. The children's body weight and height were also measured. RESULTS: The heaviest children expressed the most discontent, having a low body-esteem, a desire for thinness. By the age of 12, girls boys already differ in their body shape satisfaction and differ in their body shape aspirations. There was a significant effect of weight category on the children's body esteem(boys(P =.005), girls(P=.0001). Children in both extreme categories, under-and over-weight, had lower body-esteem scores than those in other weight categories. However, it was the overweight children who had the lowest. reported body-esteem. Body esteem was highest among girls in the 'slightly underweight' category and highest among boys on the 'average weight' category. There was no effects of either weight category or gender on the childrens appraisal of self-esteem. A comparison of the points chosen on the silhouette scales to reflect current and preferred body shapes revealed clear gender differences. Of the girls, 63% placed their preferred body shape at a point thinner than their currently perceived shape, while only 15% chose a broader figure. In contrast,, 41% of the boys rated their preferred figure as broader than their current perception, and 37% as thinner than their current perception. CONCLUSIONS: This study has noted a relationship between body weight and self-perception in 12-year old children. The heaviest children expressed low body-esteem, a desire for thinness. This pattern was more characteristic of girls than boys. Even at this age, well before they have completed physical maturation, girls are aspiring to a body shape which is thinner than their average. This discontent experienced by the heaviest children on this sample was apparent in their lower body-esteem and the distance between their current and preferred body shapes. The girls preference was for thinness, while in the boys it was for a body shape which was broader than their current shape. From their responses, it would appear that the boys' desire was not for fatness, but for a more athletic and muscular build.
Adolescent ; Adult ; Aspirations (Psychology) ; Body Weight ; Child* ; Diet ; Female ; Humans ; Korea ; Overweight ; Self Concept ; Seoul ; Sports ; Thinness ; Weights and Measures

Eosinophilia-myalgia syndrome(EMS) is a systemic illness that occurred as an epidemic by ingestion of over-the counter L-tryptophan preparation in the United States in October 1989. We report a Korean case of EMS not associated with the ingestion of either L-tryptophan or other nutritional supplements such as lysine and niacin.
Eating* ; Eosinophilia-Myalgia Syndrome* ; Lysine ; Niacin ; Tryptophan ; United States

Idiopathic atrophoderma of Pasini and Pierini(IAPP) is an uncommon condition of unknown etiology and typically affects persons in the second and third decades of life. IAPP consists of asymptomatic grey to brown depressed lesions with "cliff drop" borders, which are usually bilateral and located on the trunk. A 40-year-old woman visited our department because of unilateral atrophic lesions on the abdomen, right arm, and posterior aspect of right thigh for 20 years. Laboratory evaluations were normal and histologic examination revealed significantly decreased thickness in dermis. We report an unusual case of idiopathic atrophoderma of Pasini and Pierini presenting unilateral distribution.
Abdomen ; Adult ; Arm ; Dermis ; Female ; Humans ; Thigh

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

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