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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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Occipital Lobe Simple Partial Epilepsy Presenting as Visual Episodes Associated with Non-Ketotic Hyperglycemia.

Hakjae ROH ; Kyung Bok LEE ; Moo Young AHN

Journal of Korean Epilepsy Society.2009;13(2):71-74.

Non-ketotic hyperglycemia (NKH) is recognized both as a direct cause of a precipitating factor of many types of epileptic seizure, including simple partial motor, complex partial as well as reflex motor seizure, choreoathetosis and ballismus. Its association with isolated visual alteration is less known. A 74-year-old diabetic woman with visual complaints manifested as flashing colorful lights (red, yellow and blue) in both visual field with progressive increase in frequency. Among the laboratory tests, NKH of 508mg/dL stood out. Slow waves from the right occipital region maximum at O2 associated with visual symptom were recorded in EEG. Brain MRI showed subcortical T2WI and FLAIR hypointensities in the right occipital lobe with scanty enhancement. Patient was treated with hydration and insulin and her symptoms disappeared after hyperglycemia was corrected. We stress that isolated visual episodes may be initial manifestation of occipital lobe simple partial seizure associated with NKH.
Aged ; Brain ; Dyskinesias ; Electroencephalography ; Epilepsies, Partial ; Epilepsy ; Female ; Humans ; Hyperglycemia ; Insulin ; Light ; Occipital Lobe ; Precipitating Factors ; Reflex ; Seizures ; Visual Fields

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Stigma in Patients with Drug Refractory Epilepsy: the Risk Factor, Psychiatric Comorbidities, and Quality of Life.

Jong Mok LEE ; Hyun Seok SONG ; Yang Ha HWANG ; Ho Won LEE ; Chung Kyu SUH ; Sung Pa PARK ; Soon Hak KWON

Journal of Korean Epilepsy Society.2009;13(2):65-70.

PURPOSE: Stigma is more likely to be reported by people with epilepsy with frequent seizures and associated with various physical and psychosocial factors. We determined risk factors associated with stigma, and investigated the impact of felt stigma on psychiatric comorbidities and quality of life (QOL) in patients with drug refractory epilepsy (DRE). METHODS: Patients with DRE of partial onset, who experienced a failure of at least two antiepileptic drugs (AEDs) and at least 1/month of seizure attack for recent 6 months, were enrolled in the study. We divided patients into two groups according to the presence of stigma. We compared demographic and clinical variables, mood, anxiety, psychiatric symptoms, and QOL between two groups. RESULTS: Among 75 patients with DRE of partial onset, 34 patients (45%) had stigma. Risk factors associated with stigma were age, history of psychiatric disease, duration of epilepsy, and duration of AEDs intake. However, seizure frequency was not associated with the occurrence of stigma. Mood, anxiety, and psychiatric symptoms were significantly higher in patients with stigma than those without stigma. QOL was significantly lower in patients with stigma than those without stigma. CONCLUSIONS: A longer duration of epilepsy with previous history of psychiatric diseases may be indispensable for the occurrence of stigma in patients with DRE. Early detection and appropriate treatment of psychiatric comorbidities can lessen the degree of stigma and improve QOL.
Anticonvulsants ; Anxiety ; Comorbidity ; Epilepsy ; Humans ; Quality of Life ; Risk Factors ; Seizures

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Study of Clinical Course of Epilepsy in Children with Tuberous Sclerosis Complex.

Eun Hye LEE ; Min Hee JEONG ; Tae Sung KO

Journal of Korean Epilepsy Society.2009;13(2):58-64.

PURPOSE: The aim of this study is to investigate the incidence, clinical features and outcome in pediatric tuberous sclerosis complex(TSC) patients with epilepsy. METHODS: Fifty seven of 74 patients (77.0%) were included in the study, who were diagnosed with epilepsy associated with TSC from 1991 to 2008. Clinical data were obtained from medical records retrospectively. RESULTS: Of the 57 patients, initial seizure types were infantile spasms (n=25, 43.8%), complex partial seizure (n=24, 42.1%), generalized tonic seizure (n=5, 8.7%), simple partial seizure (n=2, 3.4%), and atonic seizure (n=1, 1.7%), respectively. Seventeen patients (29.8%) had changes of their seizure types during the clinical course. Excluding the five patients with insufficient data, 52 patients were treated with antiepileptic drugs and four of them underwent epilepsy surgery. Twenty-six of 52 patients (50.0%) with medical treatment and two patients (50.0%) with epilepsy surgery became seizure free. Among the patients with infantile spasms, vigabatrin induced seizure freedom in 13 of 14 patients (92.8%) within four weeks, and five of them maintained seizure remission with vigabatrin monotherapy. CONCLUSIONS: Half of epileptic patients showed good responses to medical treatment, especially vigabatrin for infantile spasms. Epilepsy surgery can be treatment option for selected patients.
Anticonvulsants ; Child ; Epilepsy ; Freedom ; Humans ; Incidence ; Infant ; Infant, Newborn ; Medical Records ; Retrospective Studies ; Seizures ; Spasms, Infantile ; Tuberous Sclerosis ; Vigabatrin

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