Journal Detail Information

1

Cite

Share

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*

2

Cite

Share

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

3

Cite

Share

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*

4

Cite

Share

Psychomotor Variant in a Case of Juvenile Absence Epilepsy: An Evidence of Misnomer by Gibbs.

Sung Pa PARK ; Young Jo BAE ; Eun Hee KIM ; Ho Won LEE ; Doo Kyo JUNG ; Chung Kyu SUH

Journal of Korean Epilepsy Society.2004;8(2):160-162.

The psychomotor variant is a rare EEG pattern as a rhythmical activity at about 6 Hz that may occur in brief or longer runs, independently in the temporal areas during drowsy mental state. It was originally named by Gibbs and Gibbs because of its existence during the ictal or interictal period in patients with psychomotor seizures. We report a 14-year-old girl with juvenile absence epilepsy who showed the long runs of psychomotor variant followed by generalized ictal discharges.
Adolescent ; Electroencephalography ; Epilepsy, Absence* ; Female ; Humans ; Seizures

5

Cite

Share

Reflex Epilepsy Provoked by Mental Activities Mainly Associated with Use of the Hands.

Young Mi OH ; Jeong Hwa SEO ; Sang Myung CHEON ; Sang Ho KIM

Journal of Korean Epilepsy Society.2004;8(2):155-159.

There have been very few reports on reflex seizures induced by writing. Complex precipitating behaviors such as calculation, writing, copying of complicated figure, and spatial construction have been recognized as triggering factor of epileptic seizures. We report a case of a patient with a very unusual form of complex reflex epilepsy in which seizures are usually induced by writing or spatial construction. Neurological examination was normal and brain magnetic resonance imaging showed mild brain atrophy without focal lesion. During long-term video-EEG monitoring, she was instructed to write a letter with the right hand. About 20 minutes after writing, she experienced similar aura and motion arrest and then showed an elevation of bilateral upper extremities like myoclonic jerk followed by generalized tonic clonic seizure. On ictal EEG, spike and wave complexes appeared from both centroparietal region followed by 10 Hz rhythmic activities for 20 seconds. Interictal EEG was normal. Ictal-interictal subtraction image of brain SPECT (99mTc-HMPAO) showed hyperperfusion in the middle frontal gyrus and precentral gyrus of left frontal lobe and superior and inferior frontal gyrus of right frontal lobe. We suggest that this reflex epilepsy might be originated from both central areas with maximum on the left side. Oxcarbazepine was effective in controlling this reflex epileptic seizure.
Atrophy ; Brain ; Electroencephalography ; Epilepsy ; Epilepsy, Reflex* ; Frontal Lobe ; Hand* ; Humans ; Magnetic Resonance Imaging ; Myoclonus ; Neurologic Examination ; Reflex* ; Seizures ; Tomography, Emission-Computed, Single-Photon ; Upper Extremity ; Writing

6

Cite

Share

Reflex Epilepsy Induced by Tooth Brushing: A Case Report.

Young Mi OH ; Hee Young JO ; Jong Kuk KIM ; Sang Woo KIM ; Sang Ho KIM

Journal of Korean Epilepsy Society.2004;8(2):151-154.

Reflex epilepsy describes seizures which are precipitated by clearly recognized stimuli. Reflex epileptic seizures triggered by tooth brushing are rare. We report a case with reflex epilepsy occurring exclusively during tooth brushing. He began having seizures at age 28. Neurological examinations and brain magnetic resonance images were found normal. On long term video-EEG monitoring, he presented two episodes of simple partial seizure induced by brushing molar and premolar teeth, which was right facial clonic movement persisting 3-5 seconds. He was unresponsive during the event, but had no postictal confusion. Ictal EEG showed 6 Hz rhythmic theta activity in the left frontocentral area. Interictal EEG was normal. The findings of EEG suggest that this reflex epilepsy might have epileptic focus in the left frontocentral area. Reasonable precaution such as gargling or less vigorous brushing of his teeth with fingers effectively prevented seizure recurrence.
Bicuspid ; Brain ; Electroencephalography ; Epilepsy ; Epilepsy, Reflex* ; Fingers ; Molar ; Neurologic Examination ; Recurrence ; Reflex* ; Seizures ; Tooth*

7

Cite

Share

The Contributing Factors to Utilize Complementary and Alternative Medicine in People with Epilepsy.

