• Annals of Clinical Neurophysiology
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• 제19권1호
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• pp.20-27
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• 2017

Background: We evaluated whether eye movements could reflect the efficacy of antiepileptic drugs in patients with epilepsy. Methods: Thirty patients with epilepsy of unknown cause as well as age- and sex-matched normal controls were enrolled in this study. We divided the patients into drug-controlled epilepsy (n = 22) and drug-resistant epilepsy (n = 8) groups according to their seizure controls. We analyzed the differences in the parameters of the eye movements in these two groups compared with normal controls using video-based electro-oculography. In addition, we investigated the differences in the cerebellar volumes of these two groups using whole-brain T1-weighted images. Results: The latency and accuracy of saccade in patients with epilepsy were significantly different from normal controls, but they were not different between patients with drug-controlled epilepsy and drug-resistant epilepsy. However, the gain of pursuit was significantly decreased in patients with drug-resistant epilepsy compared with normal controls (p = 0.0010), whereas it was not different between patients with drug-controlled epilepsy and normal controls (p = 0.9646). In addition, the patients with drug-resistant epilepsy had lower cerebellar volumes than normal controls (p = 0.0052), whereas the cerebellar volumes in patients with drug-controlled epilepsy were not different from normal controls (p = 0.5050). Conclusions: We demonstrated that pursuit eye movements could reflect the efficacy of antiepileptic drugs in patients with epilepsy, a finding that may be related to cerebellar dysfunction.

• Clinical and Experimental Pediatrics
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• 제52권3호
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• pp.389-391
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• 2009

AHS는 항경련제에 의한 부작용으로 드물게 발생하지만 생명을 위협할 수 있는 지연형 면역반응이다. 보통 항경련제 복용 후 1-8주 사이에 고열, 피부발진, 림프절병증의 임상 증세를 나타내고, 혈액, 간, 신장, 또는 폐 등의 내부 장기를 침범한다. AHS는 항경련제에 의한 부작용으로 증상이 전신적으로 다양하게 나타날 수 있다. 그리고 전염성 단핵구증이나 가와사키병과 같은 전신적 질환들과도 유사한 임상증상들을 보이기 때문에 이런 질환들과 감별하는 것이 중요하고 사망률도 10%에서 보고되고 있어 조기에 발견하고 치료하는 것이 중요하다. 저자들은 임상증상과 초기 검사가 전염성 단핵구증과 비전형적 가와사키병과 매우 유사한 lamotigine에 의한 AHS 1예를 보고하는 바이다.

• Journal of Dental Anesthesia and Pain Medicine
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• 제21권3호
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• pp.219-226
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• 2021

Background: Patients with disabilities often require general anesthesia for dental treatment because of their cooperative or physical problems. Since most patients with disabilities take central nervous system drugs, the management of recovery status is important because of drug interactions with anesthetics. Methods: The anesthesia records of patients under general anesthesia for dental treatment were reviewed, and data were collected. Healthy patients under general anesthesia for dental phobia or severe gagging reflex were designated as the control group. Patients with disabilities were divided into two groups: those not taking any medication and those taking antiepileptic medications. The awakening time was evaluated in 354 patients who underwent dental treatment under general anesthesia (92 healthy patients, 183 patients with disabilities, and 79 patients with disabilities taking an antiepileptic drug). Based on the data recorded in anesthesia records, the awakening time was calculated, and statistical processes were used to determine the factors affecting awakening time. Results: Significant differences in awakening time were found among the three groups. The awakening time from anesthesia in patients with disabilities (13.09 ± 5.83 min) (P < 0.0001) and patients taking antiepileptic drugs (18.18 ± 7.81 min) (P < 0.0001) were significantly longer than in healthy patients (10.29 ± 4.87 min). Conclusion: The awakening time from general anesthesia is affected by the disability status and use of antiepileptic drugs.

• Clinical and Experimental Pediatrics
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• 제57권3호
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• pp.153-156
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• 2014

Toxic epidermal necrolysis is an unpredictable and severe adverse drug reaction. In toxic epidermal necrolysis, epidermal damage appears to result from keratinocyte apoptosis. This condition is triggered by many factors, principally drugs such as antiepileptic medications, antibiotics (particularly sulfonamide), nonsteroidal anti-inflammatory drugs, allopurinol, and nevirapine. Lamotrigine has been reported potentially cause serious cutaneous reactions, and concomitant use of valproic acid with lamotrigine significantly increases this risk. We describe a case of an 11-year-old girl with tic and major depressive disorders who developed toxic epidermal necrolysis after treatment with lamotrigine, and who was diagnosed both clinically and pathologically. Children are more susceptible to lamotrigine-induced rash than adults, and risk of serious rash can be lessened by strict adherence to dosing guidelines. Unfortunately, in our case, the patient was administered a higher dose than the required regimen. Therefore, clinicians should strictly adhere to the dose regimen when using lamotrigine, especially in children.

