People with epilepsy have a higher risk of developing psychiatric problems than the general population. The degree of affective symptoms such as depression and anxiety was affected by seizure control and epileptic syndromes. The higher degree of depression symptoms was more likely to elicit the suicidal ideation, psychosocial problems, adverse events of antiepileptic drugs, and poor quality of life. Antiepileptic drugs also provoke various psychiatric problems in people with epilepsy due to their specifi c action mechanisms on epilepsy. Carbamazepine, valproate, and lamotrigine can be used as a mood stabilizer, whereas phenobarbital, vigabatrin, topiramate, and levetiracetam may cautiously apply to PWE with psychiatric comorbidity.

To investigate the cellular immune response in myasthenia gravis (MG), serum levels of interleukin-2(IL-2), soluble IL-2 receptor(sIL-2R) and neopterin were measured in 48 patients with MG, and these levels were compared with those in 22 healthy controls Also, the relationship of serum levels of IL-2. sIL-2R and neopterin to disease severity and thymic histology, and the changes of above laboratory indexes were observed according to thymectomy. Serum IL-2 was not detected in controls. But was detected in 56% of MG patients. Mean levels of serum sIL-2R were significantly increased in MG patients compared with controls (p<0.01), and mean levels of serum neopterin were increased, but not statistically significant in MG patients compared with controls. Mean levels of serum sIL-2R were significantly increased in the groups of grade IIB and m compared with the groups of grade I and IIA(p<0.01) Among 20 thymectomized MG patients, mean levels of serum sIL-2R were significantly increased in patients with thymoma compared with those with involuted thymus(p<0.05). In the follow-up study of serum levels of IL-2, slL-2R and neopterin after thymectomy, the detection rate of serum IL-2 was significantly decreased in patients more than 1 year after thymectomy compared with those before thymectomy (P<0.05), and mean levels of serum sIL-2R and neopterin were significantly decreased in patients more than 1 year after thymectomy compared with those before thymectomy (P< 0.01, p<0.05). These decrements reflected the clinical improvement. These results suggest that the cellular immune responses with T cell and macrophage activation are relevant to the pathogenesis of MG. Serum sIL-2R level is correlated with disease severity, and serum IL-2, sIL-2R and neoptrin levels may represent markers of disease activity after thymectomy.
Follow-Up Studies ; Humans ; Immunity, Cellular ; Interleukin-2 ; Macrophage Activation ; Myasthenia Gravis* ; Neopterin ; Thymectomy ; Thymoma

BACKGROUND: Myelopathies are classified as intramedullary and extramedullary one on the basis of location of lesion. Though there are some characteristic clinical findings which can differentiate extramedullary from intramedullary lesions, it is not easy to tell extramedullary from intramedullary lesions in complicated cases. We performed this study to figure out the relationships between anatomic location (intramedullary or extramedullary), clinical parameters (motor and sensory symptoms and signs), and electrophysiologic findings in myelopathy. We also investigated the diagnostic value of motor evoked potential (MEP) compared with that of somatosensory evoked potential (SSEP) in myelopathy. The amplitude changes of compound muscle action potential (CMAP) after motor cortex stimulation have a lot of intra-individual and inter-individual variability, so were not used to determine pyramidal tract dysfunction in clinical ground. We analyzed CMAP amplitude changes in myelopathy. METHODS: Fifty-six patients with myelopathy demonstrated in MRI were studied. We defined abnormal CMAP amplitude changes as intra-individual inter-side amplitude ratio more than 50%. RESULTS: Lower MEP showed abnormal findings in 93% of tests and lower SSEP, 37% (p<0.05). The correla-tions between clinical parameters and electrophysiologic findings were higher in lower MEP (71%) than lower SSEP (42%) (p<0.05). CONCLUSIONS: The results of this study suggest that MEP is more useful than SSEP for detecting spinal cord dysfunction but as false positivity of lower MEP was considerable, MEP and SSEP are reciprocal diagnostic method for myelopathy. SSEP and MEP do not have significant diagnostic values in differentiating extramedullary from intramedullary myelopathy. The inter-side CMAP amplitude difference may indicate subclinical spinal cord dysfunction.
Action Potentials ; Evoked Potentials ; Evoked Potentials, Motor* ; Evoked Potentials, Somatosensory ; Humans ; Magnetic Resonance Imaging ; Motor Cortex ; Pyramidal Tracts ; Spinal Cord ; Spinal Cord Diseases*

Norepinephrine (NE)-containing locus ceruleus (LC) has been known to participate in the regulation of the sleep-wake cycle according to the differential firing rate. The aim of this study was to know the change of extracellular NE level in the rat amygdala, which are reciprocally connected with LC, during sleep-wake-fulness. Extracellular NE levels in the rat amygdala were inrestigated during different stages of the sleep-waking cycle using in vivo microdialysis and polygraphic recording. Dialysates were collected every 5 min and correlated with the results of polygraphic recording. The content of NE was measured by high-performance liquid chromatography with electrochemical detection. NE level was the highest in active waking (AW) and, when compared to AW, NE level was progressively lower in quiet waking (QW; 86%), quiet sleep (QS; 72%), and active sleep (AS or REM sleep; 61%). This result suggests that the rat amygdala also participates in the regulation of the sleep-wake cycle according to the differential NE release.
Amygdala/*metabolism ; Animals ; Arousal/*physiology ; Electroencephalography ; Extracellular Space/metabolism ; Locus Coeruleus/metabolism ; Male ; Microdialysis ; Norepinephrine/*metabolism ; Rats ; Rats, Sprague-Dawley ; Sleep/*physiology

