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Journal of Korean Epilepsy Society.2004;8(1):3-17.

The History of epilepsy is closely associated with development of psychiatry. Epilepsy patients have been considered to be prone to psychopathology. Although there is substantial agreement on the definition of a seizure, there is much controversy about the wide range of psychological effects, seizure related behavioral manifestations, and medication-induced behavioral changes. The biopsychosocial model for understanding altered behaviors and a multidisciplinary approach for managing epilepsy are needed. Etiologic factors affecting the behavior in epilepsy patients are diverse and multifactorial. And biological and psychosocial varaiables are more important in etiologies. The important tasks and means for understanding psychiatric comorbidity are epidemiologic studies, Video-EEG monitoring examinations for behaviors, the definitions given for the seizure characteristics and psychiatric diagnoses. In this field, the relationships between epilepsy and psychiatric illness (psychosis, depression, personality problems, fear and anxiety disorder, aggression and violence, altered sexuality) are main issues. Besides, cognitive impairment in epilepsy, quality of life assessment and psychiatric or behavioral effects of antiepileptic drugs and relationships between psychopathology and epilepsy surgery are included as another important issues. The study of epilepsy and its psychiatric comorbidity gives us a unique opportunity to expand our understanding of brain-behavior relations. Modern care of persons with epilepsy goes beyond attempts to control seizures and requires consideration of broader issues related cognitive, psychiatric, and social functioning.
Aggression ; Anticonvulsants ; Anxiety Disorders ; Comorbidity* ; Depression ; Diagnosis ; Epilepsy* ; Humans ; Psychopathology ; Psychotic Disorders ; Quality of Life ; Seizures ; Violence

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Two Cases of Methyl Bromide Intoxication with Seizures and Altered Mental State.

Kwang Deog JO ; Soo Bin YIM ; Soon Keum LEE ; Seong Hoon CHOI ; Tae Hoon KIM ; Koon Hee HAN ; Kyung Il SONG

Journal of Korean Epilepsy Society.2003;7(2):125-129.

Methyl bromide is presently used as a fumigant for insects in soil, grains or fruit in storage or transport. It is a neurotoxic agent and has been responsible a number of deaths or acute poisonings among occupationally exposed persons. We report 2 patients, who had worked fumigation warehouse, presented with seizures and altered mental state. The serum concentrations of bromide were elevated 32.9 and 42.5 mg/l, respectively. Brain MRI showed bilateral symmetric high signal intensities in the splenium of corpus callosum, the globus pallidus, the quadrigeminal plate, the periaqueductal gray matter, the red nucleus, the substantia nigra, the medial lemniscus, the pontine tegmentum, the dentate nucleus, and the medulla. There was no brain lesion in the other patient. Appropriate and supervised handling of the chemical and regular education to workers are important to avoid the risk of methyl bromide poisoning.
Brain ; Edible Grain ; Cerebellar Nuclei ; Corpus Callosum ; Education ; Fruit ; Fumigation ; Globus Pallidus ; Humans ; Insects ; Magnetic Resonance Imaging ; Occupations ; Periaqueductal Gray ; Poisoning ; Red Nucleus ; Seizures* ; Soil ; Substantia Nigra ; Tectum Mesencephali

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Therapeutic Outcomes of Vagus Nerve Stimulation in Intractable Childhood Epilepsy.

Hoon Chul KANG ; Heung Dong KIM ; Yong Soon HWANG ; Sang Keun PARK

Journal of Korean Epilepsy Society.2003;7(2):118-124.

