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Pathological Findings of Tumors at Thymus and Myasthenia Gravis.

Soo Jin CHO ; Il Nam SUNWOO ; Ki Whan KIM ; Dong Whan SHIN

Journal of the Korean Neurological Association.1996;14(1):190-196.

We retrospectively studied 53 cases of thymic tumors diagnosed after thymectomy to clearfied the pathologic difference of thymic tumor associated with myasthenia gravis and without myasthenia gravis. Among them, there are 23 cases with myasthenia gravis; 19 among 36 thymomas(52.8%), 3 of 4 thymolipoma (75%) and 1 squamous cell carcinoma. Lymphoma and teratoma are not associated with myasthenia gravis. There is no significant difference in the prevalence of myasthenia gravis between types of the old traditional classification of thymoma. But according to the new Muller-Hermelink classification, about two-thirds of myasthenia gravis have the thymoma with cortical cell origin. The prevalence of myasthenia gavis were relatively low in the patients with thymoma of medullary or mixed type. The frequent association of myasthenia gravis was suggesting that the thymolipoma might be a variant of thymoma, cortical type.
Carcinoma, Squamous Cell ; Classification ; Humans ; Lymphoma ; Myasthenia Gravis* ; Prevalence ; Retrospective Studies ; Teratoma ; Thymectomy ; Thymoma ; Thymus Gland* ; Thymus Neoplasms

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Evaluation of Initiation Time in Parkinson's Disease: Cybex Isokinetic test.

Kyu Yong LEE ; Myung Kwon KIM ; Hee Tae KIM ; Seung Hyun KIM ; Ju Han KIM ; Myung Ho KIM ; Si Bock PARK ; Kang Mok LEE

Journal of the Korean Neurological Association.1996;14(1):185-189.

To quantitively evaluate the initiation failure in Parkinson's disease (PD), we studied the initiation time by using the Cybex isokinetic test machine. Eighteen patients with idiopathic PD and age-matched normal controls were selected, and the initiation time during the extension and flexion of elbow and knee joints were measured in each group. Compared to the normal subjects and the patients with PD, the patients revealed prolongation of initiation time. So, it is suggested that the quantitive measurement of initiation time by Cybex isokinetic test could be a useful clinical tool in evaluating the symptoms of initiation failure of PD.
Elbow ; Humans ; Knee Joint ; Parkinson Disease*

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Akathisia in Parkinson's Disease.

Won Yong LEE ; Beom S JEON

Journal of the Korean Neurological Association.1996;14(1):176-184.

BACKGROUND: Akathisia is defined as inner feeling or restlessness and can be associated with restless movement. It is a frequent and disabling complication of neuroleptics and was reportedly common in postencephalitic parkinsonism. Akathisia has been reported and appears to be common in Parkinson's disease(PD). OBJECTIVE: To determine the frequency and clinical features of akathisia and dexamine the relationship between presence of akathisia and various clinical parameters of PD, Method: we evaluated 137 PD patients from movement disorder clinics in Samsung Medical Center and Seoul National University Hospital, using a modified akathisia questionnare. We compared two groups between those with akathisia and those without akathisia. We analysed the pattern, location and chronology of akathisia, and the correlation between akathisia and clinical parameters of PD. RESULTS: 1. Of the 137 patients (76 women, 61 men), 43(22 women, 21 men) (31.4%) had akathisia. 2. Patients with akathisia had more advanced disease than those without akathisia as determined by Hoehn and Yahr stage (p<0.05). 3. Patients with akathisia were more often akinetic-rigid than tremor predominent (p<0.05). 4. Patients with akathisia were more frequently treated with levodopa than those without akathisia (p<0.05). 5. There was no difference between two groups for age, sex or disease duration(p<0.05). 6. Of the 43 patients with akathisia, 35 patients had motor restlessness and 27 patients had associated sensory complaints. 7. The whole body or legs were most frequently affected. 8. Akathisic symptoms occurred irregularly and mainly in the afternoon. 9. Nineteen patients had difficulty in their jobs due to akathisia. Conclusion: Akathisia is a common problem in PD especially in severe akinetic-rigid form. It can be the main cause of disability in PD. Recognition and proper management are needed.
Antipsychotic Agents ; Female ; Humans ; Leg ; Levodopa ; Movement Disorders ; Parkinson Disease* ; Parkinson Disease, Postencephalitic ; Psychomotor Agitation* ; Seoul ; Tremor

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A Comparison Study of Forensic Epileptic Patients With Mentally Disordered Offenders: Characteristics and Epilepsy in Criminal Acts.

Sang Bong LEE ; Kyung Woo PARK ; Jae Moon KIM ; Ae Young LEE ; Chin Sang CHUNG

Journal of the Korean Neurological Association.1996;14(1):164-175.

