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Newly-Developde Psychosis Following Temporal Lobectomy : 2 Cases.

Sang Ahm LEE ; Sung Yoon KIM ; Soo Bin YIM ; Joong Koo KANG ; Jung Kyo LEE

Journal of Korean Epilepsy Society.1999;3(2):209-212.

Psychosis is the most severe psychiatric complication of epilepsy surgery, We report two cases of newly-developed psychosis after temporal lobectomy, First case is a 46-year-old man with mesial temporal lobe epilepsy who presented recurrent postictal psychosis 1 year after right temporal lobectomy. Second case is a 44-years-old woman who presented chronic psychosis 6 month after left temporal lobectomy. Main psychotic symptoms were paranoid persecutory delusion. The common features in both cases were middle age, ling duration of epilepsy, and bilateral independent spike on preoperative EEG. Even if postoperative psychosis is rare, careful observation is needed because temporal lobectomy is an ever-increasing treatment.
Delusions ; Electroencephalography ; Epilepsy ; Epilepsy, Temporal Lobe ; Female ; Humans ; Middle Aged ; Psychotic Disorders*

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Vigabatrin-Induced Multifocal Action Myoclonus in a Patient with Partial Epilepsy.

Sang Ahm LEE ; Jong Pil JEONG ; Joong Koo KANG

Journal of Korean Epilepsy Society.1999;3(2):206-208.

Vigabatrin-induced myoclonus is rarely described in adult with partial epilepsy, We report vigavatrin-induced mulrifocal action myoclonus in a 34 year-old female with symptomatic partial epilepsy. Hwe seizures were resistant to catbamazepine. Vigabatrin was started as add-on therapy and multifocal action myoclonus was developed one month later. Myoclonus disappeared after withdrawal of vigabatrin and reappeared with re-use of it. Based on clinical features of myoclonus, her myoclonus may be non-epileptic in nature.
Adult ; Epilepsies, Partial* ; Female ; Humans ; Myoclonus* ; Seizures ; Vigabatrin

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The Pharmacokinetic Interaction and Therapeutic Plasma Concentration of Oxcarvazepine.

Joong Koo KANG ; Hyun Ok YANG ; Shin Young PARK ; Yang Hee JEONG ; Kyu Hwan KWAK ; Sang Ahm LEE

Journal of Korean Epilepsy Society.1999;3(2):200-205.

PURPOSE: Oxcarbazepine (OXC) is chemically related to carbamazepine (CBZ). OZC exerts less liver enzyme induction than CBZ and is completely metabolized by reduction to the active metabolite, 10, 11-dihydro-10-hydroxy-5H-dibenzo (b,f) azepine-5-carboxamide (MHD). It was known that OXC had no significant pharmacokinetic interactions with other antiepileptic drugs. But it is not thoroughly studied yet because of short duration of clinical application. We investigated whether the plasma concentration of OXC metabolite (MHD) is changed by valproic acid compared with OXC monotherapy and studied the correlation of the dose of OXC with the plasma concentration of its active metabolite (MHD). METHODS: The patient with OXC monotherapy (19 cases) and patients with OXC and valproic acid(16 cases) were incluses. We analyzed the level of its metabolites MHD by HPLC RESULTS: The plasma concerntration of MHD in OXC monotherapy is 15.5+/-3.2 microgram/ml and that of the MHD in polytherapy with valproic acid is 16.4+/-3.4 microgram/ml at the same dose of OXC. The plasma concentration of MHD is ranged from 7.4 microgram/ml at 600 mg/day of OXC to 27.0 microgram/ml at 1800 mg/day of OXC and highly correlated with OXC dose per body weight (r=0.72-84). CONCLUSION: There is no significant change or difference of MHD plasma concentraion between OXC monotherapy and polytherapy with valproic acid at the same dose of OXC. THe plasma concentration of MHD is highly correlated with OXC dose per body weight.
Anticonvulsants ; Body Weight ; Carbamazepine ; Chromatography, High Pressure Liquid ; Enzyme Induction ; Humans ; Liver ; Plasma* ; Valproic Acid

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Personality Evaluation of Intractable Epilepsy Patients and the Postsurgical Change.

