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The Recurrence of Seizure due to Decreased Valproic Acid Level after Administration of Carbapenem.

Journal of Korean Epilepsy Society.2007;11(1):64-66.

Valproic acid (VPA) is one of the most commonly used antiepileptic drug, but has many drug-drug interactions. A 58-year-old male under the vegetative state has been well controlled with valproic acid (VPA) monotherapy without seizure attacks during the last 6 months. Pneumonia developed and panipenem-betamipron (PAPM-BP) for acinetobacter baumannii was administered. Seizure attacks recurred after 12 days of initiating PAPM-BP. During the maintenance period of PAPM-BP, serum level of VPA was decreased. After the cessation of PAPM-BP, serum level of VPA increased to the previous level without further seizure attacks. PAPM-BP should be cautiously used together with VPA because of possible drug-drug interaction.
Acinetobacter baumannii ; Humans ; Male ; Middle Aged ; Persistent Vegetative State ; Pneumonia ; Recurrence* ; Seizures* ; Valproic Acid*

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A Case of Posthypoxic Myoclonus with Lamotrigine Add-On Therapy.

Woo Seok YANG ; Sook Young ROH ; Min Jung SEO ; Yoo Seok KWON ; Hyun Jeung YU

Journal of Korean Epilepsy Society.2007;11(1):59-63.

Posthypoxic myoclonus is poorly controlled with current treatments. Based on clinical experience, valproate and benzodiazepines have been used to treat myoclonic seizures. Rarely, some antiepileptic drugs may exacerbate myoclonic seizures. Although lamotrigine is controversial for treatment in myoclonic seizures, we experience a case of posthypoxic myoclonus improved with lamotrigine add-on therapy.
Anticonvulsants ; Benzodiazepines ; Myoclonus* ; Seizures ; Valproic Acid

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Long-Term Dysfunction of Frontal Lobe in a Patient with Isolated Reversible Splenial Lesion after Status Epilepticus.

Hyung Jun PARK ; Yang Je CHO ; Sang Don HAN ; Young Joon LEE ; Byung In LEE ; Kyoung HEO

Journal of Korean Epilepsy Society.2007;11(1):54-58.

Reversible splenial edema has been often reported in epilepsy patients. Clinical presentation is reported to be silent in general. We experienced a patient with splenial lesion and cognitive dysfunction. A 21-year-old man underwent video-EEG monitoring for preoperative evaluation. He had suffered from viral encephalitis eight years ago and developed chronic drug-resistant epilepsy. After antiepileptic drugs withdrawal, he developed eight episodes of secondarily generalized tonic-clonic seizures for several hours and some seizures were repeated without recovery of consciousness. Majority of ictal EEG onset presumed to originate from the left frontal region. After seizures he had shown disorientation and irritability with gradual recovery. Brain MRI demonstrated a splenial lesion. Though splenial lesion disappeared on follow-up MRI, neuropsychological test demonstrated frontal lobe dysfunction 6 months later compared with that performed just before the video-EEG monitoring. We report a patient with isolated reversible splenial lesion associated with long term dysfunction of frontal lobe.
Anticonvulsants ; Brain ; Consciousness ; Edema ; Electroencephalography ; Encephalitis, Viral ; Epilepsy ; Follow-Up Studies ; Frontal Lobe* ; Humans ; Magnetic Resonance Imaging ; Neuropsychological Tests ; Seizures ; Status Epilepticus* ; Young Adult

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Clozapine Related EEG Changes.

Young Hoon LEE ; Jun Young LEE ; Jae Moon KIM

Journal of Korean Epilepsy Society.2007;11(1):50-53.

