• Journal of Korean Neurosurgical Society
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• v.62 no.3
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• pp.328-335
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• 2019

Epilepsy is one of the most common chronic neurological disorder affecting 6-7 per 1000 worldwide. Nearly one-third of patients with newly diagnosed epilepsy continue to have recurrent seizures despite adequate trial of more than two anti-seizure drugs : drug-resistant epilepsy (DRE). Children with DRE often experience cognitive and psychosocial co-morbidities requiring more urgent and aggressive treatment than adults. Epilepsy surgery can result in seizure-freedom in approximately two-third of children with improvement in cognitive development and quality of life. Understanding fundamental differences in etiology, co-morbidity, and neural plasticity between children and adults is critical for appropriate selection of surgical candidates, appropriate presurgical evaluation and surgical approach, and improved overall outcome.

• Journal of Korean Academy of Nursing
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• v.47 no.5
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• pp.624-637
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• 2017

Purpose: This study aimed to identify variables influencing the health-related quality of life (HRQoL) of adults with epilepsy in order to establish a structural model and design an intervention strategy to improve patients' HRQoL. Methods: The selected subjects were 212 patients with epilepsy aged between 18 and 70 years who were currently receiving treatment from hospital, general hospital, and clinic. They were surveyed using a structured questionnaire. Results: The goodness of fit measures of the final hypothetical model were as follows: ${\chi}^2/df=2.51$, GFI=.91, AGFI=.90, CFI=.96, SRMR=.04, NFI=.93, and RMSEA=.08. The major variables influencing the HRQoL of adults with epilepsy were epilepsy self-efficacy, depression, social support, and side effects of anti-epileptic drugs (AEDs), which were significant in the mentioned order, whereas the duration of AEDs use and perceived stigma did not show any effects. Six variables accounted for 75.6% of HRQoL. Variables having a direct and total effect on the HRQoL of adults with epilepsy were the side effects of AEDs, social support, epilepsy self-efficacy, and depression, and those with an indirect effect were the side effects of AEDs and social support. Conclusion: It is necessary to accurately identify the side effects of AEDs in adults with epilepsy and accurately observe the physical changes caused by depression. In addition, it is imperative to establish an active and effective nursing intervention program to strengthen the self-efficacy of the patients and to improve their quality of life through social support provided by family members and medical professionals.

• Journal of Korean Academy of Nursing
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• v.28 no.4
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• pp.1003-1012
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• 1998

The purpose of this research was to identify the effect of human potential seminars on the perceived stigma of adults with epilepsy. The research employed a quasi experimental design and unequivalent control group pre-post design. The test was conducted on 15 adults with epilepsy attending one psychiartric out-patient clinic in Masan City, Korea. The stigma questionnaire was used as a pre-test to these patients. HPS was done ten times for five weeks from May 6, to July 26, 1996. The stigma questionnaire was again given, but this time as a post test. The control group of 14 adults with epilepsy were receiving medication at the same clinic. The human potential seminars were structured by McHolland(1972) and translated by Lee, Hae Seung(1990). The stigma research tool was modified and revised to be appropriate to Korean culture. It consisted of 15 sentences. The internal consistency was 0.92 with Cronbach's α. Research results are as follows. 1) To determine the homogenity of the experimental and control groups, the pre-stigma results were used and democratic-sociologic characteristics, job characteristics and disease related variables were compared. There was no significant difference between the two groups. 2) To identify the relationship between stigma and patient characteristics a pre-test was done. The study used both Mann-Whitney U-test and ANOVA test for statistical analysis. The variables related to stigma were the reason of unemployment and age at onset of epilepsy. 3) The test results of the effect of the human potential seminars on stigma in the patients with epilepsy, showed that stigma in the experimental group was lower than in the control group. The statistical method used to determine the difference between pre and post stigma results was the Wilcoxon signed rank test. The test results were statistically significant at the one percent level. 4) As a follow-up evaluation ten more patients(66.7% of the total) were additionally tested. In order to investigate if the stigmas were different between the pre, post and follow-up, Repeated measure ANOVA was used. The test results showed that the stigma scores were statistically different between the three groups at the one percent level(F=10.06, d.f.=2, p=0.00).