In Jung KIM ; Joong Koo KANG ; Sang Ahm LEE

Journal of Korean Epilepsy Society.2004;8(2):145-150.

PURPOSE: To determine which factors are influential in complementary and alternative medicine (CAM) utilization in people with epilepsy (PWE). METHOD: The 246 adult PWE (53.7% male, mean age 33.6 years) were recruited from out-patient clinic of a tertiary care hospital. Data about CAM utilization in the last five years and willingness of CAM use in the future were collected via a face-to-face semi-structured interview. RESULTS: 1) The utilization rate of CAM among PWE was 31.3% for the last 5 years. On univariate analyses, it was significantly associated with several variables such as men, younger age, shorter epilepsy duration, higher educational level, higher economic status, and the belief in safety of CAM use. Multivariate analyses identified men (p=.021 OR=2.3 [95% CI=1.1 to 4.9]), higher economic status (p=.010, OR=2.5 [95% CI=1.2 to 5.0]), and the belief in safety of CAM use (p=.001, OR=1.9 [95% CI=1.3 to 2.9]). 2) Out of our participants, 30.5% reported that they were willing to utilize CAM for their epilepsy in the future. Univariate analyses showed that it was related to experience of CAM use in the past, higher economic status, and the belief in safety of CAM use. Multivariate analyses identified experience of CAM use in the past (p=.000, OR=8.4 [95% CI=4.0 to 17.7]) and the belief in safety of CAM use (p=.002, OR=1.7 [95% CI=1.2 to 2.6]). CONCLUSION: One third of PWE reported to have use the CAM in the past or to have willingness of the CAM use in the future. The important factors contributing to the CAM use were gender, economic status, experience of the CAM use in the past, and the belief in safety of the CAM use.
Adult ; Complementary Therapies* ; Epilepsy* ; Humans ; Male ; Multivariate Analysis ; Outpatients ; Tertiary Healthcare

8

Cite

Share

A Lateralizing Ability of the Wechsler Memory Scale-III in Patients with Mesial Temporal Lobe Epilepsy.

Kyung Hee CHO ; Sang Ahm LEE ; Joong Koo KANG ; Eun Jung CHOI ; Hee Jung YOO ; Jung Kyo LEE

Journal of Korean Epilepsy Society.2004;8(2):138-144.

PURPOSE: The Wechsler Memory Scale-III (WMS-III) including new visual memory tests was developed to overcome the limitation of WMS-Revised (WMS-R). We examined the utility of the WMS-III in predicting laterality of memory impairment in patients with mesial temporal lobe epilepsy (MTLE). METHODS: We included 49 consecutive patients with unilateral MTLE who had left hemisphere dominance for language by WADA test and underwent temporal lobectomy. Methods of analysis included evaluation of group means on the various indexes and subtest scores of WMS-III, the use of ROC curves, an examination of Auditory-Visual Index (AVI) discrepancy scores and correlation analysis between AVI discrepancy scores and age, onset age of patients. RESULTS: 1) Patients with left MTLE had significantly lower scores on several scores and indexes compared to those with right MTLE. 2) In analysis of ROC curves, the area under the curve and the suggested cutting score were 0.696 and 4 (a sensitivity 0.704, a specificity 0.727) for immediate AVI discrepancy score and 0.702 and 5 (a sensitivity 0.556, a specificity 0.773) for delayed one, respectively. 3) In right MTLE, there was a tendency for linear correlation between AVI discrepancy scores and age at onset. CONCLUSIONS: Overall, WMS-III has limited value in identifying particular memory deficits associated with either left or right temporal lobe dysfunction. AVI discrepancy scores may be more useful to predict right hemispheric dysfunction rather than left ones.
Age of Onset ; Epilepsy, Temporal Lobe* ; Humans ; Memory Disorders ; Memory* ; ROC Curve ; Sensitivity and Specificity ; Temporal Lobe*

9

Cite

Share

Effects of Antiepileptic Drugs on Thyroid Hormones and Lipid Profiles.

Sang Won PARK ; Yong Won CHO ; Hyun Ah YI ; Sung Il SOHN ; Hyung LEE ; Jeong Geun LIM ; Sang Doe YI

Journal of Korean Epilepsy Society.2004;8(2):132-137.