BACKGROUND: Clozapine is an "atypical" neuroleptic drug with low affinity at most dopamine receptors, and interact at several other classes of receptors. Although it has less adverse effects, clozapine has profound impact on EEG, and may cause seizures. We retrospectively reviewed medical records and EEGs in patients with clozapine to evaluate the prevalence and risk factors of EEG abnormalities and seizures. METHODS: 163 EEGs of 44 patients and their medical records were reviewed from Jan. 2000 to Jul. 2006. EEG was graded as follows: (0: Normal, 1: Less than 50% of theta waves, 2: More than 50% of theta or less than 50% of delta waves or grade 0/1 plus epileptic discharge, 3: More than 50% of delta waves or grade 2 plus epileptic discharge, and 4: Electroclinical seizure or marked low amplitude EEGs). Relation between the dosage of clozapine and EEG abnormalities, effect of anticonvulsant on seizure prevention were reviewed. RESULTS: Dosage of clozapine and EEG abnormality was closely related (P<.001). 82% (23/28) of the EEGs with less than 100 mg of clozapine were grade 0, whereas 8/83 (9.7%) EEGs were grade 0 with more than 400 mg of clozapine. Epileptic discharges were frequently found when clozapine dosage was 200 mg or more [27/130 EEGs (21%)]. Valproate administration did not prevent EEG deterioration in 4/13 patients as long as clozapine was increased. Although preventive treatment with valproate was done in 11 patients, seizures occurred in 2 patients. CONCLUSIONS: Abnormal EEGs were significantly correlated with dosage of clozapine. Efficacy of valproate can not be determined in the prevention of seizure induced by clozapine.
Clozapine* ; Electroencephalography* ; Humans ; Medical Records ; Prevalence ; Receptors, Dopamine ; Retrospective Studies ; Risk Factors ; Seizures ; Valproic Acid

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Psychiatric Manifestations and Risk Factors in Children with Seizure Disorders.

Hee Ryung WANG ; Hanik K YOO ; Mi Sun YUM ; Tae Sung KO

Journal of Korean Epilepsy Society.2007;11(1):40-49.

PURPOSE: This study was aimed to investigate the psychiatric manifestations in children with epilepsy and the associations with seizure-related variables. METHODS: The Korean version of the Child Behavior Checklist (K-CBCL) and the ADHD Rating Scale (K-ARS) were used to assess the psychopathology of 78 children with epilepsy (39 boys, mean age: 9.8+/-3.26 years-old) and 78 healthy comparisons matched for age and sex. RESULTS: Compared with healthy comparisons, children with epilepsy showed differences in the social, school, total competence scale, withdrawn, somatic complaints, social problems, thought, attention problems, aggressive behavior, internalizing and externalizing problem, and total behavior problem scores in the K-CBCL. Significant differences in the social, school, total competence scale, withdrawn, social problems, attention, and total behavior problem scales were found between groups in clinical spectrum and nonclinical spectrum. The inattentive, hyperactive/impulsive, and total scores of the K-ARS between groups were significantly different. In addition, the total scores of the K-ARS between subjects in clinical spectrum and nonclinical spectrum were different. The more the number of antiepileptic drugs, the higher significance of the score for aggressive behavior, sex problem, somatic complaints in the K-CBCL, and the inattentive scales in the K-ARS. In addition, the withdrawn, anxious/depressed and somatic complaints in the K-CBCL were correlated with sex, onset age and seizure type, respectively. CONCLUSIONS: Children with epilepsy may experience more various and serious psychiatric problems than healthy children. Responsiveness to antiepileptic drugs and seizure itself can be risk factors of psychiatric manifestations in epileptic children.
Age of Onset ; Anticonvulsants ; Checklist ; Child Behavior ; Child* ; Epilepsy* ; Humans ; Mental Competency ; Psychopathology ; Risk Factors* ; Seizures* ; Sexual Behavior ; Social Problems ; Weights and Measures

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The Effect of Folic Acid to the Level of Homocysteine and Analysis of the Factors in Epilepsy Patients.

Young Ho KOO ; Seung Hun OH ; Nam Keun KIM ; Su Jin BAE ; Ok Joon KIM

Journal of Korean Epilepsy Society.2007;11(1):33-39.

