Ramucirumab is a vascular endothelial growth factor (VEGF) receptor-2 inhibiting monoclonal antibody for the treatment of gastric cancer, non-small cell lung cancer, colorectal cancer, and hepatocellular carcinoma. Some VEGF inhibitors are known to increase the risk of ischemic stroke; however, their association with ramucirumab remains controversial. To the best of our knowledge, only two cases of ischemic stroke following ramucirumab treatment have been reported worldwide. We herein present the first case of acute cerebral infarction secondary to ramucirumab in Korea.

Several medications are approved to treat coronavirus disease 2019 (COVID-19) in Korea including nirmatrelvir/ritonavir, remdesivir, and regdanvimab. There is potential drug-drug interaction between antiepileptic drugs (AEDs) and the medications used to treat COVID-19. Several AEDs such as phenytoin, carbamazepine, phenobarbital, and primidone are strong cytochrome P450 inducers and can inhibit the drugs used for COVID-19. Particularly, these drugs are contraindicated with nirmatrelvir/ritonavir (Paxlovid®). There is a weaker drug-drug interaction between the AEDs and remdesivir. No significant interaction has been reported between the AEDs and molnupiravir. Pharmacokinetic interactions of the AEDs are important in effective management of COVID-19 in patients with epilepsy.

Objectives: Clinicians often depend on the results of the the multiple sleep latency test (MSLT) for diagnosing narcolepsy, but the diagnosis can be confusing when there is a co-existence of obstructive sleep apnea (OSA). This study is aimed to address the diagnostic tendency and the strategies of treatment for narcolepsy and other hypersomnia in the grey zone. Methods: We performed a web-based survey of Korean neurologists who were interested in narcolepsy and had experience with sleep studies. Results: The results of this survey present their concerns according to the severity of comorbid OSA in analyzing the results of the MSLT. Conclusions This study also might help by providing the opinions of experienced Korean neurologists for the assessment and management of excessive daytime sleepiness.

Background: and Purpose Japanese encephalitis (JE) is caused by the JE virus of the Flaviviridae family and is spread by mosquito bites, and no specific antiviral treatment for it exists. Here we describe the clinical presentations, laboratory findings, clinical outcomes, and adverse events after combination treatment of immunoglobulin, ribavirin, and interferon-α2b administered to patients with JE. Methods: Data were collected and reviewed from a prospective cohort of encephalitis patients admitted to Seoul National University Hospital between August 1, 2010 and October 31, 2019.We reviewed the medical records of the patients diagnosed with JE and treated either with supportive care only or with combination treatment of intravenous immunoglobulin, oral ribavirin, and subcutaneous interferon-α2b. Results: Eleven patients were diagnosed with laboratory-confirmed JE based on the diagnosis criteria of JE. The median age was 61 years, and five patients were male. Eight patients were treated with the combination therapy, while three patients received supportive management only. Four of the eight patients (50%) treated with the combination therapy showed partial recovery, while one patient (12.5%) showed complete recovery. Two patients experienced hemolytic anemia related to ribavirin and febrile reaction to immunoglobulin, respectively. Among the three patients who received supportive management only, one (33.3%) showed partial recovery and the other two (67.7%) did not show improvement. Conclusions Combination treatment of immunoglobulin, ribavirin, and interferon-α2b was found to be tolerable in JE in this study. Further studies of appropriate designs and involving larger numbers of patients are warranted to explore the efficacy of this combination therapy.

Objectives: We analyzed theta-band phase synchrony (TBPS) under reduced and ordinary flicker lighting to determine the effect of light flickers on neurocognitive processes. Methods: Nineteen healthy participants (mean age, 30.4±4.5 years; male, 63.2%) performed the Sternberg working memory tasks with event-related potential recording under reduced and control flicker conditions, respectively. We measured the P300 amplitude during memory retrieval, and for TBPS analysis, we calculated the weighted phase lag index within the P300 time window. Furthermore, we used standardized low-resolution brain electromagnetic tomography (sLORETA) to determine differences in functional cortical source connectivity between the two flicker conditions. Results: The hit rate (F1,18=0.862, p=0.365), reaction time (F1,18=0.021, p=0.887), and P300 amplitude (F1,18=3.992, p=0.061) did not differ between the two flicker conditions. However, connectivity analysis at the scalp level showed that TBPS under reduced flicker lighting was significantly higher than that under control flicker lighting at higher memory loads (p=0.002). Cortical source imaging with sLORETA confirmed that reduced flicker lighting significantly increased TBPS between the left prefrontal cortex and right hippocampus compared with control flicker lighting (false discovery rate<0.1). Conclusions Reduced flicker lighting enhanced TBPS during the working memory task compared with control flicker lighting. Reduced flicker light may improve cognitive functioning by facilitating information transfer within the brain network. Flicker conditions should be considered when optimizing lighting, especially in environments demanding high-level cognitive performance.

