• Clinical and Experimental Pediatrics
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• v.50 no.7
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• pp.672-677
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• 2007

Purpose : To assess the prevalence and characteristics of headache comorbidity with epilepsy in children and adolescents in a specialty epilepsy clinic. Methods : Two hundred twenty nine consecutive patients attending the Chosun University Hospital Pediatric Epilepsy Clinic (mean age $10.0{\pm}4.1\;years$, range 4-17, M:F ratio 1.1:1.0) were interviewed with a standardized headache questionnaire. Headache was classified according to the International Classification of Headache Disorders, 2nd Edition and epilepsy was classified according to the International League Against Epilepsy. Disability was assessed using pediatric migraine disability assessment (PedMIDAS). Results : Of the 229 epilepsy patients, 86 (37.6%) had co-morbid headache. Of the headache patients, 64 (74.4%) had migraine (65.6%- migraine without aura, 20.3% - migraine with aura, 14.1% - probable migraine). The mean headache frequency was $7.2{\pm}8.4$ per month, mean duration was $2.2{\pm}4.0$ hours, mean severity was $5.2{\pm}2.2$ out of 10, and mean PedMIDAS score was $13.0{\pm}35.4$. The proportion of females was not higher in epilepsy with headache patients (48.8%) compared to epilepsy patients alone (48.0%). In the patients with migraine, 48.4% had complex partial seizures, 17.2% had simple partial seizures, and 34.4% had generalized seizures (P=0.368). A postictal association of migraine was reported in 18.8% with 17.2% reporting a preictal headache, and 7.8% reporting an ictal headache. Conclusion : The prevalence of headache in pediatric epilepsy is higher than that in general pediatric population, suggesting a co-morbidity of headache in epilepsy patients with migraine being the most frequent headache disorder. Altered cerebral excitability resulting in an increased occurrence of spreading depression may explain the headache comorbidity with epilepsy. Further studies are needed to assess the etiology of this co-morbidity as well as assess the frequency, duration, severity and disability response to antiepileptic drugs.

• Journal of Yeungnam Medical Science
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• v.11 no.1
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• pp.16-29
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• 1994

1. 현재 보편적으로 참고가 되는 간질 환자의 운전 면허 허용의 기준과 관련 법규등을 요약하면 표-5와 같다. 2. 아직 어떤 국가에서는 간질환자의 차량운전을 무경련 기간에 상관없이 금하고 있으나, 대다수의 국가에서는 일정한 기간의 무경련의 존재가 면허 허용의 중요한 기준으로 삼고 있으며, 대략 1년간의 기간을 요구하고 있다. 그러나 간질은 그 특징상 1년 혹은 2년의 무경련후에도 경련이 발생될 수 있어 1년간의 무경련으로 면허 발급을 허가는 제도는 더 연구하여 보완할 필요가 있다. 3. 수면시 간질, 전구증상이 있는 복합 부분 간질, 단순 운동성 간질, 특수한 여건이나 자극에서 생기는 경련환자에게 선택적으로 운전면허 허용은 장시간 운전, 고속 운전, 심리적 육체적 과로상태에서 운전을 하는 경우 기존 경련을 심하게 유발하거나, 평소와 다른 상황에서 경련이 생길 수 있어 이런 환자들에게 일괄적으로 면허를 허용하기 보다는 세밀하게 분석하여 개인별로 판별하여야 하는 것이 바람직하다. 4. 환자의 능동적이고 성실한 경련보고와 아울러 경련발생 가능성이 높아 의사의 운전중단 처방을 수용하고 따르는 협조적인 환자의 자세가 매우 중요한데, 현재까지 환자의 성실한 경련보고와 의사의 조치에 대한 환자의 적극적인 수용자세가 해결되지 않고 있다.

