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Post-stroke Epilepsy Presenting as Focal Paroxysmal Pain.

Dong Chul JUN ; Choon Gang PARK ; Kyu Yong LEE ; Young Joo LEE ; Ju Han KIM

Journal of Korean Epilepsy Society.2001;5(2):195-197.

Post-stroke epilepsy presenting as paroxysmal pain is rare. In most cases, the characteristic pain nature responsible for this kind of post-stroke epilepsy is associated with lesion of somatosensory areas. In this case, however, the precental motor cortex was responsible lesion site. A 60-year-old male with right frontal cortical and subcortical infarction complained paroxysmal shock like painful sensation on left lower extremity. This sensory symptom began after 2 weeks of stroke, and all analgesics failed to relieve the pain. EEG revealed sharp and slow wave at right frontotemporal region. Antiepileptic drug medication dramatically reduced the pain. In addition, epileptiform discharge disappeared after antiepileptic medication. In this paper, we report a post-stroke epilepsy presenting as focal paroxysmal pain associated with involvement of precental motor cortices.
Analgesics ; Cerebral Infarction ; Electroencephalography ; Epilepsy* ; Humans ; Lower Extremity ; Male ; Middle Aged ; Motor Cortex ; Sensation ; Shock ; Stroke

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One Case of Reflex Focal Seizures Associated with Nonketotic Hyperglycemia.

Jung Hee CHO ; Kyoung HEO ; Sun Ah PARK ; Sung Ryoung LIM ; Byung In LEE

Journal of Korean Epilepsy Society.2001;5(2):192-194.

BACKGROUND & SIGNIFICANCE: Focal seizures are usually due to an underlying structural lesion of the brain but occasionally caused by metabolic disturbances such as nonketotic hyperglycemia (NKH). Reflex focal seizures associated with NKH have been reported. CASE: The 69 year-old man was admitted in our hospital due to clonic movements of the right leg. His seizures did not occur spontaneously but were provoked by active or passive movements and tactile stimulation of the affected leg. The convulsive movements of the right leg often spread to the left leg without involving any other parts of his body. The seizures regressed with the control of hyperglycemia only. COMMENT: We report a patient presented with reflex focal seizures as the initial manifest-ation of NKH.
Aged ; Brain ; Humans ; Hyperglycemia* ; Leg ; Reflex* ; Seizures*

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A Case of Recurrent Dysembryoplastic Neuroepithelial Tumor in the Temporal Lobe.

Tag Geun CHUNG ; Jung Kyo LEE ; Jeong Hoon KIM ; Deok Soo KIM ; Tae Sung KO ; Shin Kwang KHANG ; Byung Duk KWUN

Journal of Korean Epilepsy Society.2001;5(2):186-191.

A boy since 6 years of his age who have had complex partial seizure was referred to our Department in March 1998. The left anterior temporal lobectomy with the resection of the head and body of hippocampus and gross total tumor removal was also performed in April 1998. He has been seizure free and stable about 3 years postoperatively. In January 2001, he revisited us due to headache, nausea, and vomiting from one week before. MRI revealed recurrence of the tumor, and a partial removal of the tumor was performed. Nine months from the second operation, the tumor recurred again and the thrid operation was followed. The pathologic findings were dysembryoplastic neuroepithelial tumor (DNT) in all three cases and no evidences of anaplastic changes were found in two recurrent cases. In general, DNT is known to be a disease that rarely transforms into the malignant, postoperative adjuvant radio-or chemotherapy is unnecessary even after partial resection of the tumor. However, in our case, there were two episodes of recurrence after the total resection. Here, we report the first case of recurrent DNT even after the total resection within three years in our knowledge.
Anterior Temporal Lobectomy ; Drug Therapy ; Head ; Headache ; Hippocampus ; Humans ; Magnetic Resonance Imaging ; Male ; Nausea ; Neoplasms, Neuroepithelial* ; Recurrence ; Seizures ; Temporal Lobe* ; Vomiting

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The Evaluation of the Quality of Life in Epileptic Patients : The Study of QOLIE(Quality of Life in Epilepsy)-89.

Joon Tae KIM ; Dae Su SHIN ; Jong Ki KIM ; In Yong HWANG ; Sung Min CHOI ; Byeong Chae KIM ; Myeong Kyu KIM ; Ki Hyun CHO

Journal of Korean Epilepsy Society.2001;5(2):177-185.