PURPOSE: This study is to evaluate the efficacy and safety of vagus nerve stimulation (VNS) in intractable childhood onset epilepsy by reviewing our experiences. MEHTHOD: Involved in the study are five patients who underwent VNS from July 23th, 1999 and had been followed up over 12 months. We reviewed data prospectively collected with a focus on clinical features, therapeutic outcomes and safety, developmental progress, and EEG findings. RESULTS: Three patients were classified as Lennox-Gastaut syndrome. One patient of the two remaining patients had gelastic seizure caused by hypothalamic harmatoma, while the other patient had partial seizure with secondary generalization. Among the 5 patients, one patient showed a seizure frequency reduction rate of about 50% from baseline in 3 months after VNS implantation and more than 90% in 12 months, 2 patients of about 50% in 3 months and of about 75% in 12 months, but the other two patients didn't show any change in seizure frequency. Side effects such as hoarseness, dyspnea during sleep and wound infection could be controlled simply through the adjustment of output current or wound revision. However, efficacy in cognitive function and EEG findings was not satisfactory. CONCLUSIONS: VNS might be an effective adjunctive therapy for intractable childhood epilepsy and transient side effects can be controlled without discontinuation of VNS therapy.
Dyspnea ; Electroencephalography ; Epilepsy* ; Generalization (Psychology) ; Hoarseness ; Humans ; Prospective Studies ; Seizures ; Vagus Nerve Stimulation* ; Vagus Nerve* ; Wound Infection ; Wounds and Injuries

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Effect of Combination of Ictal Scalp EEG and Seizure Semiology on Seizure Lateralization in Temporal Lobe Epilepsy.

Suk Yun KANG ; Kwang Deog JO ; Sang Ahm LEE ; Young Min LIM ; Soon Keum LEE ; Joong Koo KANG ; Jung Kyo LEE

Journal of Korean Epilepsy Society.2003;7(2):112-117.

PURPOSE: To compare the reliability of lateralization between seizure semiology and ictal scalp EEG findings in mesial temporal lobe epilepsy (MTLE) patients, and to examine the advantage of the combined use of these two methods. METHODS: We independently reviewed the ictal scalp EEG recordings and clinical seizure semiology of 243 seizures recorded in 58 consecutive MTLE patients. All patients were seizure-free for at least 1 year postoperatively. Each seizure was lateralized on the basis of ictal semiology and ictal scalp EEG patterns according to strictly defined criteria, respectively. Individual patients were also lateralized based on these data. RESULTS: Seizure semiology analysis lateralized 64.6 % of seizures and 82.8 % of patients. Ictal scalp EEG analysis lateralized 74.5% of seizures and 74.1% of patients. Combination of the information from the two methods allowed for lateralization in a greater portion of both seizures (79.8%) and patients (89.7%). CONCLUSION: This study suggests that combination of ictal scalp EEG findings and seizure semiology improves the lateralization of individual seizures and patients. Therefore, it is worth lateralizing with standardized combined ictal EEG and semiology analysis for noninvasive presurgical evaluation in TLE patients.
Electroencephalography* ; Epilepsy, Temporal Lobe* ; Humans ; Scalp* ; Seizures* ; Temporal Lobe*

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A Study on the Age-Dependent Ketosis Induced by the Ketogenic Diet.

Dong Wook KIM ; Jin Soo MOON ; Hyun Oh JANG ; Hee Dong PARK ; Jae Moon KIM ; Ki Young JUNG ; Soo Ahn CHAE ; Ho Jin PARK

Journal of Korean Epilepsy Society.2003;7(2):108-111.

PURPOSE: Ketogenic diet (KD) remains a therapy in search of explanation although it is an established treatment for patients with intractable epilepsy. It has been clinically proven more efficacious at younger ages, presumably because of the enhanced ability of the immature brain to extract and utilize ketone bodies. The study was designed to investigate whether ketosis induced by the KD is age-dependent. METHODS: A KD ([fat]:[protein+carbohydrate] ratio of 4.3:1) was administered to male Sprague-Dawley rats for 3 weeks, while control animals were fed a standard rodent chow. Dietary treatment was initiated at either postnatal 3 or 12 weeks. Blood beta-hydroxybutyrate (BHB) levels were assayed from blood obtained via the tail vein with the Keto-SiteTM reflectance meter and test cards on treatment day 21. RESULTS: Blood BHB levels in the KD-treated group were significantly higher than those in the control group in 3 week-old rats (4.18+/-0.62 [n=30] vs. 0.27+/-0.02 [n=30] mM, respectively; p<0.0001) and 12 week-old rats (0.86+/-0.06 [n=30] vs. 0.22+/-0.02 [n=30] mM, respectively; p<0.0001). In the KD-treated groups, blood BHB levels of 3 week-old animals were significantly higher than those of 12 week-old ones (p<0.0001), whereas in the control groups, no significant differences in blood BHB levels between the two age groups (p>0.05). CONCLUSIONS: The present study demonstrates that the KD induces more severe ketosis in younger rats. Age-dependent differences in the degree of ketosis induced by the KD may explain that the diet is clinically more efficacious at younger ages.
3-Hydroxybutyric Acid ; Animals ; Blood Group Antigens ; Brain ; Diet ; Epilepsy ; Humans ; Ketogenic Diet* ; Ketone Bodies ; Ketosis* ; Male ; Rats ; Rats, Sprague-Dawley ; Rodentia ; Veins