Driving is a complicated process that demands coordination between a range of neurocognitive functions, including attention, visuo-perception, and appropriate judgment, as well as sensory and motor responses. Therefore, several factors may reduce the driving performance of an individual, such as sleepiness, distraction, overspeeding, alcohol consumption, and sedative drugs, all of which increase the hazard of motor vehicle accidents. Among them, drowsy driving is a major cause of traffic accidents, leading to more serious injuries as compared to other causes of major traffic accidents. Although sleep disorders have been highly associated among drowsy drivers, they are often untreated and unrecognized as a disease. In particular, obstructive sleep apnea and narcolepsy are some sleep disorders that are highly related to traffic accidents. Insomnia, which can cause inadequate sleep duration and promote sedative effects from sleeping pills, may also cause traffic accidents. These conditions are especially applicable to commercial bus or truck drivers, nocturnal workers, and shift workers, who are highly vulnerable to drowsy driving. Therefore, assertive screening and management of sleep disorders are necessary in general private drivers and relevant occupational drivers.

Narcolepsy is a chronic sleep disorder characterized by irresistible sleep attacks, hypersomnolence, cataplexy (sudden loss of muscle tone provoked by emotion), and sleep paralysis. Individuals with narcolepsy are at a high risk of experiencing sleepiness while driving leading to road traffic accidents. To prevent such accidents, some countries have regulations for commercial and noncommercial drivers with narcolepsy. Evaluating sleepiness is essential. Therefore, several subjective reports and objective tests were used to predict the possibility of car crashes or near-misses. Brain stimulants are effective in treating narcolepsy and can reduce daytime sleepiness in these patients. However, no guideline has been established for the driving safety of patients with narcolepsy in Korea. The Korean Sleep Research Society has prepared this proposal for preventing motor vehicle accidents caused by drowsy driving in patients with narcolepsy.

Obstructive sleep apnea (OSA) is known to be associated with various health concerns, including sleepiness, fatigue, cognitive dysfunction, diminished quality of life, hypertension, cardiovascular diseases, and stroke. OSA-induced sleepiness at the wheel reduces vigilance and driving performance, which significantly increase the risk of motor vehicle accidents. Sleepiness-induced motor vehicle accidents are characterized by high morbidity and mortality. OSA is a well-established significant risk factor for drowsy driving-related motor vehicle accidents, which can be prevented through appropriate treatment. However, currently no clinical guidelines or regulations are available for evaluation or management of the risk of motor vehicle accidents in patients with OSA in Korea. In this review, we discuss the risk of motor vehicle accidents in patients with OSA, the effects of positive airway pressure therapy as a preventive measure to reduce this risk, and the published recommendations for OSA in other countries with regard to fitness to drive. We propose recommendations for screening, evaluation, and treatment of OSA with regard to the risk of motor vehicle accidents, which would serve as useful practical guidelines for sleep specialists in clinical practice. Further research is warranted to establish optimal strategies for effective improvements in OSA-related traffic safety.

Background: and Purpose Japanese encephalitis (JE) is caused by the JE virus of the Flaviviridae family and is spread by mosquito bites, and no specific antiviral treatment for it exists. Here we describe the clinical presentations, laboratory findings, clinical outcomes, and adverse events after combination treatment of immunoglobulin, ribavirin, and interferon-α2b administered to patients with JE. Methods: Data were collected and reviewed from a prospective cohort of encephalitis patients admitted to Seoul National University Hospital between August 1, 2010 and October 31, 2019.We reviewed the medical records of the patients diagnosed with JE and treated either with supportive care only or with combination treatment of intravenous immunoglobulin, oral ribavirin, and subcutaneous interferon-α2b. Results: Eleven patients were diagnosed with laboratory-confirmed JE based on the diagnosis criteria of JE. The median age was 61 years, and five patients were male. Eight patients were treated with the combination therapy, while three patients received supportive management only. Four of the eight patients (50%) treated with the combination therapy showed partial recovery, while one patient (12.5%) showed complete recovery. Two patients experienced hemolytic anemia related to ribavirin and febrile reaction to immunoglobulin, respectively. Among the three patients who received supportive management only, one (33.3%) showed partial recovery and the other two (67.7%) did not show improvement. Conclusions Combination treatment of immunoglobulin, ribavirin, and interferon-α2b was found to be tolerable in JE in this study. Further studies of appropriate designs and involving larger numbers of patients are warranted to explore the efficacy of this combination therapy.