Su Jung CHOI ; Jiyeong YI ; Yeonwook KANG ; Dae Won SEO ; Seung Chyul HONG ; Seung Bong HONG

Journal of Korean Epilepsy Society.1999;3(2):195-199.

BACKGROUND: Epilepsy patients may have a various whole gamut of psychological problems attending upon, in part or in whole, epileptic seizure focus. To investigate psychological problems related to epileptic focus and their postsurgical change, personality evaluation was performed in medically intractable epilepsy patients before and after the epilepsy surgery. METHODS: There were 103 temporal lobe epilepsy (TLE) patients with or without hippicampal sclerosis (HS) and 22 extratemporal lobe epilepsy (XTLE). We used MMPI as an objective method of assessing emotional state and personality profile of the patients. The preoperative MMPI scales were compared between the TLE group and the XTLE group, between TLE with HS group and without HS group (NHS), and right and left TLE groups. In addition, the postsurgical changes of MMPI scales were analyzed upon only 31 TLE patients who had preoperative and postoperative MMPI RESULTS: First of all, in terms of mean value of each scale, all results observed were within normal range. When these results were analyzed using t-test, the scores of social introversion were significantly higher in HS group than in NHS group. Secondly, there were significant postoperative decrease of depression, hypochondriasis, psychasthenia, schizophrenia scales in HS groups and mascu-linity-frminity scale in NHS group. There was no significant difference of MMPI scales between TLE and XTLE CONCLUSION: The results of this study that hippocampal sclerosis may affect the preoperative personality and the removal of pathologic hippocampus may improve MMPI scales.
Depression ; Epilepsy* ; Epilepsy, Temporal Lobe ; Hippocampus ; Humans ; Hypochondriasis ; Introversion (Psychology) ; MMPI ; Reference Values ; Schizophrenia ; Sclerosis ; Weights and Measures

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An Analysis of Results of Surgical Treatment of Epilepsy at National Epilepsy Center in Japan.

Jin Kyu SONG ; Tadahiro MIHARA

Journal of Korean Epilepsy Society.1999;3(2):186-194.

PURPOSE: The neurosurgical group of the National Epilepsy Center in Japan has been operating on epileptic patients for 17years. In recent 10 years, The 387 patients that have been operated on have enjoyed positive results. in this study, the authors will attempts to make a scheme for surgical treatment of epilepsy based upon the analysis of the patients who were treated with surgery METHODS: THe authors investugated the influenced of advanced in diagnostic procedures. In order to study the relationship between the previous disease and the histologic results, we divided the 152 temporal lobe epilepsy patients who received a resection of both medial temporal structure and lateral neocortex two groups : those with hippocampal sclerosis and those with some other histologic finding. For analysis, patients were divided into 3 groups : first, a lesional group : second, a skip group that had no chronic intractanial recording : third, an intracranial recording group. The results at 2 years, 5 years, 8 years, and 10 years after surgery were studied based on Engel's classification RESULTS & CONCLUSION: With the development of better diagnostic equipment, the incidences of epilepsy surgery have increased, while the percentage of the cases requiring invasive diagnostic procedure has been decreased overall. Not only have the cases of surgery for temporal lobe epilepsy increased but also for extratemporal epilepsy as well. Mesial temporal sclerosis and cortical migration disorder were the most common lesions requiring operative treatment. Febrile status epilepticus in childhood was the most common etiology of epilepsy found. Eighteen children among the twenty-three who had been operated were lesional cases. Longterm follow up studies up studies up to 10 years after surgery shows no worsening in patients condition based on Ecgel's grade of temporal lobe epilepsy.
Child ; Classification ; Diagnostic Equipment ; Epilepsy* ; Epilepsy, Temporal Lobe ; Follow-Up Studies ; Humans ; Incidence ; Japan* ; Malformations of Cortical Development ; Neocortex ; Sclerosis ; Status Epilepticus

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Usefulness of ICTAL (99m)TC-ECD Brain SPECT for Pre-Surgical Evaluation in Temporal Lobe Epilepsy.