PURPOSE: It is known that serum thyroid hormones and lipid profiles are affected by the different biotransformation pathways of antiepileptic drugs (AEDs). The aim of this study was to evaluate thyroid functions and lipids in epileptic patients taking AEDs. METHODS: We prospectively examined serum thyroid hormone concentrations and lipid profiles in 45 patients with epilepsy and compared them with 45 healthy age- and sex-matched controls. We measured serum free T4 (FT4), thyroid stimulating hormone (TSH), thyroid peroxidase antibody (TPO-ab), thyroid globulin antibody (TG-ab), total cholesterol, low density lipoprotein (LDL), high density lipoprotein (HDL) and triglycerides (TG). To analyze, the patient groups were divided into two groups:36 patients using hepatic enzyme inducing AEDs and 9 patients using non-enzyme-inducing AEDs. RESULTS: Mean age, sex and body mass index (BMI) were not different in both groups. The serum free T4 level of all patients was lower than that of the control group (p<0.05). The serum free T4 level of the patients taking hepatic enzyme inducing AEDs was lower than that of the control group. TSH, TPO-ab and TG-ab levels were not different in both groups. There was no correlation between free T4 levels and the duration of therapy in the patient group. For lipids, LDL, HDL, TG and total cholesterol, levels were not different in both groups. CONCLUSIONS: Hepatic enzyme inducing AEDs led to a decrease in free T4 levels but the TSH level remained normal. These findings seem to be not only due to liver enzyme induction but also hypothalamic interference of regulation of thyroid hormone production by the drugs. Lipid profiles were not significantly influenced by AEDs but further evaluation should be needed.
Anticonvulsants* ; Biotransformation ; Body Mass Index ; Cholesterol ; Enzyme Induction ; Epilepsy ; Humans ; Iodide Peroxidase ; Lipoproteins ; Liver ; Prospective Studies ; Thyroid Gland* ; Thyroid Hormones* ; Thyrotropin ; Triglycerides

10

Cite

Share

Predicting Factors of Long-term Surgical Outcome for Mesial Temporal Lobe Epilepsy with Unilateral Hippocampal Atrophy on MRI.

Soo Bin YIM ; Suk Yun KANG ; Young Min LIM ; Sang Ahm LEE

Journal of Korean Epilepsy Society.2004;8(2):123-131.

PURPOSE: To identify the clinical and electroencephalographic factors which are independently predictive of a postoperative seizure-free outcome for 4 years. We compared the outcomes of the first 2 years with the subsequent 2 years one after anterior temporal lobectomy (ATL) for mesial temporal lobe epilepsy (MTLE) with unilateral hippocampal atrophy (HA) on MRI. METHODS: We studied 51 consecutive operated patients who had above 4 years of follow-up and had MTLE with definite unilateral HA on MRI. The surgical outcome was classified as either seizure-free or not seizure-free in the first postoperative 2 years and the subsequent 2 years. Several clinical variables were included. The scalp EEG parameters included the lateralization of interictal epileptiform discharges, ictal onset location, ictal onset frequency, ictal EEG lateralization, and ictal scalp EEG propagation (bitemporal asynchrony or switch of lateralization). Variable factors were subjected to univariate analysis. RESULTS: Overall, 36 patients (71%) became seizure-free during the postoperative 4 years. On univariate analysis, only one factor was significantly associated with poor outcome (p<0.05): ictal scalp EEG propagation pattern such as bitemporal asynchrony or switch of lateralization. The seizure-free outcome was seen in 88.9% of patients without bitemporal asynchroncy, or switch of lateralization while only 54.5% of patients with those patterns (p=0.007) during the postoperative third and fourth year. However, those propagation patterns did not show the prognostic value during the first 2 years (p=0.449). Other variable factors were found not to be predictive of prognosis on early or late recurrence. CONCLUSIONS: Bitemporal asynchrony or a switch of lateralization in the ictal scalp EEG might be a highly predictive factor for an undesirable surgical outcome, late recurrence of seizure during a follow-up period after ATL, and probably an index of bitemporal epileptogenicity in MTLE.
Anterior Temporal Lobectomy ; Atrophy* ; Electroencephalography ; Epilepsy, Temporal Lobe* ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging* ; Prognosis ; Recurrence ; Scalp ; Seizures ; Temporal Lobe*

DISPLAY OPTIONS

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share