PURPOSE: Patients with epilepsy experience the impairment of Quality of life (QOL). The objective of this study was to investigate the 'Quality of Life' in epileptic patients and the influences of clinical factors upon QOL in epileptic patients. METHODS: Total 138 epileptic patients (male : 77, female : 61) were recruited for the study. The Quality of Life in Epilepsy (QOLIE)-89 was applied to evaluate QOL in epileptic patients. We gathered data about clinical variables (seizure type, frequency, duration of disease, number of antiepileptic drug, and depression) and socio-demographic variables (age, sex, marriage, employment, and education), and compared each variables in use of QOLIE-89 score. RESULTS: Depression influenced negatively the most of all subscales (16 of 20 subscales) and overall score (p<0.01), and was the most significant inverse predictor of QOL in patients with epilepsy. Patients who were seizure-free in the past year reported better QOL than those with seizure-doing (p<0.05). Patients with polypharmacy showed lower scores at overall QOL, health discouragement, language, and overall score than those with monopharmacy (p<0.05). Male showed lower score than female at the scale of sexual relation (p<0.05), but higher scores at scales of health perception, overall health, and physical health (p<0.05). Highly-educated group (> or =16 year) had higher score at overall score and emotional well-being (p<0.05). However, age, marital state, employment, seizure type, and duration of disease did not affect QOL significantly. CONCLUSIONS: Sex, education, number of AEDs, depression, and seizure free state were major socio-clinical factors affecting QOL in patients with epilepsy. It is suggested that physician should recognize these factors and manage appropriately for improving the QOL.
Depression ; Education ; Employment ; Epilepsy ; Female ; Humans ; Male ; Marriage ; Polypharmacy ; Quality of Life* ; Seizures ; Weights and Measures

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The Relationship of Stigma and Quality of Life in Patients with Epilepsy.

Soo Young YOUN ; Seung Bong HONG ; Jun Kyu KWAK

Journal of Korean Epilepsy Society.2001;5(2):172-176.

BACKGROUND: Stigma may affect the interpersonal relationship and coping ability of epilepsy patients. This study was aimed to evaluate the degree of stigma and the relationship between the clinical factors, quality of life (QOL) and the stigma in epilepsy patients. METHODS: One hundred and sixty-three patients with epilepsy were included. The research instruments were questionnaires for collecting demographic and disease-specific data, the stigma and quality of life. The modified Kim Eun Ja's stigma scale (1997) was used. It consists of two domains (enacted stigma, felt stigma) and has 10 items. The quality of life was evaluated by QOLIE-31. To test the correlation between the clinical factors, QOL and the stigma, Pearson correlation coefficient and ANCOVA were used. RESULTS: 51.5% of all patients had stigma. There was a significant negative correlation (r=-0.585, p<0.01) between the total score of stigma and the QOL. Two domains of stigma were also negatively correlated with QOL as follows : felt stigma vs. QOL (r=-0.429, p<0.01) and enacted stigma vs. QOL (r=-0.542, p<0.01). The patients with higher seizure frequency had lower QOL (F=4.834, p=0.03). The clinical factors that could predict the degree of stigma were the seizure frequency (F=7.86, p=0.006), duration of seizure disorder (F=7.34, p=0.008), seizure pattern (F=4.48, p=0.036) and the number of AED (F=2.51, p=0.045). CONCLUSIONS: The felt stigma and the enacted stigma affected the QOL of epilepsy patients. These results suggest that psychosocial interventions are necessary to treat the negative reaction and depressed self-esteems of epilepsy patients in order to improve their QOL.
Epilepsy* ; Humans ; Quality of Life* ; Surveys and Questionnaires ; Seizures

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Sang Nam BAE ; Seong Shik PARK ; Sang Ook NAM ; Hee Ju PARK

Journal of Korean Epilepsy Society.2001;5(2):165-171.

PURPOSE: Weight gain is a common side effect of valproic acid (VPA) that leads to discontinuation in some patients, but its incidence and correlates have been rarely studied in children. This study was undertaken to investigate factors related to weight changes in children treated with VPA. METHODS: We have analyzed mean weight standard deviation score (SDS) retrospectively and interviewed 39 childhood epileptic patients attending Pusan National University Hospital on VPA monotherapy followed over 36 months. Putative risk factors including sex, age, duration of VPA administration, mean weight SDS score at diagnosis, dose of VPA administration, seizure type (generalized or partial), and etiology (idipathic or symptomatic) were statistically analyzed. RESULTS: Thirty nine children (23 boys, 16 girls) were treated with VPA monotherapy. Mean age of patients at diagnosis was 6.18+/-3.74 years, and mean weight SDS at diagnosis was 0.54+/-1.17. After the administration of VPA, mean weight SDS was significantly increased (p<0.05). Increase in mean weight SDS was significant in children with negative mean weight SDS at diagnosis, idiopathic epilepsy, partial seizure, and also significant in children below 1 year old. Mean weight SDS was well correlated with the dose of VPA administration after 18 months of VPA monotherapy (p<0.05). CONCLUSIONS: Our data indicate that VPA monotherapy significantly increased body weight of patients treated for epilepsy. It will be better, if possible, combination therapy of VPA with other antiepileptic drugs (such as vigabatrin, carbamazepine, gabapentin) which can lead to weight gain.
Anticonvulsants ; Body Weight ; Busan ; Carbamazepine ; Child* ; Diagnosis ; Epilepsies, Partial ; Epilepsy ; Humans ; Incidence ; Retrospective Studies ; Risk Factors ; Seizures ; Valproic Acid* ; Vigabatrin ; Weight Gain