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Role of Apoptosis in Development of Experimental Rat Cerebral Cortical Dysplasia.

Yun Jin LEE ; Chun Kee CHUNG

Journal of Korean Epilepsy Society.2003;7(2):101-107.

Microgyria is one type of cortical dysplasia with dyslaminations and anomalous cell densities, which could be produced experimentally. In a normal rat cortical development, overproduced neuroblasts gradually die by apoptosis. Thus, the diminished apoptosis may lead to the anomalous cell densities and dyslaminations. This study examined the ontogeny of cell densities in rat microgyria, in homotopic contralateral cortex and in control cortex. Multiple applications of cold probe (-70degrees C) on the right hemisphere in postnatal day (PN) 0 rat pups produced unilateral microgyria. Cell densities had decreased from PN 1 to 2 in microgyria, in the contralateral left hemisphere, and in the control cortex. From PN3 to PN10, while the cell density of the microgyria had increased (p<0.001), cell densities of the control and homotopic area continued to decrease. Apoptosis was greater in the microgyria than in the control and left hemisphere from PN1 to 3 and then remarkably decreased (p<0.001). These results suggest that the increased cell density in microgyria is not from decreased apoptosis, but probably caused by the increased proliferation or migration.
Animals ; Apoptosis* ; Cell Count ; Cell Movement ; Malformations of Cortical Development* ; Rats*

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Effect of Valproic Acid on Bcl-2, Bim, and Caspase-3 Expression in Rat Hippocampus after Kainic Acid-Induced Seizures.

Meyung Kug KIM ; Kwang Soo KIM ; Min Jeong KIM ; Jong Kuk KIM ; Bong Goo YOO ; Ji Hyun AHN ; Hee Kyung CHANG

Journal of Korean Epilepsy Society.2006;10(2):95-103.

PURPOSE: To investigate the regional and temporal patterns of Bcl-2, Bim, and caspase-3 expression in rat hippocampus after kainic acid (KA)-induced seizures, and to determine whether valproic acid (VA) has the neuroprotective effect on hippocampal apoptotic cell death. METHODS: Thirty five male Sprague-Dawley rats were used. KA (20 mg/kg) was injected once intraperitoneally in the experimental group, and 15 rats were immediately treated with repeated subcutaneous injections of VA. The brain was extracted at 4, 24, and 72 hours after KA injection. Immunohistochemical staining was conducted to assess the degree of Bcl-2, Bim, and caspase-3 expression at each hippocampal region. To investigate the effect of VA on apoptotic cell death, the expression degrees of Bcl-2, Bim, and caspase-3 were compared. RESULTS: Bcl-2 expression started to increase 4 hours after KA injection at CA3 and CA4 regions, and lasted up to 72 hours. Bim expression was increased at CA2 and CA3 regions 4 and 24 hours after KA injection. Caspase-3 expression was increased at all regions of hippocampus 4 hours after the injection, and lasted up to 72 hours. The expressions of Bcl-2, Bim, and caspase-3 were not different between KA-injected group and KA and VA-injected group. CONCLUSION: Although the present study was unable to confirm the neuroprotective effect of VA on KA-induced apoptotic cell death, this study showed that KA-induced seizures increased the expression of Bcl-2, Bim, and caspase-3. These results suggest that apoptotic cell death mechanism, such as the activation of cell death-regulating proteins Bcl-2, Bim, and caspase-3, involves in the KA-induced neuronal death.
Animals ; Brain ; Caspase 3* ; Cell Death ; Hippocampus* ; Humans ; Injections, Subcutaneous ; Kainic Acid ; Male ; Neurons ; Neuroprotective Agents ; Rats* ; Rats, Sprague-Dawley ; Seizures* ; Valproic Acid*

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Evaluation of Epilepsy-Related Information on the Korean Web Sites.