• Clinical and Experimental Pediatrics
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• v.56 no.7
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• pp.275-281
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• 2013

Temporal lobe epilepsy (TLE) is the most common type of medically intractable epilepsy in adults and children, and mesial temporal sclerosis is the most common underlying cause of TLE. Unlike in the case of adults, TLE in infants and young children often has etiologies other than mesial temporal sclerosis, such as tumors, cortical dysplasia, trauma, and vascular malformations. Differences in seizure semiology have also been reported. Motor manifestations are prominent in infants and young children, but they become less obvious with increasing age. Further, automatisms tend to become increasingly complex with age. However, in childhood and especially in adolescence, the clinical manifestations are similar to those of the adult population. Selective amygdalohippocampectomy can lead to excellent postoperative seizure outcome in adults, but favorable results have been seen in children as well. Anterior temporal lobectomy may prove to be a more successful surgery than amygdalohippocampectomy in children with intractable TLE. The presence of a focal brain lesion on magnetic resonance imaging is one of the most reliable independent predictors of a good postoperative seizure outcome. Seizure-free status is the most important predictor of improved psychosocial outcome with advanced quality of life and a lower proportion of disability among adults and children. Since the brain is more plastic during infancy and early childhood, recovery is promoted. In contrast, long epilepsy duration is an important risk factor for surgically refractory seizures. Therefore, patients with medically intractable TLE should undergo surgery as early as possible.

• Clinical and Experimental Pediatrics
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• v.63 no.8
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• pp.291-300
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• 2020

Advances in autoimmune encephalitis studies in the past 10 years have led to the identification of new syndromes and biomarkers that have transformed the diagnostic approach to the disorder. The disorder or syndrome has been linked to a wide variety of pathologic processes associated with the neuron-specific autoantibodies targeting intracellular and plasma membrane antigens. However, current criteria for autoimmune encephalitis are quite dependent on antibody testing and responses to immunotherapy, which might delay the diagnosis. This form of encephalitis can involve the multifaceted presentation of seizures and unexpected behavioral changes. The spectrum of neuropsychiatric symptoms in children is less definitive than that in adults, and the incorporation of clinical, immunological, electrophysiological, and neuroradiological results is critical to the diagnostic approach. In this review, we document the clinical and immunologic characteristics of autoimmune encephalitis known to date, with the goal of helping clinicians in differential diagnosis and to provide prompt and effective treatment.

• Korean Journal of Clinical Laboratory Science
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• v.38 no.2
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• pp.141-146
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• 2006

Vagal nerve stimulation (VNS) has been proposed as a possible way to improve the control of refractory epilepsy. We report the effects following VNS treatment in patients with refractory epilepsy. Seventeen patients with a mean age of 12.8 years, ranging from 5 to 29 years, underwent the implantation of vagal nerve stimulation (Cyberonics, Houston, TX). We reviewed the clinical findings before and after VNS in seizure frequency, number of antiepileptic drugs (AED), and quality of life (QOL). All of the patients had intractable seizures, eleven of the patients had additional medical complications, three had hippocampus atrophy, one had encephalomalacia, five had encephalitis, one had pachygyria, and one had schizencephaly. Thirteen patients had symptomatic partial epilepsies, three patients had Lennox-Gastaut syndrome and one had cryptogenic partial epilepsy. The mean follow up duration was 35 months. The mean reduction of seizure frequency compared with baseline before VNS was 26.1% after 3 months (p<0.005), 41.9% after 6 months (p<0.001), 46.9% after 1 year (p<0.001), and 53% at the latest follow-up (p<0.001). Twelve patients showed an improvement of QOL such as mood, language, alertness, expression, and motor function. The most common side effects were transient hoarseness or voice change or cough, which was detected in six patients (35%) and wound infection in one patient (5%). This study has shown a good anti-seizure effect of VNS, decrease in seizure frequency and improvements in QOL. We concluded that VNS is a beneficial therapy in refractory epilepsy with a non-resectable epileptic focus. Further studies should be focused on the prediction of unresponsiveness and the adjustment of VNS parameters for maximum efficacy in patients with various medical histories.

• Journal of Korean Neurosurgical Society
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• v.44 no.4
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• pp.234-239
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• 2008

Objective : There are a few reports on the complications of surgery for epilepsy. We surveyed our data to present complications of epilepsy surgeries from the neurosurgeon's point of view and compare our results with other previous reports. Methods : A total of 179 surgical procedures for intractable epilepsy (41 diagnostic, 138 therapeutic) were performed in 92 consecutive patients (10 adults, 82 children) during the last 9.2 years (February. 1997-April. 2006). Their medical records and radiological findings were reviewed to identify and analyze the surgical complications. Results : The diagnostic procedures encompassed various combinations of subdural grid, subdural strips, and depth electrodes. Four minor transient complications developed in 41 diagnostic procedures (4/41=9.8%). A total of 138 therapeutic procedures included 28 anterior temporal lobectomies, 21 other lobectomies, 6 lesionectomies, 21 topectomies, 13 callosotomies, 20 vagus nerve stimulations, 13 multiple subpial transections, and 16 hemispherectomies. Twenty-six complications developed in therapeutic procedures (26/138=18.8%). Out of the 26 complications, 21 complications were transient and reversible (minor; 21/138=15.2%), and 5 were serious complications (major; 5/138=3.6%). Five major complications were one visual field defect, two mortality cases and two vegetative states. There were 2 additional mortality cases which were not related to the surgery itself. Conclusion : Our results indicate that complication rate was higher than previous other reports in minor complications and was comparable in major complications. However, our results show relatively high frequency of mortality cases and severe morbidity case compared to other previous reports. The authors would like to emphasize the importance of acute postoperative care in young pediatric patients as well as meticulous surgical techniques to reduce morbidity and mortality in epilepsy surgery.