BACKGROUND AND PURPOSE: Levetiracetam (LEV) is an antiepileptic drug (AED) that has favorable effects on cognition. Although neuropsychological studies have demonstrated these favorable outcomes on cognition, there are few electrophysiologic data describing the functional changes exerted by LEV. The purpose of this study was to determine the effects of LEV adjunctive therapy on the current-source density (CSD) in the high beta frequency band (22-30 Hz) of EEG background activity in refractory partial epilepsy (RPE). METHODS: We conducted a 24-week, open-label, prospective study in 24 patients with RPE. Scalp electroencephalography and neuropsychological tests (NPTs) were conducted twice, once before the LEV trial and then again after 24 weeks of medication. RESULTS: The CSD in the 22-30 Hz band of EEG background activity increased in the bilateral anterior cingulate gyri, left parahippocampal gyrus, and a small area of the right anterior parahippocampal gyrus after the LEV trial. Neither seizure freedom nor the dosage increment of LEV elicited meaningful CSD changes. Verbal memory and executive function were improved after the 24-week LEV trial. CONCLUSIONS: To our knowledge, this is the first study to examine the changes in CSD induced by LEV adjunctive therapy in RPE patients. The CSD changes and NPT results suggest that LEV enhances the activities of the neuronal networks in the prefrontal cortex and left hippocampus.
Cognition ; Electroencephalography ; Epilepsies, Partial ; Executive Function ; Freedom ; Hippocampus ; Humans ; Memory ; Neurons ; Neuropsychological Tests ; Parahippocampal Gyrus ; Piracetam ; Prefrontal Cortex ; Prospective Studies ; Scalp ; Seizures

Measuring motor nerve conduction (MNC) in the hypoglossal nerve is an uncommon electrophysiologic study. However, this measurement can be easily performed with a wooden tongue depressor, to which a bipolar bar electrode is fixed by skin tape. We measured the MNC of the hypoglossal nerve in a patient with idiopathic unilateral weakness of the tongue. In the initial MNCs of the hypoglossal nerves, the CMAP amplitude was decreased and the latency was delayed in the lesion site when compared to the healthy site. In the follow-up study after 3 months, similar findings were found. Comparing the initial study with the follow-up one, however, the CMAP amplitude was increased and the latency was shortened in the lesion site. In conclusion, the MNC in the hypoglossal nerve is easy to measure and is useful for the evaluation of the hypoglossal nerve damage.
Electrodes ; Follow-Up Studies ; Humans ; Hypoglossal Nerve* ; Neural Conduction ; Surgical Tape ; Tongue*

BACKGROUND: This study aimed to evaluate the abilities of transcranial magnetic stimulations(TMS) and electrical stimulations(ES) in predicting clinical recovery in patients with Bell's palsy and to contribute to the understanding of the relations observed between the clinical and electrophysiological time courses of the disease. METHOD: We serially studied 22 patients(9 males, mean age 42) with Bell's palsy. Facial nerve function was graded according to the House-Brackmann grading system. RESULTS: A side-to-side comparison(amplitude ratio) of the amplitude of evoked responses between the initial and follow up studies showed a significant change except for the TMS on the stylomastoid foramen. With the TMS over the parieto-occipital area, the absence of a compound muscle action potential(CMAP) was observed in 19 patients during the early course of the disease. The reappearance(n=14) of evoked muscle potentials after an initial absence was observed in 14 patients with satisfactory recoveries at the last follow-up study. The amplitude ratio of ES and TMS during the early course of the disease correlated with the clinical outcome. CONCLUSIONS: Our findings indicate that TMS and ES can provide an early prediction for the outcome of the palsy. The presence of CMAP at the acute phase or the reappearance of CMAP after an initial absence with TMS suggests a rather good prognosis. Both TMS and ES were found to be useful methods for the assessment of facial palsy and as early predictors for the outcome in patients with Bell's palsy. Serial neurophysiologic studies were also important for evaluation of the prognosis of facial palsy.
Bell Palsy* ; Electric Stimulation ; Facial Nerve ; Facial Paralysis ; Follow-Up Studies ; Humans ; Male ; Paralysis ; Prognosis* ; Transcranial Magnetic Stimulation

No abstract available.
Arsenic ; Parkinsonian Disorders

PURPOSE: The aim of the study was to evaluate the validity and reliability of the Korean version of the Liverpool Adverse Events Profile (K-LAEP).METHODS: An observational, cross-sectional study was performed in people with epilepsy (PWE) treated with a stable dose of antiepileptic drugs (AEDs). The scale was translated from the English version into a Korean version and was then back-translated to examine its accuracy. Patients completed the K-LAEP, Quality of Life in Epilepsy-31 (QOLIE-31), Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI).RESULTS: Three hundreds twelve patients were enrolled. The K-LAEP was completed in a short time, perceived as easy to comprehend, and there was no relevant information missing. Ceiling/floor effects were negligible. Internal consistency (Cronbach's alpha=0.9) and test-retest reliability (ICC=0.8) were satisfactory. The K-LAEP scores consistently correlated with QOLIE-31 (r= -0.528), BDI (r=0.526) and BAI (r=0.557) scores. When the K-LAEP was used to discriminate between patients with and without AED-related toxicity, the scores on the QOLIE, BDI and BAI corresponded. Anxiety symptoms were the strongest predictor to determine K-LAEP scores.CONCLUSIONS: The K-LAEP scale reveals highly acceptable parameters of the validity and reliability, suggesting that it is an appropriate instrument to measure adverse effects among Korean PWE.
Anticonvulsants ; Anxiety ; Cross-Sectional Studies ; Depression ; Epilepsy ; Humans ; Quality of Life ; Reproducibility of Results

The Korean version of Neurological Disorders Depression Inventory for Epilepsy in Table 3 was inadvertently omitted from the original publication of this article.