RESEARCH OBJECTIVE: Epileptic patient's crime rate has been increasing. Causes of such increasing crime rate by epileptic patients are attribute to many factors. To clarify uncertain causative role of epilepsy in crime, analyzed the characteristics of their epilepsy and criminal acts. METHODS: Medical records, documentations of Justice Department, EEG, Brain CT, and psychiatric tests (Barratt Impulsiveness Scale, BIS) of 22 forensic epileptics and 20 forensic psychopathic patients were reviewed. Demograhic features, socioeconomic status, associated psychiatric illness, and characteristics: of epilepsy and criminal acts were analyzed. RESULTS: All patients were male and the most frequent seizure type found Complex Partial Seizure (CPS) in 14 patients. Nine lateralized patients had right-sided Ictal discharges. Ten patients showed postictal aggression but only one patient committed crime during his postictal confusion state. Intervals between the first seizure and their criminal act were relatively long(14.6 +/- 4.81 years) and compliance prior to their crime was mostly poor. Thirteen epileptic offenders had psychopathic disorders, which may or may be associated with epilepsy. Characteristics of their criminal acts were remarkably different from psychopathic patients. CONCLUSIONS: Peri-ictal events are rarely associated with crime. 4 complex interplay of organic factors and socially mediated factors such as underlying personality change or psychiatric disorders may play a role in criminal acts of epileptic patients.
Aggression ; Brain ; Compliance ; Crime ; Criminals* ; Documentation ; Electroencephalography ; Epilepsy* ; Humans ; Male ; Medical Records ; Seizures ; Social Class ; Social Justice

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Electroencephalographic and Clinical Aspects in Subjects with Paretic Form of Cerebral Palsy.

Yoe Hun YUN ; Hong Ki SONG ; Hyung Cheol KIM ; Byung Chul LEE ; Sook Ja LEE

Journal of the Korean Neurological Association.1996;14(1):158-163.

There have been few articles describing incidences of epileptiform discharges in EEG and epilepsy in subjects with cerebral palsy(CP) and probably no references about lateralizing significance of EEG and brain imaging findings in asymmetrically quadriparetic patients. We reviewed clinical, EEG and brain imaging findings of one hundred and fifty patients with paretic cerebral palsy to assess incidences of epileptiform discharges(Eds), background abnormalities and epilepsy as well as lateralizing significance of those findings in 52 patients who were asymmetrically quadriparetic. The results were as follows. 1) Incidence of Ebs on serial EEG and epilepsy excluding febrile convulsion were 28.0 %(42/150) and 30.0 %(4S/1SO), respectively. 2) Among 42 patients with Eds, 19(45.2 %) did not have any history of epileptic seizure. 3) In 52 patients who were asymmetrically quadriparetic, unilateral background abnormality or focal BDs were observed in 21 and unilateral brain imaging abnormalities in 13 subjects. There was a positive correlation between side of unilateral EEG abnormalities and the more severely affected side of the body in 17/52 (32.3%), while there was a positive correlation between side of brain imaging abnormalities and the more severely affected side of the body in 12/52 (23.1%). Also, there was a positive correlation between unilateral EEG abnormalities and brain imaging laterality in 8 subjects. In conclusion, if any lateralized abnormalities, EEG as well as brain imaging are thought to be useful in determining the side of maximal brain damage in asymmetrically quadriparetic CP.
Brain ; Cerebral Palsy* ; Electroencephalography ; Epilepsy ; Humans ; Incidence ; Neuroimaging ; Seizures, Febrile

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Influence of the Hippocampal Atrophy Extent on Secondary Generalized Tonic-Clonic Seizures in Temporal Lobe Epilepsy.

Jang Sung KIM ; Kyoon HUH ; Oh Young KWON ; Sun Yong KIM

Journal of the Korean Neurological Association.1996;14(1):150-157.