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Measurement of Corpus Callosal Area in Juvenile Myoclonic Epilepsy Using High Resolution Magnetic Resonance Imaging.

Woo Suk TAE ; Seung Bong HONG ; Won Cheol SHIN ; Hyang Woon LEE ; Dae Won SEO ; Moon Hyang LEE ; Kyun Rak CHONG ; Young Tae BYUN

Journal of Korean Epilepsy Society.2001;5(2):156-164.

BACKGROUND: To investigate the change of corpus callosal area in juvenile myoclonic epilepsy (JME), the mid-sagittal areas of corpus callosum and its seven sub-regions were measured in JME patients and normal subjects. METHODS: Nineteen JME patients (22.6+/-5.0 year-old, 6 males, 13 females) and 19 normal controls (22.9+/-7.3 year-old, 6 males, 13 females) underwent 1.6 mm thickness whole brain SPGR MRI. Exact mid-sagittal image was obtained with image reconstruction and geometric correction. According to Witelson's work, the area of corpus callosum was divided into 7 sub-regions (a1 to a7 from anterior to posterior) with a semi-automated method. In each sub-region, the pixel number was counted according to ROI definition. The whole cerebral volume was measured. The mid-sagittal cerebral area was measured by tracing inner surface of skull and basal cortical surface of the cerebrum except for corpus callosum and cerebellum. The difference of corpus callosum areas between JME patients and normal controls were tested by t-test and ANCOVA. RESULTS: There was no difference in sex [chi-square(1)=1.00, chi square] and age (p=0.941, Mann-Whitney U test). The areas of rostrum (p<0.001) and rostral body (p < or = 0.05) were significantly smaller in JME group by t-test and ANCOVA (adjusted by age and cerebral volume). Cerebral volume and mid-sagittal cerebral area were not different between JME and normal groups (p>0.25, t-test). CONCLUSION: Rostrum and rostral body are significantly smaller in JME patients, which suggests frontal lobe abnormality in JME. This finding is consistent with previous studies reported structural and functional abnormalities of frontal lobe in JME.
Brain ; Cerebellum ; Cerebrum ; Corpus Callosum ; Frontal Lobe ; Humans ; Image Processing, Computer-Assisted ; Magnetic Resonance Imaging* ; Male ; Myoclonic Epilepsy, Juvenile* ; Skull

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Comparison of Electroencephalography, Neuroimaging Studies and Surgical Outcome between Mesial and Neocortical Temporal Lobe Epilepsies.

Kwang Soo KIM ; Andrew J COLE

Journal of Korean Epilepsy Society.2001;5(2):151-155.

PURPOSE: To compare the diagnostic value of electroencephalography (EEG), MRI and PET studies and surgical outcome in patients with medically refractory temporal lobe epilepsy due to hippocampal sclerosis (HS) versus temporal lobe lesions (TLL). METHODS: Records of 122 consecutive patients who underwent surgery for epilepsy from January 1993 to April 2000 were retrieved from the MGH Epilepsy Surgery Database. Fifty eight patients with temporal lobe epilepsy due to pathologically proven HS or TLL were identified and presurgical interictal and ictal EEG, MRI, and 2-[(18)F]fluoro-2-deoxy-D-glucose (FDG)-PET data and surgical outcome were reviewed. Patients with dual or normal pathology were excluded. Pathologically proven HS was present in 32 patients, and 26 patients has temporal lobe lesions (cortical dysplasia in 6 patients, vascular malformation in 6, gliomas in 5, DNET in 4, heterotopia in 1, other pathologies in 4). Comparisons of the diagnostic value of EEG, MRI and FDG-PET studies were performed in 43 patients who were seizure-free after epilepsy surgery. Among 43 patients, HS was in 24 patients and TLL in 19. RESULTS: The occurrence of abnormal interictal and ictal EEG, MRI and FDG-PET findings in the side of operation was not significantly different between patients with HS and with TLL respectively. There was no significant difference in at least one year follow-up surgical outcome between the two groups. CONCLUSIONS: Diagnostic value of presurgical interictal and ictal EEG, MRI and FDG-PET findings, and surgical outcome were not different in patients with mesial versus neocortical temporal lobe epilepsies.
Electroencephalography* ; Epilepsy ; Epilepsy, Temporal Lobe* ; Follow-Up Studies ; Glioma ; Humans ; Magnetic Resonance Imaging ; Neuroimaging* ; Pathology ; Sclerosis ; Temporal Lobe* ; Vascular Malformations