Joong Koo KANG ; Sang Ahm LEE ; Hyeo Il MA ; Jin Sook RYU ; Do Young KANG ; Jung Kyo LEE

Journal of Korean Epilepsy Society.1999;3(2):180-185.

PURPOSE: We evaluated usefulness of ictal (99m)Tc-ECD SPECT in temporal lobe epilepsy (TLE) patients for per-surfical evaluation and also correlated ictal SPECT patterns with the semiology of seizures. We also investifated whether there are any differences in ictal SPECT pattern between temporal lobe seizures with or without secondary generalized tonic-clonic seizure (GTC). METHODS: ictal SPECT was performed in 26 TLE patients who had unlateral hippocampal atrophy (20 patients), other focal remporal lesions (4 patients), and normal MRI finding (2 patients). All patients underwent temporal lobectomy with a minimim 27 months follow-up with excellent post-surgical seizure outcome (Engel's classification class I). During CCTV monitoring (99m)Tc-ECD was injected during ictal peroid in all patients with a mean delay of 37.5+/-13.3 sec after seizure onset (mean seizure duration : 99.3+/-38.0 sec). Ictal SPECT was visually analysed by two blinded observers. RESULTS: Ictal (99m)Tc-ECD SPECT showed unilateral temporal hyperperfusion concordant with epileptogenic foci in 25/26 (96.2%). The hyperperfusion of the ipsilateral basal ganglia was evident in 12/19 (63.2%) during contralateral (or predominantly contralateral) hand dystonic/ tonic posture. The contralateral cerebellar hyperperfusion was observed in the 6/26 (23.1%). Seizures with secondary GTC at the time of injection showed brainstem and bilateral thalamic hyperperfusion in 6/8 (75.0%) and seizures without secondary GTC at the time of injection showed brainstem and bilateral thalamic hyperperfusion in 2/18 (11.1%). There was significant difference between two groups (p<0.01). CONCLUSION: L Ictal (99m)Tc-ECD SPECT is a useful method to localize the epileptic foci for pre-surfical evaluation and the hyperperfusion of bilateral thalamus and brainstem is significantly frequent during secondary generalization of temporal lobe seizure.
Atrophy ; Basal Ganglia ; Brain Stem ; Brain* ; Classification ; Epilepsy, Temporal Lobe* ; Follow-Up Studies ; Generalization (Psychology) ; Hand ; Humans ; Magnetic Resonance Imaging ; Posture ; Seizures ; Temporal Lobe* ; Thalamus ; Tomography, Emission-Computed, Single-Photon*

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Status Epilepticus in Adult Hospitalizde Patients: Cause and Clinical Outcome.

Hwi Chul CHOI ; Hong Ki SONG ; Byung Chul LEE

Journal of Korean Epilepsy Society.1999;3(2):174-179.