Eventhough the hippocampal sclerosis (HS) is crucial in pathophysiology of temporal lobe epilepsy (TLE), the seizure semiology in relation to the extent of hippocampal atrophy(HA) has not been well addressed. We attempted to investigate whether the extent of HA contributes to secondary generalized tonic-clonic seizure (2GTCS) occurrence in TLE. Clinical information in medical records, archived data of video-EEG monitoring (VEM) of 11 TLE patients were reviewed and findings of temporal lobe magnetic resonance imagines (TLMRIs) of those patients were analyzed. According to the extent of HA and the presence of amygdala atrophy (AA) in TLMRI findings, patients were divided into partial hippocampal atrophy group(PHA) (3 patients: HA limited to a partial portion of hippocampus), diffuse hippocampal atrophy group (DHA) (3 patients: extensive HA from head to tail of hippocampus) and amygdala atrophy group(AA) with HA(S patients). We analyzed 2GTCS occurrence rate (rate during previous one years and during VEM period) between PHA and DHA, between AA and only HA group, and between AA, DHA and PHA. There was no significant difference in age, sex, onset age, febrile seizure history and seizure duration. Both 2GTCS rate of the previous one month and that during VEM monitoring period were not significantly different between DHA and PHA, between AA and HA, and between AA, BHA and PHA, either. We preliminarily conclude that neither the hippocampal atrophy extent nor the presence of amygdala atrophy influenced the occurrence of 2GTCS in TLE.
Age of Onset ; Amygdala ; Atrophy* ; Butylated Hydroxyanisole ; Epilepsy, Temporal Lobe* ; Head ; Humans ; Medical Records ; Sclerosis ; Seizures* ; Seizures, Febrile ; Temporal Lobe*

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Correlation of Icatal Scalp/Sphenoidal EEG Patterns and MRI Findings with Surgical Outcome in Temporal Lobe Epilepsy.

Byung Kuk NAM ; Joong Koo KANG ; Youn Mee HWANG

Journal of the Korean Neurological Association.1996;14(1):142-149.

BACKGROUND & OBJECTIVE: It has not been clear that the correlation between individual ictal scalp/sphenoidal EEG patterns and MRI findings or surgical outcome. So we investigated the correlation between the differences in individual ictal EEG patterns, MRI findings and surgical outcome. METHOD: Twenty nine temporal lobe epilepsy patients undergoing anterior temporal lobectomy with hippocampectomy in AMC since 1993 were evaluated. Ictal EEGs were classified as A(focal ictal onset) and B(lateralizing pattern) MRI findings were grouped as hippocampal atrophy (HA) with or without lateral temporal atrophy (LTA). RESULT: In group A(19), 7(37%) had HA with LTA on MRI and 12(63%) showed HA only. In group B(10), 8(80%) had HA with LTA and 2(20%) showed HA only. Among the 20 patients whose postoperative follow up period were more than 1 year, 11 cases(73%) of group A(IS) had seizure free outcome, whereas all (100%) of group B (5) had seizure free outcome. Eight (72.7%) out of 11 cases with HA only on MRI were seizure free outcome, whereas 8(89%) out of 9 cases with HA with LTA were seizure free after surgery. CONCLUSION: Focal ictal EEG pattern was more commonly noticed in HA only and lateralized Ictal EEG pattern was more commonly noticed in HA with LTA on MRI. Surgical outcome seems not to be directly correlated with the ictal EEG patterns or accompanied LTA on MRI in temporal lobe epilepsy.
Anterior Temporal Lobectomy ; Atrophy ; Electroencephalography* ; Epilepsy, Temporal Lobe* ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging* ; Seizures ; Temporal Lobe*

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Semiology and its Lateralizing Signs in Mesial Temporal Lobe Epilepsy.

Hyeo Il MA ; Joong Koo KANG ; Sang Ahm LEE ; Youn Mee HWANG

Journal of the Korean Neurological Association.1996;14(1):134-141.

We analysed video tapes in 31 patients of 97 seizures who were evaluated for epilepsy surgery at AMC Neurology department between 1992 and 1994. All patients had epilepsy surgery such as temporal lobe resection or gamma knife radiosurgery. They were either seizure free or had a greater than 90% reduction in the number of seizures for at least 12 months following surgery. Oromandibular automatism (74.2%), behavioral arrest/staring (63.9%), and upper extremity automatisms (37 1%) were frequent ictal manifestations of mesial temporal lobe epilepsy in our patients, Initial non-versive head turning was observed in 49 events (ipsilateral 77.8%, contralateral 22.2%), while versive head turning was noticed in 25 events (ipsilateral 7.1%, contralateral 92.9%). Contralateral dystonic posture was observed in 47 events (48.5%). Vocalization was observed in 2 among 12 patients (16.7%) with non-dominant sided lesions, and 9 among 19 patients (47.4%) with dominant sided lesions. Dystonic posture was observed contralaterally (100%), hand automatism ipsilaterally (94.4%) and versive head/eye turning wart observed ipsilaterally (92.3%) in our patients. So we concluded that valuable lateralizing sign in mesial temporal lobe origin seizure are contralateral dystonic posture, ipsilateral hand automatism, and versive contralateral head/eye turning. And also turning and rounding sign may have possible lateralizing value.
Automatism ; Epilepsy ; Epilepsy, Temporal Lobe* ; Hand ; Head ; Humans ; Neurology ; Posture ; Radiosurgery ; Seizures ; Temporal Lobe* ; Upper Extremity ; Warts

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Lateralizing Value of Ictal Behaviors in Temporal Lobe Epilepsy.

