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An Intracranial Metallic Nail Manifesting as Late Onset Epileptic Seizures.

Hee Young SHIN ; Jung Im SEOK ; Ki Young JUNG ; Dae Won SEO ; Jung Il LEE ; Seung Kyu CHUNG ; Seung Bong HONG

Journal of Korean Epilepsy Society.2004;8(1):65-67.

A 32-year-old man with an intracranial nail lodged in the right temporo-occipital lobes for 21 years presented late onset epileptic seizures. His neurologic examination revealed no abnormality and electroencephalography showed only continuous slow waves localized in right temporo-occipital region. Skull X-ray showed the nail head was caught in the posterior maxillary wall and the nail body was through the temporal lobe. After removing the nail, his postoperative course was uneventful, and he has become seizure-free. The metallic nail was toxic to the adjacent brain and may have caused chronic inflammation, which may have been a cause of remote onset epileptogenesis.
Adult ; Brain ; Electroencephalography ; Epilepsy* ; Head ; Humans ; Inflammation ; Neurologic Examination ; Skull ; Temporal Lobe

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Simple Partial Status Epilepticus Localized by SPECT Subtraction in Chronic Cerebral Paragonimiasis.

Eun Yeon JOO ; Jee hyun KIM ; Hyung Jin KIM ; Hee Young SHIN ; Woo Suk TAE ; Ki Young CHUNG ; Dae Weo SEO ; Seunghwan KIM ; Seung Bong HONG

Journal of Korean Epilepsy Society.2004;8(1):61-64.

A patient with chronic cerebral paragonimiasis began to have new motor seizures of the right face clonic contractions that occurred several hundred times a day resulting in the simple partial status epilepticus. The ictal EEG discharge started from the left frontal region and then spread to the left hemisphere. The ictal discharges were limited clearly to the left hemisphere. The brain MRI showed the multiple conglomerated round nodules with encephalomalacia in the left temporo-occipital lobes. Applying the ictal-interictal subtracted SPECT, we were able to localize the focal ictal hyperperfusion on the left precentral cortex adjacent to the lesions that correspond to the anatomical distribution of the left face motor area.
Brain ; Electroencephalography ; Encephalomalacia ; Epilepsies, Partial ; Humans ; Magnetic Resonance Imaging ; Paragonimiasis* ; Seizures ; Status Epilepticus* ; Subtraction Technique ; Tomography, Emission-Computed, Single-Photon*

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The Effect of Resection Extent Upon Postoperative Outcome of Seizures and Memory in Anterior Temporal Lobectomy with Amygdalohippocampectomy.

Eun Yeon JOO ; Eun Kyung LEE ; Woo Suk TAE ; Jee Hyun KIM ; Sun Jung HAN ; Joo Hee JIN ; Dae Won SEO ; Seung Chyul HONG ; Moon Hyang LEE ; Hong Sik BYUN ; Myoung Hee KIM ; Seunghwan KIM ; Seung Bong HONG

Journal of Korean Epilepsy Society.2004;8(1):54-60.

PURPOSE: To investigate the relationship of the resection extent of hippocampus and temporal neocortex with the postsurgical outcome in patients with mesial temporal lobe epilepsy (TLE). METHODS: Sixty-eight patients with TLE underwent brain MRI pre- and post-operatively. They were divided into two groups by seizure outcomes:seizure free group (SF, N=54) and non-seizure free group (NSF, N=14). Patients were classified further according to the post-surgical memory changes:MD group (with postsurgical memory decline, N=15) and NMD group (without postsurgical memory decline, N=16). The hippocampal resection was estimated by subtracting the length of post-surgical hippocampus from the pre-surgical length. The resection of temporal neocortex was measured by comparing the resection lengths on superior, middle, inferior and basal temporal gyri shown on three dimensional brain MRI. RESULTS: The mean extent of hippocampal resection was significantly larger in SF than in NSF (33.2+/-7.5 mm vs. 24.8+/-7.4 mm p=0.001) while that between MD and NMD was not significantly different. The resection extent of temporal neocortex was not significantly different between SF and NSF as well as between MD and NMD, but the resection extent of basal temporal gyrus of left TLE was significantly larger in MD than in NMD. CONCLUSIONS: The hippocampal resection was significantly greater in SF. The overall resection extent of the temporal neocortex did not correlate to the surgical outcomes of seizures or memory although that of the basal temporal gyrus of the left TLE was larger in MD.
Anterior Temporal Lobectomy* ; Brain ; Epilepsy, Temporal Lobe ; Hippocampus ; Humans ; Magnetic Resonance Imaging ; Memory* ; Neocortex ; Seizures*

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Effect of Seizure on Hippocampus in Mesial Temporal Lobe Epilepsy and Neocortical Epilepsy: MR Spectroscopy Study.