• The Korean Journal of Physiology and Pharmacology
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• 제15권2호
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• pp.67-81
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• 2011

Epilepsy is a chronic disease occurring in approximately 1.0% of the world's population. About 30% of the epileptic patients treated with availably antiepileptic drugs (AEDs) continue to have seizures and are considered therapy-resistant or refractory patients. The ultimate goal for the use of AEDs is complete cessation of seizures without side effects. Because of a narrow therapeutic index of AEDs, a complete understanding of its clinical pharmacokinetics is essential for understanding of the pharmacodynamics of these drugs. These drug concentrations in biological fluids serve as surrogate markers and can be used to guide or target drug dosing. Because early studies demonstrated clinical and/or electroencephalographic correlations with serum concentrations of several AEDs, It has been almost 50 years since clinicians started using plasma concentrations of AEDs to optimize pharmacotherapy in patients with epilepsy. Therefore, validated analytical method for concentrations of AEDs in biological fluids is a necessity in order to explore pharmacokinetics, bioequivalence and TDM in various clinical situations. There are hundreds of published articles on the analysis of specific AEDs by a wide variety of analytical methods in biological samples have appears over the past decade. This review intends to provide an updated, concise overview on the modern method development for monitoring AEDs for pharmacokinetic studies, bioequivalence and therapeutic drug monitoring.

• The Korean Journal of Physiology and Pharmacology
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• 제21권2호
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• pp.169-177
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• 2017

Lamotrigine is an antiepileptic drug widely used to treat epileptic seizures. Using whole-cell voltage clamp recordings in combination with a fast drug application approach, we investigated the effects of lamotrigine on 5-hydroxytryptamine $(5-HT)_3$ receptors in NCB-20 neuroblastoma cells. Co-application of lamotrigine ($1{\sim}300{\mu}M$) resulted in a concentration-dependent reduction in peak amplitude of currents induced by $3{\mu}m$ of 5-HT for an $IC_{50}$ value of $28.2{\pm}3.6{\mu}M$ with a Hill coefficient of $1.2{\pm}0.1$. These peak amplitude decreases were accompanied by the rise slope reduction. In addition, $5-HT_3$-mediated currents evoked by 1 mM dopamine, a partial $5-HT_3$ receptor agonist, were inhibited by lamotrigine co-application. The $EC_{50}$ of 5-HT for $5-HT_3$ receptor currents were shifted to the right by co-application of lamotrigine without a significant change of maximal effect. Currents activated by 5-HT and lamotrigine co-application in the presence of 1 min pretreatment of lamotrigine were similar to those activated by 5-HT and lamotrigine co-application alone. Moreover, subsequent application of lamotrigine in the presence of 5-HT and 5-hydroxyindole, known to attenuate $5-HT_3$ receptor desensitization, inhibited $5-HT_3$ receptor currents in a concentration-dependent manner. The deactivation of $5-HT_3$ receptor was delayed by washing with an external solution containing lamotrigine. Lamotrigine accelerated the desensitization process of $5-HT_3$ receptors. There was no voltage-dependency in the inhibitory effects of lamotrigine on the $5-HT_3$ receptor currents. These results indicate that lamotrigine inhibits $5-HT_3$-activated currents in a competitive manner by binding to the open state of the channels and blocking channel activation or accelerating receptor desensitization.

• Child Health Nursing Research
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• 제10권2호
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• pp.225-232
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• 2004

The purpose of this article is to describe the overview of current medical treatments of childhood epilepsy in Korea and to review several recent nursing researches related to quality of life problems, especially psychological functioning in children with epilepsy and the stress of the family. The prognosis of childhood epilepsy has been improved considerably and about 80％ of patients can now be expected to achieve complete seizure control by the antiepileptic drug treatment. Even for the intractable epilepsy, with the combination of ketogenic diet program and antiepileptic drug therapy or surgical treatment, the prognosis became very much better than before. The majority of research has reported that children with epilepsy were experiencing quality of life problems. They are at risk for impaired functioning, compared to either general population controls or to other chronic illness groups such as asthma and diabetes. The ultimate goal of providing care to children with epilepsy is to control seizures while facilitating an optimal quality of life for the child as well as the family. Recommendations are included for future research and intervention programs for children, parents and our society.

