OBJECTIVE: To analyze the disease patterns and acupoint selection characteristics of acupuncture for epilepsy in ancient acupuncture texts, providing references and ideas for clinical acupuncture treatment of epilepsy. METHODS: Texts from the Chinese Medical Classics (5th edition) regarding acupuncture for epilepsy are reviewed. The frequency of acupoints, meridian association, distribution, specific points, corresponding epilepsy subtypes, and needling techniques are statistically analyzed. The Apriori algorithm is used for association rule analysis, and a complex network analysis is conducted for high-frequency acupoints and their corresponding subtypes and treatments. RESULTS: A total of 205 acupuncture prescriptions are identified. Ancient texts favored differentiation-based treatments for epilepsy, primarily classified into epilepsy, wind epilepsy, and five epilepsy. Commonly used acupoints include Baihui (GV20), Jiuwei (CV15), Shenmen (HT7), Shenting (GV24), and Xinshu (BL15), with a focus on the acupoints of the governor vessel, the bladder meridian, and the conception vessel. The acupoints on the head, face are combined with the acupoints on the limbs, with skillful use of the five-shu points and intersection acupoints. The most frequent combinations are Shenmen (HT7)-Baihui (GV20), Shenting (GV24)-Baihui (GV20), and Xinshu (BL15)-Shenmen (HT7). Visual network analysis revealed that Baihui (GV20)-Shenting (GV24), Baihui (GV20)-Shenmen (HT7), and Baihui (GV20)-Zhaohai (KI6) are core acupoint combinations. Treatment mainly involved moxibustion or combined acupuncture and moxibustion. CONCLUSION The acupoint selection for epilepsy treatment in ancient texts is precise, frequently using Baihui (GV20), Jiuwei (CV15), Shenmen (HT7), Shenting (GV24), and Xinshu (BL15), etc., with emphasis on calming epilepsy, awakening the spirit, relaxing tendons, and nourishing the heart.
Acupuncture Points ; Humans ; Epilepsy/history* ; History, Ancient ; Acupuncture Therapy/history* ; Medicine in Literature/history* ; Meridians ; China

PURPOSE: The developmental history is an important element in the evaluation of children with epilepsy. However, obtaining accurate information from history is often very difficult especially in older children because of their parents' incomplete recollection. This study was aimed to investigate if the timing of independent walking has a valuable clinical significance in children with epilepsy. METHODS: We classified 262 patients with epilepsy into normal and delayed groups from a history of the timing of independent walking at 18 months as a cutoff point. We compared their clinical and laboratory characteristics between two groups. RESULTS: Out of 262 patients, twenty one (8%) were delayed. There was no difference in seizure types between two groups. The Age of seizure onset and diagnosis of epilepsy was earlier in delayed group (5.6:2.2 years, P<0.001; 7.0:3.2 years, P<0.001). The proportion of Cesarean section and preterm delivery were also higher in delayed group (25%:52%, P= 0.010; 6%:29%, P<0.001). Abnormal MRI findings were more frequent in the delayed group (19%:86%, P<0.001). EEG at diagnosis showed no difference in epileptiform discharges, but background abnormality was more common in the delayed group (15%:81%, P<0.001). EEG at 1 year after the diagnosis showed both epileptiform discharges and background abnormality were more frequent in the delayed group (60%:90%, P=0.004; 14%:67%, P<0.001). CONCLUSION: Based on the result of this study, we strongly recommended that we should take a history of the timing of independent walking in children and adolescents with epilepsy.
Adolescent ; Cesarean Section ; Child ; Electroencephalography ; Epilepsy ; Female ; Humans ; Medical History Taking ; Pregnancy ; Seizures ; Walking

