• Clinical and Experimental Pediatrics
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• v.50 no.5
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• pp.484-488
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• 2007

Purpose : The purpose of this study was to determine the incidence and potential predictors of weight gain in older children and teens treated with valproate (VPA) for epilepsy. Methods : Sixty-five subjects aged 8 to 17 years of age, who began VPA treatment between January 1, 2001, and December 31, 2004, and who had documented weight and height measurements at medication initiation and at least one follow-up visit were retrospectively identified. Exclusion criteria were follow-up <6 months, discontinuation of VPA within 6 months, and concurrent therapy with medication known to affect weight (such as topiramate, carbamazepin). Body mass index (BMI) was calculated at initiation and either discontinuation of VPA or last follow-up and stratified into four categories: group 1, underweight <5%; group 2, appropriate 5-85%; group 3, potentially overweight 85-95%; group 4, overweight >95%. Results : Twenty-eight subjects (77.8%) remained within their same category and eight (22.2%) moved up at least one category. Weight gain (increase in BMI difference) was observed in 72.2% of the 36 subjects treated with VPA. Three factors, neurocognitive status (P=0.017), seizure type (P=0.001) and duration of VPA treatment (P=0.035) were identified to be significant predictors of BMI difference. Conclusion : VPA induces weight gain in children and teens with epilepsy. These factors which are normal neurocognitive status, primary generalized type and duration of VPA treatment over the 12 months were predictors for an increase of weight gain. Therefore potential weight gain should be discussed with patients before the initiation of therapy and BMI should be monitored closely.

• Pediatric Infection and Vaccine
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• v.3 no.2
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• pp.154-162
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• 1996

Purpose : Adenoviruses(Ad) have been shown to play an important role in the etiology of severely acute respiratory diseases, particulary in infants and young children, and the occurrence of fatal outcome and chronic pulmonary sequelae in association with adenoviral infection has been a cause of great interest and concern. This report presents the resul of a retrospective analysis on 30 cases of lower respiratory infection from which adenovirus was isolated. Patients & Methods : The 30 patients in this study represent all detected cases of adenovial infection out of 240 children who were admitted to Sang Sung Medical Center between February to June 1996 showing signs and symptoms of lower respiratory tract infection. The diagnosis of adenovirus infection was based on microscopic visualization of typical cytopathic effect in HEp-2 tissue culture and used monoclonal Ab with nasopharyngeal aspiration. Results : The male/female ratio was 2:1 and the majority of age range was below 36months. Clinical diagnoses in all 30 patients were pneumonia(n=21), bronchitis and Bronchiolitis(n=5) and ARDS(n=4). We recieved the most of patients in the month of May. The chief complaints were fever(93.3%) and cough(80%) and extrapulmonary symptoms were diarrhea(n=5), seizure(n=4), abdominal pain(n=1). The mean duration of fever was $11.95{\pm}6.54$days. Physical examination on admission were crackles(73.3%), coarse breathing sounds(60%), hepatosplenomegaly(33.3%), decreased brething sounds(30%). In WBC counts, 8cases were below $4000/mm^3$ and 14 cases were above $10,000/mm^3$. In platelets counts, 4cases were below $150,000/mm^3$ and 10 cases were above $450,000/mm^3$. 21 cases were above 1 in CRP. GOT and GPT were abnormal in some cases. Chest X-ray revealed diffuse pulmonary infiltration(n=15), pleural effusion(n=6), consolidation(n=4) and hyperaeration(n=3). Seven patients were treated at the peditric intensive care unit with respiratory support and high dose of gammaglobulin. However, one patients died even through he was treated with NO ventilation and high frequency ventilation. Conclusion : Those with adenoviral pneumonia and respiratory infection having long fever duration and symptoms like bacterial pneumonia must be carefully differentiated in order to provide proper treatement and preventive measures due to possible fatal outcome.

• 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.

• Clinical and Experimental Pediatrics
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• v.48 no.12
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• pp.1342-1347
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• 2005