• Clinical and Experimental Pediatrics
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• v.51 no.8
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• pp.861-867
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• 2008

Purpose : We carried out this study to determine if there is any difference in the occurrence rate of the epileptiform discharge between awake EEG and sleep EEG and if there are any factors influencing on the occurrence rate of EEG. Methods : This study included 178 epileptic children who had visited neurology clinic of the department of pediatrics, Pusan National University Hospital from July 2005 to July 2006. The medical and EEG records of these children who had had both awake EEG and sleep EEG were reviewed. We analysed the occurrence rate of the epileptiform discharge between awake EEG and sleep EEG. We investigated the related clinical factors which included sex, seizure types, underlying causes, age at first seizure, antiepileptic drug (AED) medication, age at recording, and background activity. Results : Among 178 epileptic children, 91 patients (51.1%) showed epileptiform discharge in awake or sleep states, 10 patients (11.0%) abnormal only in awake, 40 patients (44.0%) abnormal only in sleep, 41 patients (45.0%) abnormal in both awake EEG and sleep EEG. The occurrence rate of sleep EEG was 81 of 178 patients (45.5%) which was more than that of the awake EEG (28.7%) (P<0.001). The occurrence rate of sleep EEG is more than that of the awake EEG regardless of sex and underlying causes. But there is no significant difference from awake EEG and sleep EEG in finding the epileptiform discharge in the patient with generalized seizure, younger than 5 years old at first seizure, younger than 10 years old at recording, no antiepileptic medication, and abnormal background activity. Conclusion : The sleep EEG is thought to be more helpful in the diagnosis of childhood epilepsy.

• Clinical and Experimental Pediatrics
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• v.50 no.9
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• pp.896-900
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• 2007

Purpose : The aim of this study was to investigate the speech problems in benign rolandic epilepsy (BRE) according to the seizure focus in EEG and semiology. Methods : Twenty three patients [right origin (13 patients) or left side (10 patients)] who met the BRE criteria by International League Against Epilepsy (ILAE) were prospectively enrolled. We excluded the patients who had abnormal MRI or showed both side spikes in EEG. Computerized Speech Lab was used to assess the speech characteristics of the patients. Results : The error pattern of laryngeal articulation in BRE was exclusively substitution of stop consonants, these errors showed more frequent in the left group (16.0% vs 25.5%). Voice onset time (VOT) of stop consonants and Total duration (TD) of word in both groups were prolonged than normal control group, especially in left group (P<0.05). The first formant of vowel /o/ and second formant of /e/ were significantly decreased in left group (P<0.05). The right group scored wider on pitch range ($192.9{\pm}54.0Hz$) and energy range in spontaneous speech ($14.2{\pm}6.4db$) than the left group ($233.3{\pm}12.5Hz$, $19.4{\pm}9.3db$, respectively, P>0.05). Duration of counting (5 to 9) in left group slower than right group ($8.6{\pm}1.7$ vs $7.9{\pm}1.8sec$). Conclusion : Our data suggested that interictal spikes and seizures in either centrotemporal sides, especially left side group, may induce speech problems. We recommend the logopedic and phoniatric evaluations of speech in BRE patients.

• Journal of Yeungnam Medical Science
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• v.24 no.2
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• pp.107-118
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• 2007

Background : It is well known that non-rapid eye movement(NREM) sleep activates the occurrence of interictal epileptiform discharges(IED) in many epileptic syndromes. We performed this study to assess the effect of NREM sleep on IED in epileptic patients with organic brain lesions. Materials and Methods : We analyzed awake and sleep electroencephalopathy(EEG) recorded simultaneously after partial sleep deprivation in 50 patients. We calculated the awake and sleep spike index (ASI and SSI, spikes/epoch), and the percentage increase of ASI and SSI during sleep. Results : In the 50 patients, the IEDs were recorded exclusively during the awake state in 1 (2%) patient, and during the sleep state in 13(26%) patients. The SSI was higher in 44 (88%) patients, and the ASI was higher in 5 (10%) patients. The mean ASI and the SSI in patients with organic brain lesions were $0.058{\pm}0.121$ and $0.148{\pm}0.187$, and it was $0.081{\pm}0.150$ and $0.174{\pm}0.226$ in patients without organic brain lesions. There were significant increases in the spike index (P<0.05) during NREM sleep in both groups (n=36), but no significant difference in the percent increase of spike index (P>0.05). Conclusion : The IEDs were activated significantly during NREM sleep both in patients with and without organic brain lesions, but there were no differences in the degree of activation in both groups. The activating effect of NREM sleep was not correlated with clinical factors such as, frequent nocturnal seizures, frequent generalized tonic clonic seizures, type of epilepsy and taking anticonvulsants. We conclude that the routine EEG used to evaluate epileptiform discharges in epileptic patients should include sleep recordings after partial sleep deprivation.