BACKGROUND: Folic acid has been frequently used for hyperhomocyesteinemia in various diseases and decreases the level of homocysteine. OBJECTIVES: To assess the effect of folic acid in the level of homocysteine in epilepsy patients, and to analyze factors affecting its responsiveness and the difference of its efficacy according to methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism. METHODS: Total 75 epilepsy patients with antiepileptic drugs (AEDs) therapy were included. 41 patients had normal level of homocysteine and 34 patients with hyperhomocysteinemia (> or =12 micro mol/ ) were supplemented with folic acid for 1 year. Thirty-four patients with hyperhomocyteinemia were divided into two groups according to the responsiveness of homocysteine to folic acid; decrease group (DG) and non-decrease group (NDG). RESULTS: The level of homocysteine in patients with hyperhomocysteinemia was significantly decreased after administration of folic acid, comparing with patients with normal level. DG was younger and had more male gender, shorter duration of seizure, and initial higher homocysteine level, compared to NDG (p<0.05). Patients with mutant type of MTHFR (CT+TT) had more decreased homocysteine level after supplement of folic acid, but had more increased homocysteine level without supplement of folic acid. Comparing between MTHFR genotypes, TT type had the most decreased homocysteine level than others, but there was no significance. CONCLUSION: Folic acid is useful treatment of hyperhomocysteinemia in epilepsy patients and the supplement of folic acid might be considered in patients with mutant type of MTHFR regardless of homocysteine level. The effect of folic acid supplement is greater in younger age, male sex, shorter duration of seizure, and initial higher homocysteine level.
Anticonvulsants ; Epilepsy* ; Folic Acid* ; Genotype ; Homocysteine* ; Humans ; Hyperhomocysteinemia ; Male ; Methylenetetrahydrofolate Reductase (NADPH2) ; Seizures

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Efficacy and Safety of Levetiracetam as Adjunctive Treatment in a Multicenter Open-Label Single-Arm Trial in Korean Patients with Refractory Partial Epilepsy: Over 1-Year Follow-Up.

Kyoung HEO ; Byung In LEE ; Sang Do YI ; Kyoon HUH ; Jae Moon KIM ; Sang Ahm LEE ; Dong Jin SHIN ; Hong Ki SONG ; Sang Kun LEE ; Jeong Yeon KIM

Journal of Korean Epilepsy Society.2007;11(1):25-32.

PURPOSE: This prospective, open-label study evaluated the efficacy and safety of adjunctive levetiracetam (LEV) in Korean adults with uncontrolled partial epilepsy. METHODS: A total of 100 patients whose partial seizures were inadequately controlled on their current antiepileptic drugs were enrolled and received LEV (1000-3000 mg/day). Seizure count and adverse events (AEs) were recorded by patients. Global evaluation scale (GES) and quality of life (QOLIE-31) were also evaluated. Additionally effectiveness over 1-year follow-up was investigated. RESULTS: Ninety-two patients completed the short-term 16-week trial. The median percent reduction in weekly seizure frequency over the treatment period was 43.2%. The > or =50% and > or =75% responder rates were 45.4% and 36.1%, respectively. Seizure freedom was observed in 17 patients throughout the initial 16-week treatment period. On investigator's GES, 81 patients were considered improved, with 41 patients showing marked improvement. Most QOLIE-31 scales improved significantly. At the end of the trial, 79 chose to continue follow-up treatment with LEV. At the follow-up visit (ranging 60 to 81 weeks), 64 patients were still taking LEV; during the last 16 weeks, 65.6% of patients had > or =50% reduction, 50.0% had > or =75% reduction, and 35.9% had a 100% reduction. Seven patients showed continuous seizure freedom from the initiation of LEV treatment. During the entire treatment period, LEV was withdrawn in 36 patients; due to lack of efficacy in 22, AEs in six, both in three, other reasons in five. CONCLUSION: Adjunctive LEV therapy in patients with refractory partial epilepsy was effective and well-tolerated, as evidenced by the high seizure freedom and retention rates in both the short-term trial and the long-term follow-up.
Adult ; Anticonvulsants ; Epilepsies, Partial* ; Epilepsy ; Follow-Up Studies* ; Freedom ; Humans ; Prospective Studies ; Quality of Life ; Seizures ; Weights and Measures

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A Pediatric Case of Topiramate Treatment for Refractory Status Epilepticus.

So Yeon KIM ; Jin Kyung KIM ; Jun Hwa LEE

Journal of Korean Epilepsy Society.2004;8(2):171-174.