Dong Wook KIM ; Sang Kun LEE ; Chun Kee CHUNG ; In Chan SONG ; Kee Hyun CHANG

Journal of Korean Epilepsy Society.2004;8(1):47-53.

PURPOSE: This study was performed to evaluate the effect of seizures on the bilateral hippocampus in mesial temporal lobe epilepsy (mTLE) and neocortical epilepsy by single voxel proton magnetic spectroscopy. METHODS: Forty-one patients with mTLE having unilateral hippocampal sclerosis and 43 patients with a neocortical epilepsy who underwent subsequent epilepsy surgery were recruited. Ninety-five percent confidence intervals of N-acetyl aspartate/choline (NAA/Cho) and NAA/creatine (NAA/Cr) ratios in 20 healthy control subjects were used as threshold values to determine abnormal NAA/Cho and NAA/Cr. The relationship between the results of MRS and the duration of epilepsy, the frequency of seizure, the effect of secondary generalized tonic clonic seizures (2GTCS), and the postsurgical outcome was evaluated. RESULTS: NAA/Cho and NAA/Cr were significantly lower in the ipsilateral hippocampus of mTLE and neocortical epilepsy. NAA/Cho was abnormally low in the ipsilateral hippocampus in 43.9% (18/41) and bilateral hippocampus in 26.8% of mTLE patients. Ipsilateral or bilateral abnormal NAA/Cr was detected in 46.3% (19/41) of mTLE. NAA/Cho was abnormally lower in the ipsilateral hippocampus in 27.9% and bilateral hippocampus in 41.9% of neocortical epilepsy patients. Ipsilateral or bilateral abnormal NAA/Cr was detected in 32.6% of the patients with neocortical epilepsy. Using AIs for patients with bilaterally abnormal ratios of NAA/Cho and NAA/Cr combined with unilateral abnormal ratio, the seizure focus was correctly lateralized in 65.9% of the patients with mTLE and 48.8% of neocortical epilepsy patients. Bilateral NAA/Cho abnormality was significantly related with a poor surgical outcome in mTLE. No significant relationship was found between the results of NAA/Cho or NAA/Cr and the surgical outcome in neocortical epilepsy. The mean contralateral NAA/Cr ratio of the hippocampus in mTLE was significantly lower in patients with a history of the secondary generalized tonic clonic seizure (2GTCS) than in those without it. CONCLUSIONS: Our results demonstrate functional abnormality of the hippocampus in neocortical epilepsy and the relation between 2GTCS and NAA/Cr of the contralateral hippocampus in mTLE. This proves the presence of the seizure effect on the hippocampus in neocortical epilepsy as well as in mTLE.
Epilepsy* ; Epilepsy, Temporal Lobe* ; Hippocampus* ; Humans ; Magnetic Resonance Spectroscopy* ; Protons ; Sclerosis ; Seizures* ; Spectrum Analysis ; Temporal Lobe*

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The Clinical Findings of Unitemporal and Bitemporal Glucose Hypometabolism in Mesial Temporal Lobe Epilepsy.

Eun Yeon JOO ; Seung Bong HONG

Journal of Korean Epilepsy Society.2004;8(1):41-46.