• The Journal of Korea Assosiation for Disability and Oral Health
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• v.3 no.2
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• pp.69-74
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• 2007

진단기술과 약물치료기법 및 신경학적 과정에 대한 이해가 발전됨으로 인하여 치과의사는 간질환자를 더 잘 이해하고 치료할 수 있게 되었다. 간질환자는 몇 가지 주의사항만 지킨다면 일반치과에서도 쉽게 치료할 수 있다. 즉, 의학적 병력과 함께 매 번 방문 시 마다 치과치료 전에 현재상태에 대한 평가가 필요하다. 기왕력 중 발작은 치료계획수립시 반드시 고려되어야 한다. 치과의사는 간질이나 경련성질환에 대하여 포괄적이며 통합적 이해를 통하여 환자의 구강건강뿐 아니라 나아가 전신건강을 증진하는 데 기여할 수 있다.

• The Korean Journal of Nuclear Medicine
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• v.29 no.1
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• pp.9-14
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• 1995

뇌졸증환자의 뇌 SPECT 소견상 나타나는 소뇌교차해리현상(crossed cerebellar diaschisis)은 잘 알려진 현상이다. 한편 간질 환자의 발작시 뇌 SPECT에서 반대편 소뇌에 혈류증가를 보이는 역교차해리현상(reverse type of crossed cerebellar diashisis)은 드물게 보고되었었다. 따라서 본 저자들은 발작시 뇌 SPECT에서 역교차해리현상의 빈도 및 간질병소를 찾는데 있어서의 유용성에 대해 알아보고자 하였다. 복합부분발작환자 중 임상적, 뇌파검사상 및 SPECT 소견등에서 간질병소가 일치하는 12명의 환자를 대상으로 하였다. 환자 모두에서 시행한 발작시 스캔은 발작중 혹은 환자가 aura를 호소할때 $^{99m}Tc$-HMPAO 15-20mCi를 정맥주입 후 시행하였으며 발작간 스캔은 11명의 환자에서 발작시 스캔 후 적어도 3일 간격을 두고 시행하였다. 간질병소는 우측측두엽이 6예, 좌측측두엽이 4예, 우측후두엽이 1예, 좌측전두엽이 1예 등이었다. 발작시 스캔상 간질병소 및 반대편 소뇌에 혈류가 증가하는 역해리현상은 모두 8명(75%)의 환자에서 나타났으며 특히 2명의 환자에서는 간질병소보다 반대편 소뇌의 동위원소 섭취가 더욱 뚜렸했다. 역해리현상을 보였던 환자의 발작간 스캔소견에서는 발작시 증가되었었던 소뇌의 동위원소 섭취가 7예에서 정상화되었고 나머지 1예에서는 감소되었다. 따라서 소뇌의 역교차해리현상은 발작시 뇌 SPECT의 자주 볼 수 있는 현상으로 간질병소의 편측화에 도움을 줄 수 있을 것으로 생각된다.

• Korean Journal of Psychosomatic Medicine
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• v.17 no.2
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• pp.82-89
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• 2009

Objectives : Anxiety is a common co-morbid symptom in patients with epilepsy, which can affect the treatment and prognosis of epilepsy patients. This study is designed to compare the characteristics of anxiety between epilepsy patients and normal controls and also analyze them in epilepsy patients by examining both seizure-related and socio-demographic variables. Methods : As cross-sectional study, 80 epilepsy patients were enrolled from January to July 2008. The State-Trait Anxiety Inventory-(STAI) was used to assess the characteristics of anxiety. STAI is composed of transitory episodes of anxiety-(state subscale of STAI ; STAI-S) and stable personality features presenting chronic levels of anxiety-(trait subscale of STAI ; STAI-T). As controls, 113 healthy age-and sex-matched people were included. Results : The mean score of STAI-S and STAI-T were not different in both groups(STAI-S ; p=0.998, STAIT ; p=0.343). Within patients, patients without occupational engagement showed higher STAI-S(p<0.001) and tendency to higher STAI-T(p=0.052). Patients with depression showed higher score in both modalities(STAIS and STAI-T ; p<0.001). Patients with aura showed higher STAI-T(p=0.031). Conclusions : STAI-S and STAI-T was not significantly different between patients and controls. Of 3 factors related to anxiety, higher STAI-T in patients with aura is likely to represent misunderstanding internal and external changes as an aura and worrying about impending seizure. Occupational engagement and depression had relation to both STAI-S and STAI-T and more concern is needed to evaluate the risk of anxiety and manage it appropriately.