The definition of refractory status epilepticus (RSE) is the state of epilepticus that persists for longer than 60 minutes despite an adequate dose of benzodiazepine and an antiepileptic drug. Topiramate is a broad-spectrum antiepileptic drug used as a monotherapy as well as an adjunctive therapy in the treatment of epilepsy. We encountered a 32-month-old girl with RSE, who showed spastic quadriplegia, hydrocephalus and a previous history of 3 times recurrence of status epilepticus in the presence of global development. Although the girl was treated with lorazepam, phenytoin, phenobarbital and even with midazolam, seizure lasted for more than 60 minutes. Through pentobarbital coma, seizure was controlled clinically on the state of EEG. However, it recurred. Therefore, the patient was treated with an overdose amount of topiramate (10 mg/kg/day) by nasogastric tube without titration as an add-on therapy and then treated with a reduced amount of topiramate (4 mg/kg/day). Finally, the seizure became controlled.
Benzodiazepines ; Child, Preschool ; Coma ; Electroencephalography ; Epilepsy ; Female ; Humans ; Hydrocephalus ; Lorazepam ; Midazolam ; Pentobarbital ; Phenobarbital ; Phenytoin ; Quadriplegia ; Recurrence ; Seizures ; Status Epilepticus*

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Complex Partial Seizure Like Symptoms Presented by a Patient with Insulinoma and Hyperproinsulinemia.

Young Rok DO ; Oh Dae KWON ; Ji Eun KIM ; Jin Kuk DO ; Dong Kuck LEE

Journal of Korean Epilepsy Society.2004;8(2):167-170.

Insulinoma with hyperproinsulinemia and normal serum insulin level is a rare disease. Because of the neuroglycopenic symptoms, the initial diagnosis tends to be made as epilepsy or as psychosis. A 43-year-old man was admitted to our hospital because of recurrent confusional episodes. Symptoms are intermittent and consist of staring, confusion, amnesia, and bizarre behavior. Vital signs during the episode were normal but the serum glucose level was 27 mg/dl. The serum level of insulin during the episode was lower than normal and those of proinsulin and growth hormone were higher than normal. Solitary pancreatic mass was found by abdominal CT, measuring 15 mm in diameter. Pathologic evaluation showed islet cell tumor. This suggests that the serum level of proinsulin should be checked when insulinoma with neuroglycopenic symptom is suspected.
Adenoma, Islet Cell ; Adult ; Amnesia ; Blood Glucose ; Diagnosis ; Epilepsy ; Growth Hormone ; Humans ; Insulin ; Insulinoma* ; Proinsulin ; Psychotic Disorders ; Rare Diseases ; Seizures* ; Tomography, X-Ray Computed ; Vital Signs

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A Case of Idiopathic Localized Hypertrophic Pachymeningitis Presented with Partial Seizures.

Yoon Jeong CHOI ; Sook Hui KIM ; Jee Young KIM ; Yong Jae CHO ; Shi Nae LEE ; Heasoo KOO ; Hyang Woon LEE

Journal of Korean Epilepsy Society.2004;8(2):163-166.

Idiopathic hypertrophic pachymeningitis is a clinical disorder caused by a localized or diffuse thickening of the dura mater, with an associated chronic inflammation. This can be diagnosed when there is no evidence of other etiologies such as trauma, infection, tumors, and Wegener's disease. Clinical manifestations are chronic headache with or without neurological manifestations such as cranial nerve palsies, cerebellar ataxia, neuro-ophthalmologic complications, and rarely clinical seizures. We described a patient with simple partial seizures with focal sensory and motor symptoms in the right hand as an initial and the only clinical manifestation, accompanied by a tumor-like lesion in the left parietal convexity on brain MRI. The patient underwent a lesionectomy, and the seizures have been well controlled so far without immunosuppressant treatment.
Brain ; Cerebellar Ataxia ; Cranial Nerve Diseases ; Dura Mater ; Epilepsies, Partial ; Hand ; Headache Disorders ; Humans ; Inflammation ; Magnetic Resonance Imaging ; Meningitis* ; Neurologic Manifestations ; Rabeprazole ; Seizures*

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