Background AND PURPOSE: Status epilepticus (SE) is one of the major neurological emergency that requires immediate treatment to avoid significant morbidity and mortality. Thus, understanding the cause, features and prognosis of SE is important for the evaluation and treatment of this condition. We retrospectively reviewed the possible cause and clinical outcome of adult patients treated for SE at the Hallym Univrsity Hospital from 1994 to 1998. METHODS: For the identification of patients, we searched the data bank for patients meetinf criteria of SE who were 18 year or older, and their medical records were reviewed. We also investigated the relationships between cause, response to anticonvulsant therapy and short-term clinical outcome. RESULTS: The selected 127 patients wer 84 males and 43 females, aged 18 to 85 yeats (meen age: 49.5 years). The possible etiologies of SE were withdrawal of AED (n=27, 21.3%), anoxia (n=22, 17.3%), CNS infection (n=20, 15.7%), stroke (n=16, 12.6%), alcohol-related (n=15, 11.8%), metabolic (n=8, 6.3%), unknown (n=7, 5.5%), drug inroxicatio (n=5, 3.9%), trauma (n=4, 3.2%) and cerebral tumor (n=3, 2.4%). in 77 patients (n=77, 60.6%), SE was successfully aborted with first-line therapy, which usually included diazepam with or without phenytoin. The food responders to AEDs occurred in patients with AED withdrawal, alcohol-related, stroke, unknown, and trauma, The poor response related to anoxia, drug intoxication and CNS infection. Seventy nine patients (62.2%) had food outcome, but nineteen patients (14.9) were died. Anoxia, drug intoxication, CNS infection and metabolic abnormalities were associated with particularly poor outcome compared with other etiologies. CONCLUSION: This study indicates that the etiology of SE may help predict both the intial response to drug therapy and short-term clinical outcome.
Adult* ; Anoxia ; Diazepam ; Drug Therapy ; Emergencies ; Female ; Humans ; Male ; Medical Records ; Mortality ; Phenytoin ; Prognosis ; Retrospective Studies ; Status Epilepticus* ; Stroke

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Effect of Body Temperature on Seizure and Hippocampal Damage in Rats with Lithium-Pilocarpine Induced Status Epilepticus.

Kwang Soo LEE ; Yeong In KIM ; Sung Woo CHUNG ; Beum Soeng KIM

Journal of Korean Epilepsy Society.1999;3(2):164-173.

BACKGROUND: To investigate the effect of body temperature on seizure and hippocampal damage in the lithium and pilocarpine-induced status epilepticus METHODS: We pretreated the Sprague-Dawley rats with lithium (3mEq/kg) and pilocapine (30 mg/kg) and divided into three groups by their body temperatures which were maintained at normothermia (36.5+/-0.5 degrees C), hyperthermia(40.0+/-0.5 degrees C) and hypothermia (320+/-0.5 degrees C). Each group was maintained in a state of status epilepticus with assigned body temperatyre for 4 hours. After 24 hours, the rats were sacrificed, the pattern of EEG changes and degree of hippocampal cellular damage were compared between different groups. RESULTS: (1) Progression of typical EEG pattern of status epilepticus were observed in normothermic group ; discrete ictal discharge with slowing (30 min), wax and waning ictal discharge (60 min), continuous ictal discharge (90 min), continuous ictal discharge with flat period (180 min) and periodic epileptiform discharge (240 min) in time orfer. In hyperthermic group, the progression of EEG pattern was more rapid tha that od normothermic group ; continuos ictal dischatge was appeared within 30 minutes and periodic epileptiform discharge was within 90 minutes. On the other hand, the hypothermic group showed delayed evolution and wax and waning ictal discharge persisted until 240 minutes. (2) The survived neuronal cellular counts at CA1 and CA3 area of ventral hippocampus were compared between each group. The survived neuronal cellular counts were 90.9+/-5.55 (CA1) and 73.9+/-5.15 (CA3) in hypithermic group, 56.1+/-5.38 (CA1) and 40.6+/-7.03 (CA3) in normothermic group and 42.7+/-4.08 (CA1) and 31.7+/-4.64 (CA3) in hyperthermic group (p<0.05). CONCLUSION: The body temperatyre might influence the severity of seizure and seizure-induced brain damage. Hyperthermia aggravated the severity of seizure and seizure induced hippocampal damage, while hypothermia inhibited them.
Animals ; Body Temperature* ; Brain ; Electroencephalography ; Fever ; Hand ; Hippocampus ; Hypothermia ; Lithium ; Neurons ; Rats* ; Rats, Sprague-Dawley ; Seizures* ; Status Epilepticus*

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Effect of MK-801 on Neuronal Cell Loss and Fos Expression of Hippocampus in Lithium-Pilocarpine Induced Status Epilepticus.

Kwang Soo LEE ; Yeong In KIM ; Jeong Wook PARK ; Sung Woo CHUNG ; Sang Bong LEE

Journal of Korean Epilepsy Society.1999;3(2):155-163.