• The Korean Journal of Nuclear Medicine
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• v.38 no.1
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• pp.30-40
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• 2004

Purpose: The aims of this study were to find brain regions in which gray matter volume was reduced and to show the capability of voxel-based morphometry (VBM) analysis for lateralizing epileptogenic zones in medial temporal lobe epilepsy (mTLE). The findings were compared with fluorodeoxyglucose positron omission tomography (FDG PET). Materials and Methods: MR T1-weighted images of 12 left mTLE and 11 right mTLE patients were compared with those of 37 normal controls. Images were transformed to standard MNI space and averaged in order to create study-specific brain template. Each image was normalized to this local template and brain tissues were segmented. Modulation VBM analysis was performed in order to observe gray matter volume change. Gray matter was smoothed with a Gaussian kernel. After these preprocessing, statistical analysis was peformed using statistical parametric mapping software (SPM99). FDG PET images were compared with those of 22 normal controls using SPM. Results: Gray matter volume was significantly reduced in the left amygdala and hippocampus in left mTLE. In addition, volume of cerebellum, anterior cingulate, and fusiform gyrus in both sides and left insula was reduced. In right mTLE, volume was reduced significantly in right hippocampus. In contrast, FDG uptake was decreased in broad areas of left or right temporal lobes in left TLE and right TLE, respectively. Conclusions: Gray matter loss was found in the ipsilateral hippocampus by modulation VBM analysis in medial temporal lobe epilepsy. This VBM analysis might be useful in lateralizing the epileptogenic zones in medial temporal lobe epilepsy, while SPM analysis of FDG PET disclosed hypometabolic epileptogenic zones.

• Tuberculosis and Respiratory Diseases
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• v.46 no.1
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• pp.65-74
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• 1999

Background : Open lung biopsy(OLB) has conventionally been regarded as the gold standard for the diagnosis in interstitial lung disease. With recent advances in diagnostic technique such as high resolution computed tomography(HRCT), and transbronchial lung biopsy(TBLB) which provide relatively accurate diagnosis of ILD, it is necessary to reevaluate the role of these methods in the diagnosis of ILD. Methods: We carried out a retrospective analysis of nineteen patients who underwent OLB at Dankook University Hospital for the diagnosis of acute and chronic ILD, between May 1995 and June 1998. By reviewing the medical records, the demographic findings, underlying conditions, HRCT and TBLB findings, OLB diagnosis, therapy after OLB, and complication of OLB were evaluated. Results: Thirteen patients(68.4%) had chronic ILD(symptom duration over 2 weeks prior to OLB), and six patients(31.6%) had acute ILD(symptom duration less than 2 weeks). Specific diagnosis were reached in 92%(12/13) of chronic ILD(5 bronchiolitis obliterans organizing pneumonia(BOOP), 2 constrictive bronchiolitis, 3 usual interstitial pneumonia, 1 hypersensitivity pneumonitis, 1 eosinophilic pneumonia), and in all patients of acute ILD(5 acute interstitial pneumonia, 1 pneumocystis carinii pneumonia). HRCT were performed in all patients and a correct first choice diagnosis rate of HRCT was 42%(5/12) in chronic ILD. In chronic ILD patients, 62%(8/13) received specific therapy(steroid therapy in 7 patients and moving in one patient), after OLB, but in acute ILD, all patients received specific therapy(steroid therapy in 5 patients and steroid and antibiotic therapy in one patient) after OLB. The in-hospital mortality after OLB was 5.3%(1/19). Conclusion: OLB is an excellent diagnostic technique with relatively low complications in patients with ILD. Therefore OLB should be considered in patients with ILD when the specific diagnosis is important for the treatment, especially in patients with acute ILD.