PURPOSE: To identify clinical characteristics in patients with unitemporal hypometabolism (UTH) or bitemporal hypometabolism (BTH) in mesial temporal lobe epilepsy (TLE). METHODS: We enrolled 95 patients with mesial TLE, 87 of whom subsequently had a surgery. Seizures, interictal and ictal EEG, brain MRI, Wada test, and neuropsychological test results were reviewed. (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET) scans were visually interpreted. Patients were divided into two groups, UTH and BTH. RESULTS: There were 59 UTH patients and 36 BTH patients. Semiology showed that UTH had higher frequencies of aura and unilateral dystonic posturing than BTH, whereas BTH had higher frequencies of a non-lateralized bilateral ictal EEG pattern and of bilateral interictal spikes than UTH. Moreover, BTH had symmetric Wada memory scores more frequently than UTH, and white matter changes of the bilateral temporal lobes in brain MRI were more frequent in BTH than UTH. All UTH patients with bilateral TLE in scalp EEG showed unilateral seizure onset in intracranial EEG. CONCLUSION: The characteristic clinical findings of mesial TLE patients with BTH were more frequent non-lateralized ictal EEG pattern, bitemporal interictal spikes, symmetric Wada memory score, the presence of anterior temporal white matter changes, and less frequent aura, and unilateral dystonic posturing. Surgical outcomes were similar and good in both groups although surgery could not be performed in 8 (22.2%) BTH patients.
Brain ; Electroencephalography ; Epilepsy ; Epilepsy, Temporal Lobe* ; Glucose* ; Humans ; Magnetic Resonance Imaging ; Memory ; Neuropsychological Tests ; Positron-Emission Tomography ; Scalp ; Seizures ; Temporal Lobe*

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Relations between Demographic, Clinical, Psychopathological Characteristics and the Ways of Coping for Psychosocial Adjustment in Epileptic Patients.

Hun Jeong EUN ; Goan Ho CHOI ; Sun Mi LEE ; Tae Hyoung KIM ; Mal Rye CHOI

Journal of Korean Epilepsy Society.2004;8(1):31-40.

PURPOSE: The purpose of this study is to understand the relations of demographic and clinical characteristics, psychopathology and ways of coping with psychosocial adjustment of epileptic patients. METHODS: The participants were 200 epileptic outpatients. They completed Korean version of Washington Psychosocial Seizure Inventory (K-WPSI), Symptom Check List-90-Revised (SCL-90-R) and The Ways of Coping Checklist (WCC). RESULTS: The results showed that frequency of seizure, education level, socioeconomic level, occupation, all of subscales in SCL-90-R and passive coping styles were significantly related to overall psychosocial functioning of epileptic patients. The global severity index score that indicated present psychopathology of SCL-90-R best explained overall psychosocial functioning. And the frequency of seizure, education level, socioeconomic level, occupation, and somatization were also significant factors. The global severity index score was explained by emotional focused coping, socioeconomic level, frequency of seizure, and problem focused coping. CONCLUSIONS: The results of this study suggested that psychosocial adjustment of epileptic patients showed a significant relations with psychopathology, clinical and socioeconomic factors and the ways of coping.
Checklist ; Education ; Epilepsy ; Humans ; Occupations ; Outpatients ; Psychopathology ; Seizures ; Socioeconomic Factors ; Washington

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Antiepileptic and Neuroprotective Effect of Ketamine in Lithium-Pilocarpine Induced Status Epilepticus Rat Model.

Seok Bum KO ; Soung Kyeong PARK ; Young Min SHON ; Yeong In KIM

Journal of Korean Epilepsy Society.2004;8(1):26-30.

PURPOSE: To examine the putative seizure-protective properties of ketamine in lithium-pilocarpine induced status epilepticus (LPSE). METHODS: Lithium chloride followed 24 h later by pilocarpine was administered for seizure induction. Ketamine (40 mg/kg) or phenytoin (50 mg/kg) was injected intraperitoneally 10 min or 60 min after the onset of continuous ictal discharge. Then the seizure behavior and EEG were observed and histological changes were compared through Nissl stain at 72 hours. RESULTS: The antiepileptic effect of ketamine, injected during the early stages of LPSE (10 min after the onset of continuous ictal discharge), was comparable to that of phenytoin. Ketamine was more effective than phenytoin in decreasing spike frequency, when administered on the plateau of LPSE (injection 60 min after onset of continuous ictal discharge electrographically). Anticonvulsant action of ketamine was confirmed by a less neuronal injury in hippocampus compared with control rats injected with phenytoin. CONCLUSIONS: In prolonged status epilepticus rat model, ketamine was effective as an antiepileptic, but phenytoin was not. Ketamine was also neuroprotective on the neuronal injury in the hippocampus. These results suggest that ketamine might be useful as an antiepileptic drug when standard antiepileptic drugs fail in the treatment of the refractory cases of status epilepticus.
Animals ; Anticonvulsants ; Electroencephalography ; Hippocampus ; Ketamine* ; Lithium Chloride ; Models, Animal* ; Neurons ; Neuroprotective Agents* ; Phenytoin ; Pilocarpine ; Rats* ; Seizures ; Status Epilepticus*

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Cognitive Effects of Newer Antiepileptic Drugs.