PURPOSE: The aim of this study was to investigate the natural history of epilepsy and response to anti-epileptic drug treatment in patients with Angelman syndrome (AS) in Korea. METHODS: We retrospectively reviewed the clinical records of 14 patients diagnosed with epilepsy out of a total of 17 patients with a genetic diagnosis of AS. These patients were seen at the Department of Pediatric Neurology at Severance Children's Hospital from March 2005 to March 2011. RESULTS: Fourteen (9 males and 5 females) subjects (82.3%) were diagnosed with epilepsy in AS. The most common seizure types were generalized tonic-clonic (n=9, 27%) and myoclonic (n=9, 27%), followed by atonic (n=8, 24%), atypical absence (n=4, 12%) and complex partial seizure (n=3, 9%). The most commonly prescribed antiepileptic drug (AED) was valproic acid (VPA, n=12, 86%), followed by lamotrigine (LTG, n=9, 64%), and topiramate (n=8, 57%). According to questionnaires that determined whether each AED was efficacious or not, VPA had the highest response rate and LTG was associated with the highest rate of seizure exacerbation. Complete control of seizures was achieved in 6 patients. Partial control was achieved in 7 patients, while one patient was not controlled. CONCLUSION: Epilepsy is observed in the great majority of AS patients. It may have early onset and is often refractory to treatment. There are few reports about epilepsy in AS in Korea. This study will be helpful in understanding epilepsy in AS in Korea.
Angelman Syndrome ; Anticonvulsants ; Epilepsy ; Fructose ; Humans ; Korea ; Male ; Natural History ; Neurology ; Surveys and Questionnaires ; Retrospective Studies ; Seizures ; Triazines ; Valproic Acid

PURPOSE: Seizure outcomes are more complicated in terms of repeated remission and relapse in the course of epilepsy. We aim to investigate the different patterns of evolution in new-onset pediatric epilepsy and the seizure outcome of different types of epilepsy syndromes. METHODS: We examined the evolution pattern of remission and relapse in the course of epilepsy in 326 children who were less than 15 years of age, with new-onset epilepsy. Different remission-relapse patterns were determined in each patient and according to epilepsy syndromes. The probability of repeated remission and relapse were analyzed with Markov process. RESULTS: During follow-up (mean+/-SD: 79+/-25 months) of 326 patients, early remission, defined as remission within the first year of treatment, was seen in 288 patients (88.4%), and late remission was achieved in 21 patients (6.4%). 17 patients (5.2%) never achieved remission. 94.8% of the cohort experienced at least one remission, with first relapse, second relapse, and third relapse occurring in 115 patients (35.3%), 61 patients (18.7%), and 28 patients (8.6%), respectively. At the end of follow-up period, 281 patients (86.2%) were in terminal remission. 194 patients (59.6%) showed a continuous remitting course, and 87 patients (26.7%) showed a remitting-relapse course. 45 patients (13.8%), including worsening courses in 28 patients (8.6%) and drug resistant courses in 17 patients (5.2%), did not show terminal remission. Markov process disclosed that children with epileptic encephalopathy and symptomatic partial epilepsy were less likely to show remission than children with idiopathic partial or generalized epilepsy (P<0.001). CONCLUSION: Only 13.8% of children with new-onset epilepsy have poor seizure outcome in terms of never achieving remission or persistent seizure after achieving at least one remission. The etiology of epilepsy syndrome is an important factor determining seizure outcome.
Child ; Cohort Studies ; Epilepsies, Partial ; Epilepsy ; Epilepsy, Generalized ; Follow-Up Studies ; Humans ; Markov Chains ; Natural History ; Recurrence ; Seizures

PURPOSE: We describe 2 cases of bilateral acute angle-closure glaucoma associated with topiramate, a drug that has recently been prescribed for epilepsy or weight reduction. METHODS: A 51-year-old man and a 27-year-old woman, previously devoid of ocular problems, visited the emergency room with blurry vision after taking topiramate for epilepsy and weight reduction, respectively. Thorough medical history taking and ocular examinations including ultrasound biomicroscopy were performed. RESULTS: Ultrasound biomicroscopy revealed supraciliary choroidal effusion causing forward displacement of the lens-iris diaphragm, which resulted in myopia, anterior chamber shallowing, and increased intraocular pressure by angle-closure. Discontinuation of topiramate and the administration of cycloplegics, steroids and pressure-lowering agents led to the resolution of the symptoms. CONCLUSIONS: An idiosyncratic reaction of topiramate may produce supraciliary choroidal effusion and ciliary body edema, resulting in anterior displacement of lens-iris diaphragm, increased myopia and acute angle-closure glaucoma. Thorough medical history taking and ocular examinations are necessary to rule out the drug-induced acute angle-closure glaucoma.
Adult ; Anterior Chamber ; Choroid ; Ciliary Body ; Diaphragm ; Edema ; Emergency Service, Hospital ; Epilepsy ; Female ; Glaucoma, Angle-Closure* ; Humans ; Intraocular Pressure ; Medical History Taking ; Microscopy, Acoustic ; Middle Aged ; Mydriatics ; Myopia ; Steroids ; Weight Loss