Sook Young ROH ; Seung Bong HONG ; Dae Won SEO

Journal of the Korean Neurological Association.1996;14(1):126-133.

To find out whether the commonly observed ictal behaviors in temporal lobe epilepsy (TLE) contribute to the lateralization of epileptogenic focus, 116 seizures in 19 unilateral TLE patients were reviewed and analyzed carefully by two epileptologists. Unilateral motor manifestations such as dystonia, tonic posturing, clonic jerking, head version, head turning, eye deviation, unilateral eye blinking and unilateral automatism were observed in ipsilateral or contralateral side of EEG seizure focus. Ictal language was classified as normal speech, speech arrest, dysphasia and nonidentifiable speech. They were evaluated for their significance in determining dominant (DHS) or nondominant hemisphere onset (NHS) based on the results of Wada test. Other categories of automatisms were analyzed to investigate whether they indicate right or left TLE. Dystonia(in 34 seizures), tonic posture(17), clonic jerking(24) and head version (14) were observed only in contralateral side of EEG seizure focus in 89 seizures. The direction of head turning was ipsilateral to seizure focus in 15 seizures (46.9%) and contralateral to seizure focus in 17 seizures (53.1%), Eye deviation direction inclined to suggest contralateral hemisphere seizure origin without statistical significance [contralateral in 13 seizures (65%) and ipsilateral in 7 seizures (35%)]. Unilateral eye blinking and unilateral automatism were seen in 35 seizures and occurred exclusively in ipsilateral side to ictal EEG onset (12,85.7% ;23,88.5%) compared with contralateral side(2,14.3% ;3,11.5%). Ictal normal speech was observed in 9 seizures of 2 patients who had NHS, wheares dysphasia occurred in 4 DHS of 3 patients. Deglutition, sexual automatism and sniffing were observed in both right and left TLE, and not valuable in seizure lateralization. These results show unilateral dystonia, tonic posture, clonic jerking and head version suggest strongly contralateral hemisphere seizure origin. Unilateral eye blinking and unilateral automatism indicate ipsilateral hemisphere seizure focus. Among ictal speech manifestations, ictal normal speech and dysphasia suggested NHS and DHS respectively.
Aphasia ; Automatism ; Blinking ; Deglutition ; Dystonia ; Electroencephalography ; Epilepsy, Temporal Lobe* ; Head ; Humans ; Posture ; Seizures ; Temporal Lobe*

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The Effect of Unilateral Dopaminergic Deafferentation on Kainic acid Induced Seizures in the Rat.

Kun Woo PARK ; Dae Hie LEE

Journal of the Korean Neurological Association.1996;14(1):114-125.

There has been quite a number of research regarding the role of dopamine in epilepsy and it has been still very controversial, In this study, the effect of dopaminergic deafferentation on kainic acid induced seizures was evaluated with behavioral study and molecular biologic method. We produced unilateral dopaminergic deafferentation via injection of 6-hydroxydopamine at the location of right substantia nigra in the Spague- Dawley rats (250-300gm) using the stereotaxic technique under pentobarbital anesthesia. Four weeks after this procedure, kainic acid (10m9/kg) was injected into the peritoneal cavity for induction of seizures. Observations of seizure pattern and mRNA expression of c-fos, dynorphin and enkephalin were obtained in the lesion group and were compared with those in the non-lesion group in terms of behavior characteristics and in situ hybridization histochemistry. In behavior study, the results demonstrated that more severe seizure patterns (rearing, falling, tonic-clonic seizure and status epilepticus) and more fast seizure evolution time(from onset to stage V) in the lesion group than those in the non-lesion group, which may indicated statistically significant (16.21+/-12.84 min. vs 35.88+/-16.55 min., p(0.05) The results of in situ hybridization revealed that the expression of c-fos, dynorphin and enkephalin mRNAs in certain areas of brain was higher in the lesion group than that in non-lesion group; c-fos in cerebral cortex, dynorphin in dentate gyrus, enkephalin in the entorhinal cortex and amygdala nuclei. Although the lesion was unilateral, the mRNA expression patterns appeared symmetrical shape. The characteristic behavior and molecular biologic study results are suggested that the dopamine may plays a important role in control of kainic acid induced seizures.
Amygdala ; Anesthesia ; Animals ; Brain ; Cerebral Cortex ; Dentate Gyrus ; Dopamine ; Dynorphins ; Enkephalins ; Entorhinal Cortex ; Epilepsy ; In Situ Hybridization ; Kainic Acid* ; Oxidopamine ; Pentobarbital ; Peritoneal Cavity ; Rats* ; RNA, Messenger ; Seizures* ; Stereotaxic Techniques ; Substantia Nigra

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