Woong Yong YOON ; Hyun Young KIM ; Ki Wook OH ; Wooyoung CHANG ; Hee Tae KIM ; Juhan KIM

Journal of Korean Epilepsy Society.2006;10(2):87-94.

BACKGROUND: The internet has a great amount of medical information for patients, but because no standards exist regarding the publication of medical literature on the internet, the quality of the internet information is quite variable. The purpose of our study was to assess the content and ethics of information on epilepsy, which is available on the Korean internet. METHODS: The search word "epilepsy" or "seizure" was entered into the five most commonly utilized Korean internet search engines. The web sites were divided into the higher or lower rank site on the basis of popularity ranking, and then evaluated by using both ethic and content value scales. The comparison between two groups was analyzed. RESULTS: Twenty eight epilepsy web sites were identified and divided into two equal groups. The average scores of ethic and content value scales were below half of the total score in the higher rank group as well as the lower. The score of higher rank group was not different statistically to that of lower rank group in both value scales. In addition, the score in the epilepsy specialists group was not higher than that in the non-specialists as well. DISCUSSION: The internet is easily accessible source of medical information including epilepsy. Moreover, because lots of epileptic patients are using the web for obtaining the information, the web information should be standardized. The results of our study show that clinicians should not recommend the epilepsy web site as a source of information for epileptic patients unless the epilepsy websites have been evaluated and assessed.
Epilepsy ; Ethics ; Humans ; Internet ; Publications ; Search Engine ; Specialization ; Weights and Measures

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Magnetoencephalography in Children.

Hoon Chul KANG ; Imai KATSUMI ; Ayako OCHI ; Hiroshi OTSUBO

Journal of Korean Epilepsy Society.2006;10(2):78-86.

Magnetoencephalography (MEG) and magnetic source imaging (MSI) are becoming increasingly important modalities in the functional neuroimaging of children. MEG is the magnetic equivalent of electroencephalography (EEG) and is thus capable of noninvasively characterizing neuronal activity on a millisecond time scale. MSI combines this functional information provided by MEG with the high anatomic detail of conventional magnetic resonance imagings. Considerable effort is placed on analyzing the configuration and number of spike waves by MEG that relate to a primary epileptiform discharge. Such MEG spike clusters are corroborated now by intraoperative invasive subdural grid monitoring that show good correlation in the majority of cases. Another important role of MEG relates to the mapping of critical regions of brain function using known paradigms for speech, motor, sensory, visual, and auditory brain cortex. In this review, I would introduce the background of MEG, data acquisition and analysis, and clinical application of MEG in children with epilepsy.
Brain ; Child* ; Electroencephalography ; Epilepsy ; Functional Neuroimaging ; Humans ; Magnetoencephalography* ; Neurons

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Biostatistical Methods for Epilepsy Trials.

Sung Min MYOUNG ; Shin Young KIM

Journal of Korean Epilepsy Society.2006;10(2):71-77.

Clinical trial provide reliable basis for evaluating the efficacy and safty of new treatments. To proceed effectively with clinical trial requires an comprehension of the basic principles of clinical design and biostatistical methods. This review focuses on fundamentals of biostatistical theory, on studies of calculating sample size, on definitions for classsification of evidence in epilepsy trials and on examining biostatistical methods for evaluating efficacy of antiepileptic drugs. This review guide how to understand basic statistical concepts and types of study design for epilepsy trials.
Anticonvulsants ; Biostatistics ; Comprehension ; Epilepsy* ; Sample Size

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