• Tuberculosis and Respiratory Diseases
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• 제77권3호
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• pp.145-148
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• 2014

Valproic acid is one of the most common antiepileptic drugs used for the treatment of several seizure disorders. A 20-year-old man presented with a sudden decline of consciousness. He had a neurosurgery operation for intracranial and intraventricular hemorrhage. Following surgery, antiepileptic medication was administered to the patient in order to control his seizure events. On valproic acid treatment, he began to complain of fever and dyspnea. His symptoms persisted despite receiving empirical antibiotic treatment. All diagnostic tests for infectious causes were negative. A high-resolution computed tomography scan of the chest revealed predominantly dependent consolidation and ground-glass opacities in both lower lobes. The primary differential was drug associated with interstitial lung disease. Therefore, we discontinued valproic acid treatment and began methylprednisolone treatment. His symptoms and radiologic findings had significantly improved after receiving steroid therapy. We propose that clinicians should be made aware of the potential for valproic acid to induce lung injury.

• Clinical and Experimental Pediatrics
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• 제46권9호
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• pp.893-897
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• 2003

목 적 : 중심-측두엽 극파를 보이는 양성 소아 간질은 소아간질의 6-16%를 차지하며 2-13세 사이에 발병하나 사춘기 이후에는 자연 소실된다. 이들 환아들에게 항경련제를 투여하는 것에 대해 효과 및 효율성에서 상이한 결과가 많이 보고되고 있다. 이에 본 연구는 항경련제를 투여한 군과 항경련제를 투여 받지 않은 군에서 그 약물 효과 및 효율성에 관해 조사하였다. 방 법 : 고대의료원 소아신경클리닉에서 임상 증상 및 뇌파 검사상 중심-측두엽 극파를 보이는 양성 소아 간질로 진단된 환아 56명을 대상으로 하였다. 대상 환아들을 항경련제 투여군과 항경련제 비투여군으로 분류한 후 의무기록지 분석을 통한 후향적 조사로 두 군간의 인구역동학, 항경련제 투여의 기준, 임상양상 등을 확인하였다. 결 과 : 양 군간 성별, 지역별, 연령별 차이는 없었다. 첫 경련이 시작된 연령, 경련의 주, 야간 비율, 경련 지속 시간 등에 있어서도 양 군간 차이는 보이지 않았다. 항경련제 투여군이 항경련제 비투여군에 비해 경련의 빈도가 줄었으나(P<0.05) 항경련제 비투여군과 투여군간의 장기적 예후 차이는 볼 수 없었다. 결 론 : 중심-측두엽 극파를 보이는 양성 소아 간질 환아들은 항경련제의 투여 여부와 무관하게 양성 예후를 보이며 경련 지속 기간에도 뇌 손상이나 신체 상해를 입을 만한 합병증을 나타내지 않으므로 이 질환에 대한 본인 혹은 보호자의 충분한 이해가 선행된다면 항경련제를 1차 치료로 선택하지 않아도 무난하다고 여겨진다.

• Journal of Korean Neurosurgical Society
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• 제62권3호
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• pp.296-301
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• 2019

An epileptic seizure is defined as the transient occurrence of signs and/or symptoms due to abnormally excessive or synchronous neuronal activity in the brain. The type of seizure is defined by the mode of onset and termination, clinical manifestation, and by the abnormal enhanced synchrony. If seizures recur, that state is defined as epilepsy. Antiepileptic drugs (AEDs) are the mainstay of treatment. Knowledge about initiating and maintaining adequate AEDs is beneficial for the clinician who treats children with epilepsy. This article will delineate the general principles for selecting, introducing, and discontinuing AEDs and outline guidelines for monitoring adverse effects. In general, AED therapy following a first unprovoked seizure in children is not recommended. However, treatment should be considered after a second seizure. In children and adolescents, if they are seizure-free for at least 2 years, attempts to withdraw medication/s should be made, taking into account the risks vs. benefits for the individual patient. The decision on when and what AED to use should be tailored according to the patient. For optimal treatment, the selection of adequate AEDs can be achieved by considering the precise definition of the patient's seizure and epilepsy syndrome. Continuous monitoring of both therapeutic and adverse effects is critical for successful treatment with AEDs.