BACKGROUND: Semiology of epileptic seizure is very important for diagnosis and treatment. However, little is known about the reliability of the observers' description. This study aims to determine the description reliability of seizures in the aspects of classification and lateralization. METHODS: We recorded 72 patients with habitual seizures during video-EEG monitorings. We, then, compared the ictal behaviors described by frequency observers and those recorded on the videotape to compare the accuracy of the observers' descriptions. Finally, we reviewed which aspects of the informants affected the reliability of the data. RESULTS: The classification of seizures based only on the observer-description was somewhat discordant from the videotape (correct classification: 82%) especially in dividing simple partial from complex partial seizures. Description of many ictal behaviors in presumed complex partial seizure such as oroalimentary automatism, motionless staring, tonic/clonic posture and version was accurate except for the hand automatism. A specified direction by the observer has a very high true positive rate. The accuracy of the description was related to the educational status of the observer. CONCLUSIONS: Semiology description by well-educated observers is may be reliable, but every physician should keep its limitation in mind and judge accordingly.
Automatism ; Classification ; Diagnosis ; Educational Status ; Epilepsy ; Hand ; Humans ; Medical History Taking ; Posture ; Reproducibility of Results ; Seizures ; Videotape Recording

Although it's been about 100 years since the vascular malformation was first discovered, it is very recent situation that the natural history of cavernous malformations is being clarified. Once it was considered to be very rare, but the introduction of MRI made it possible to diagnose more asymptomatic patients than ever. With this sophiscated tool, it become easy to diagnose and follow up this vascular disease. As more and more asymptomatic or minimally symptomatic patient are being discovered, it become very difficult part for a neurosurgical surgeon to choose the method of treatment in each clinical case. A great deal of recent controversy has been generated concerning the best surgical approach to treat benign lesions that are associated with epilepsy. Since the definition of the bleeding and the clinically significant symptom are different from author to author, one should be careful to recognize the statistical numbers of the from articles. We reviewed dozens of articles to figure out the right indication, approach and microsurgical technique. The surgical risk should be carefully weighed against the morbidity from the natural history of the disease.
Epilepsy ; Follow-Up Studies ; Hemorrhage ; Humans ; Magnetic Resonance Imaging ; Natural History ; Vascular Diseases ; Vascular Malformations

PURPOSE: We performed the study to determine the clinical characteristics and natural history of Gaucher disease with CNS involvement in Korea as well as to determine whether gene analysis would be helpful in the identification of neuronopathic Gaucher disease. METHODS: We described the initial symptom, clinical manifestations, age of onset, clinical neurophysiologic findings and brain MRI findings from the medical records of 13 patients with neuronopathic Gaucher disease identifed from the Korean Gaucher Disease Patient Registry. Mutation analysis was performed in 7 cases of neurono pathic Gaucher disease patients by PCR or PCR-single strand conformation polymorphism (SSCP). RESULTS: Among 46 cases of Korean Gaucher disease, type ll was found in 6 cases (13%) and type lll was found in 7 cases (15%). Type II Gaucher disease showed typical clinical features, and those patients expired in less than 2 years of age. All the type IIIa patients presented epileptic seizure as an initial symptom and most of the patients survived. All the type IIIa patients revealed epileptiform activity and photoparoxysmal response. Mutation analysis in neuronopathic Gaucher disease patients revealed L444P/L444P (2 cases), F213I/F213I (1 case), F213I/? (1 case) and N188S/? (1 case). However, mutation analysis in type I Gaucher disease revealed L444P/? (4 cases), F213I/? (2 cases) and L444P/F213I (1 case). CONCLUSION: The clinical characteristics and natural history of Korean Gaucher disease is similar to those of Jewish Gaucher disease. Brain MRI, clinical neurophysiologic study and gene analysis are not helpful in the identification of neuronopathic Gaucher disease. Regular neurologic examinations are the only method to determine CNS involvement in Gaucher disease.
Age of Onset ; Brain ; Central Nervous System* ; Epilepsy ; Gaucher Disease* ; Humans ; Korea ; Magnetic Resonance Imaging ; Medical Records ; Natural History ; Neurologic Examination ; Polymerase Chain Reaction