BACKGROUND & OBJECTIVES: Endogenous excitatory amino acid has been implicated in neuronal damages occurred neurotransmitter in the CNS, Exerts its neurotoxic activity primarily by binding to the NMDA receptor, one of the three glutamate receptors, We evaluated the effect of MK-801, a non-competitive NMDA receptor antagonist, on both Fos expression and neuronal damages in lithium-pilocarpine induced status epilepticus rat model. METHODS: Seizured was induced in rats by lithum pretreatment followed by low dose of pilocarpine (30 mg/kg, ip). MK-801 (1 mg/kg) was treated 15 min before (MK-801 Pre group, N=5) or 20 min after the injection of pilocarpine (MK-801 Post group, N-5). Saline, instead of MK-801, was injected for the Control group (N=5). RESULTS: Seizure-induced neuronal damages, which was evaluated by the counting of the number of viable pyramidal cells in the area of CA1 and CA3 of the hippocampus, were significantly inhibited by MK-801 in both MK-801 Pre and Post groups. This protective effect of MK-801 was observed only in the CA1 area and was not typical in the CA3 area in both groups, and there was no differences in MK-801 activity between Pre and Post group. We also examined the expression of Fos, which has been known to be involved in long-term neuronal plasticty or delayed neuronal insults, by the immunohistochemical analysis in the hippocampus and thalamus. Pilocarpine induced Fos expression significantly in the Control group and moderately in the MK-801 Post groups, whereas, it was completely blocked by the pretreatment of MK-801 in hippocampus. CONCLUSION: Our results showed that MK-801 prevented the hippicampal cells from neuronal damages as well as inhibited Fos expression in the pilocarpine-induced rat seizure models. These results suggest the roles of NMDA receptor and Fos protein in seizure-related hippicampal damages.
Animals ; Dizocilpine Maleate* ; Excitatory Amino Acids ; Hippocampus* ; Models, Animal ; N-Methylaspartate ; Neurons* ; Neurotransmitter Agents ; Pilocarpine ; Pyramidal Cells ; Rats ; Receptors, Glutamate ; Seizures ; Status Epilepticus* ; Thalamus

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A Preliminary Study for the Estimation of the First Positive Lyapunov Exponent of the EEG in Experimental Status Epilepticus Rats.

Kwang Soo LEE ; Yeong In KIM ; Sang Bong LEE ; Doi Jin KIM ; Jae Seung JEONG ; Soo Yong KIM

Journal of Korean Epilepsy Society.1999;3(2):150-154.

BACKGROUND AND OBJECTIVES: The hypothesis that brain is a nonlinear dynamic system exhibiting deterministic chaos has offered new methods to the investigation of information processing in the brain by analysis and classification of EEG signals. We used the first positiveLyapunov exponent (L1) which is one of indicator of nonlinear dynamic to evaluate the brain function in chemical seizure models METHODS: Lithium-Pilocarpine induced seizure model and kainic acid induced seizure model are used. From serial EEG according to seizure stages. 32.768 sec of data (16.384 data point) were recorded and digirized by a 12-bit analog-digital converter in an IBM PC. The data from serial EEG according to seizure stageswere analyzed for determining the L1. We used the time delays calculated by the method of mutual information to reconstruct the attactor. Time delays of 46-58 msec and enbedding dimensions of 13-19 were used for chemical seizure model. The L1 were calculated for 4 channels. RESULTS: The averaged valued of L1 were serially decreased in both lithium-pilocarpin model and kainic acid model according to increasing seizure stages. CONCLUSION: Our results reveal the decrease of the chaotic activity according to increasing seizure stage. It is suggested that the brain has decreased information procedding and a less flexible neural network during seizure. However further evaluation is required because the significance of these changes are not confirmed.
Animals ; Automatic Data Processing ; Brain ; Classification ; Electroencephalography* ; Kainic Acid ; Nonlinear Dynamics ; Rats* ; Seizures ; Status Epilepticus*

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