Sang Ahm LEE

Journal of Korean Epilepsy Society.2004;8(1):18-25.

People with epilepsy are at increased risk of cognitive impairment as a result of multiple factors:the underlying etiology of epilepsy, the effects of seizures themselves, and the central nervous system effects of antiepileptic drugs (AEDs). Cognitive effects of AEDs are of special concern because AEDs are the major therapeutic modality for seizures. All commonly used AEDs have some effect on cognitive function. The risk of AEDs cognitive adverse effects is increased with polypharmacy and at higher dosages and higher AED blood levels. Also children and the elderly are especially vulnerable to adverse effects on cognition. The most common AED cognitive effects include psychomotor slowing, reduced vigilance, and impairments in memory. This review focuses on studies of the cognitive effects of the new AEDs, and in particular on studies that compare cognitive effects of the old and new drugs. The available evidence is insufficient to support definite conclusions about the cognitive effects of the new AEDs. Neuropsychological testing has been the major method of objectively examining cognitive function related to the use of AEDs but a number of methodological problems blur the results. However, some of the new AEDs appear to produce fewer adverse cognitive effects than the old AEDs. Lamotrigine, for which a relatively large number of studies are available, has demonstrated a favorable cognitive profile overall, both in volunteers and in patients with epilepsy. Oxcarbazepine appears not to affect cognitive function in healthy volunteers or adults with newly diagnosed epilepsy. Gabapentin, tiagabine, and vigabatrin also have shown few cognitive effects compared with placebo. Although dose and titration speed may be confounding factors in some of the studies of topiramate, there is clear evidence that this agent does affect cognitive function, with specific effects on attention and verbal function. Additional studies are needed to delineate fully the relative effects of all the new AEDs to each other and to the older AEDs.
Adult ; Aged ; Anticonvulsants* ; Central Nervous System ; Child ; Cognition ; Epilepsy ; Healthy Volunteers ; Humans ; Memory ; Neuropsychological Tests ; Polypharmacy ; Seizures ; Vigabatrin ; Volunteers

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Concomitance of Childhood Absence Epilepsy and Benign Rolandic Spikes.

Tae Hong KANG ; Jun Sung AN ; Sung Eun KIM ; Tae Gyu HWANG

Journal of Korean Epilepsy Society.2003;7(1):54-56.

Childhood absence epilepsy (CAE) and benign epilepsy of childhood with centro-temporal spikes (BECT) are common forms of idiopathic epilepsy of childhood onset and share many features such as the marked age dependence of onset. The occurrence of generalized 3 Hz spike and waves in BECT or rolandic spikes in CAE has rarely been reported. We report 2 cases of concomitance of CAE and benign rolandic spikes. All of the two patients were female and had clinically absence seizure only. On EEG the two patients simultaneously showed centro-temporal spikes as well as ictal onset of absence seizure consisting of generalized 3 Hz spike and waves. All of the two patients have become seizure-free with valporic acid. It is rare but not impossible that (Rolandic spikes can concur with CAE rather than as a continuum between CAE and BECT), because all of the two patients have not shown BECT so far.
Electroencephalography ; Epilepsy ; Epilepsy, Absence* ; Female ; Humans

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A Case of Propofol-induced Seizure-like Phenomena (SLP).

Seong Hae JEONG ; Tae Woo KIM ; Ki Young JUNG ; Jae Moon KIM

Journal of Korean Epilepsy Society.2003;7(1):51-53.

Propofol is a commonly used intravenous anaesthetic agent. SLP (Seizure-like phenomena) induced by propofol is a currently well recognized clinical entity. These phenomena can be classified according to the time point of their occurrence during anaesthesia or sedation, and their clinical presentation. The common time of occurrence is during the anaesthetic induction, and during the emergence from the anaesthesia. The typical SLP include generalized tonic-clonic movement with twitching and rhythmic movements not perceived as generalized tonic-clonic seizures. We report a 42-year-old man who suffered propofol-induced SLP.
Adult ; Humans ; Propofol ; Seizures

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