• Korean Journal of Clinical Laboratory Science
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• v.48 no.4
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• pp.388-393
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• 2016

Epilepsy, characterized by enduring the predisposition to generate epileptic seizures, was conceptually defined in 2005 as a disorder of the brain. According to the international league against epilepsy in 2014 that there is a high risk of recurrence within 10 years. The existence of interictal epileptiform discharges (IEDs) at the Electroencephalography (EEG) is an important risk factor for a possible recurrence of seizures, disproving that the seizures may increase. The purpose of this study was to analyze the correlation between recurrent seizures and epilepsy EEG findings in patients with IEDs, which was carried out to serve as the basis for the EEG to predict the prognosis of patients with epilepsy. This study included 432 adults older than 20 years of age who care for patients with epilepsy at Seoul National University Hospital, between June 2007 and December 2010. The results showed no difference between men and women in the EEG epilepsy disease, but there was a difference between various age groups. Correlation analysis showed a negative correlation between recurrence of seizures and age; it showed a positive correlation between recurrence and IEDs. In addition, age was associated with a predictive power of 10.9% and IEDs showed a predictive power of 15% on recurrent seizures. Therefore, EEG is considered as a very important test in epilepsy diagnosis. Therefore, further studies are necessary on the relationship between seizure recurrence and EEG.

• Journal of Korean Neurosurgical Society
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• v.67 no.3
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• pp.299-307
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• 2024

Cerebral cavernous malformation (CCM) is a vascular anomaly commonly found in children and young adults. Common clinical presentations of pediatric patients with CCMs include headache, focal neurological deficits, and seizures. Approximately 40% of pediatric patients are asymptomatic. Understanding the natural history of CCM is crucial and hemorrhagic rates are higher in patients with an initial hemorrhagic presentation, whereas it is low in asymptomatic patients. There is a phenomenon known as temporal clustering in which a higher frequency of symptomatic hemorrhages occurs within a few years following the initial hemorrhagic event. Surgical resection remains the mainstay of treatment for pediatric CCMs. Excision of a hemosiderin-laden rim is controversial regarding its impact on epilepsy outcomes. Stereotactic radiosurgery is an alternative treatment, especially for deep-seated CCMs, but its true efficacy needs to be verified in a clinical trial.

• Clinical and Experimental Pediatrics
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• v.52 no.9
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• pp.1005-1014
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• 2009

Purpose:Epilepsy of child may cause high level of psychosocial difficulties for parents including stigmatization and stress and therefore worsen their quality of life (QOL). The purpose of this study was to evaluate the mediating effect of perceived stigma against epilepsy on QOL among parents with epileptic child. Methods:Two hundred and sixty parents of epileptic child recruited from five separated university hospital child neurology clinics specializing in epilepsy completed a demographic questionnaire, a medical questionnaire, a perceived stigma questionnaire and the Ro's Quality of Life Inventory, a popular tool for evaluating QOL of adults in Korea which is composed of 6 domains and 47 questions. Data was analyzed with SPSS 14.0 program using frequency analysis and descriptive analysis and with AMOS 7.0 program using Structural Equation Model (SEM) analysis. Results:The level of parents' QOL was relatively fair. SEM analysis on the quality of life level of parents showed that all variables (especially having religion, the monthly income, employment state, age of child, the leisure time, the perceived stigma level against epilepsy, and seizure frequency) directly affect the quality of life level of parents and that disease-related variables also affect the quality of life level of parents indirectly through the mediating factor (the perceived stigma), where the indirect effect is large with the existence of combined disabilities. The total effect on the quality of life level of parents is large with the existence of combined disabilities, the perceived stigma level, the leisure time, having religion, and the monthly income. Conclusion:The results of this study indicated that many factors including parents' perceived stigma may affect the quality of life of parents with epileptic children directly, and that some disease-related factors may affect indirectly through a mediating factor, the perceived stigma. Multidisciplinary collaboration would be imperative for their welfare.