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The Anticipation of Epileptic Seizures by Non-linear Periodicity of Inter-Spike Intervals.

Hyang Woon LEE ; Seung Bong HONG ; Won Chyul SHIN ; Young Min SHON ; Woon Chyul LEE ; Sae Yong KIM ; Seung Whan KIM

Journal of Korean Epilepsy Society.2001;5(2):142-150.

PURPOSE: To develop a fast and robust seizure anticipation program and test its usefulness in seizure prediction and localization of epileptic focus. METHODS: The video-EEG monitoring was performed in 20 epilepsy patients. The NPISI (Nonlinear Periodicity of Inter-Spike Intervals) of each channel and averaged NPISI of all channels were calculated in pre-ictal and ictal periods of 21 epileptic seizures. Seizure prediction times of NPISI in each channel and all channels were determined. RESULTS: There were eight mesial TLE, twelve neocortical epilepsies. The significantly reduced NPISI prior to seizure onset was observed in 20 seizures (95.2%) by NPISI of single EEG channel and in 14 seizures (66.7%) by the averaged NPISI of all channels. Time of seizure anticipation was 17.3+/-7.3 min by single channel NPISI and 14.0+/-6.0 min by all channel NPISI prior to the seizure onset. The earliest NPISI reduction was detected at electrodes concordant to the seizure focus in 6/20 (30.0%) seizures, electrodes adjacent to the focus in 5/20 (25.5%), mirror electrodes contralateral to the seizure focus in 4/20 (20.0%), and irrelevant electrodes to the focus in 5/20 (25.5%). CONCLUSIONS: This study demonstrated that the reduction of NPISI could predict epileptic seizures long before clinical seizure onset. Although the earliest NPISI reduction was observed at or near to epileptic focus in most cases, pre-ictal changes of NPISI occurred far beyond the epileptic focus. These findings suggest that pre-ictal NPISI reduction may reflect a widespread facilitation of brain before the seizure onset.
Brain ; Electrodes ; Electroencephalography ; Epilepsy* ; Humans ; Periodicity* ; Seizures

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Usefulness of Sphenoidal Electrodes for Localization of Temporal Lobe Seizure Focus : Ictal EEG.

Kyu Hwan KWAK ; Joong Koo KANG ; Jung Kyo LEE ; Sang Ahm LEE

Journal of Korean Epilepsy Society.2001;5(2):137-141.

PURPOSE: Usefulness of sphenoidal electrodes for detecting mesial temporal seizure foci remains controversial. Our aim is to determine whether sphenoidal electrodes are superior to surface electrodes for EEG localization in patients with mesial temporal lobe epilepsy (TLE). METHODS: We retrospectively reviewed ictal EEGs recorded simultaneously with standard International 10-20 System, subtemporal and sphenoidal electrodes in 92 patients who underwent temporal lobectomy. Patients were divided into mesial (n=67) and neocortical (n=25) TLE. Ictal EEGs were reviewed in a blinded fashion in both longitudinal bipolar and Pz referential montages. RESULTS: Thirty four (13.1%) of 259 mesial temporal seizures were exclusively isolated to sphenoidal electrode at least 3 seconds before involvement of subtemporal electrodes or were localized to temporal lobe on sphenoidal electrode when scalp electrode failed to localize seizure onset, whereas only 2 (2.6%) of 75 neocortical temporal seizures were (p<0.05). The usefulness of sphenoidal electrode was related to the distribution but not the frequency of ictal onset on scalp EEG. CONCLUSIONS: Although isolated or localized sphenoidal seizure onset in patients with mesial TLE are not frequent, sphenoidal electrodes are superior to scalp electrodes for the localization of mesial temporal seizure foci.
Electrodes* ; Electroencephalography* ; Epilepsy, Temporal Lobe ; Humans ; Retrospective Studies ; Scalp ; Seizures* ; Temporal Lobe*

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