Purpose : Among perinatal risk factors, neonatal seizures are one of the strongest independent discriminators of adverse outcome, representing high risks of mortality and neurologic morbidity. This study was undertaken to evaluate the neurologic outcome of neonatal status epilepticus according to underlying etiology, seizure pattern, onset time, and duration. Methods : We reviewed retrospectively 36 neonates(19 males, 17 females) with status epilepticus who were admitted to the neonatal intensive care unit, Inha Hospital between July, 1988 and June, 2003. They were evaluated with neurologic examination, laboratory data, EEG findings, and neuroimaging studies etc. Results : The mean gestational period of the patients was $37.0{\pm}3.6$ weeks and birth weight was $2.70{\pm}0.82$ kilogram. Fifty two point eight percent of the neonates were male and 66.7 percent were born at term. The most common cause of neonatal status epilepticus was hypoxic-ischemic encephalopathy. In preterm babies, intracranial hemorrhages showed an especially high frequency(P=0.034). Gestational age and birth weight did not show a correlation with neurologic complications. The incidence of neurological sequelae were significantly related to prolonged seizures lasting more than 1 hour(P=0.002). Neonates with seizures within the first 72 hours tended to be more frequent among those who developed adverse outcomes(P=0.016). Generalized tonic seizures had the worst prognosis, whereas those children who had subtle seizures had better outcomes than any other type(P<0.05). Generalized tonic seizures were primarily represented on EEG by abnormal background, whereas subtle seizure showed a significantly more normal EEG than any other seizures(P<0.05). Conclusion : Our results indicate that neonatal status epilepticus with early onsets, prolonged durations. And generalized tonic types can predict an increased risk for neurologic sequelae. So, those seizures must be perceived as medical emergencies and treated aggressively with antiepileptic drugs.

• Pediatric Infection and Vaccine
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• v.22 no.1
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• pp.23-28
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• 2015

Purpose: The aim of this study was to investigate the clinical manifestations and laboratory characteristics of eosinophilic meningitis in Severance Children's Hospital. Methods: We examined 6,335 children under the age of 18 years old who had visited the tertiary hospital in Seoul, Korea, and had received cerebrospinal study results between January 2007 and July 2012. The medical records of the patients identified as eosinophilic meningitis were retrospectively reviewed. Results: Eosinophilic meningitis was diagnosed in 39 patients (0.6%). The mean age was 6 years (range 0-18 years) and the sex ratio was 1.3:1 (22 males and 17 females). The underlying diseases and past history were neurologic disease (n=36, 92%). Eosinophilic meningitis was diagnosed in thirty-five patients who had undergone postoperation neurosurgery (90%). The most common symptoms were fever (50%), headache (20%), vomiting (15%), seizure (10%), and dizziness (5%). The average duration for recovery was five days, and intravenous antibiotics or steroids were used. Conclusions: Manifestations of eosinophilic meningitis are similar to other types of meningitis. The most common cause of eosinophilic meningitis in children was neurosurgery. Eosinophilic meningitis should be considered for patients showing fever and headache after neurosurgery. Through careful investigation, use of improper antibiotics could be avoided.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.11 no.2
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• pp.186-197
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• 2000

This study evaluated the improvement of autistic symptoms during the 4-7 year follow-up in autistic children. Fifty subjects(44 males and 6 females whose age ranged between one to 13 years) diagnosed with DSM-III-R autistic disorder were included in this study. Their autistic symptoms were assessed with DSM-III-R diagnostic criteria of autistic disorder(grouped as A, B and C which include 5, 6 and 5 items respectively). The mean of follow-up duration was 6.4${\pm}$1.1 years. Symptoms between baseline and follow-up were examined according to treatment types, age, sex, IQ and physical problems of them were identified. There were statistically significant decreases of symptom items at follow-up as a whole and A, B and C, respectively. The most symptom decrease occurred in communication and followed social interaction, and activities and interests at follow-up assessment. Symptom items that decreased more than 50% at follow-up evaluation include A1, A2, A3 and B1, B2, B3, B4, B5, and C1, C3. Groups with special education only and combined treatment of special education and seizure pharmacotherapy showed better improvement of symptoms than the group with psychiatric pharmacotherapy with special education. Age was a significant factors in the improvement of symptoms. The author concluded that some autistic children improved with aging, therefore they should be treated actively with special education, pharmacothrapy and other scientific methods.

• Korean Journal of Biological Psychiatry
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• v.7 no.2
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• pp.191-197
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• 2000

Objectives : Risperidone is a new antipsychotic drug developed to overcome the therapeutic limitation of conventional antipsychotics. It responses to negative as well as positive symptoms by blocking both dopaminergic and serotonergic receptors, causing no significant side effects such as agranulocytosis and seizure. It is, however, not known whether it induces any serious cardiovascular side effects as evoked by other conventional antipsychotic drugs. The aims of this study were to evaluate the effect of risperidone on cardiovascular function, and to discuss the factors affecting the cardiovascular function. Methods : For 42 patients(22 males and 20 females) diagnosed as schizophrenia, schizophreniform disorder or schizoaffective disorder according to the DSM-IV classification, the cardiovascular fuctions such as heart rate, systolic and diastolic blood pressure, PR interval, QRS interval and QT interval were successively checked before and after 2 weeks and 4 weeks risperidone administration. Furthermore, variables such as body weight, Brief Psychiatric Rating Scale(BPRS), Clinical Global Impression(CGI), Extrapyramidal Symptom Rating Scale(ESRS), Anticholinergic Rating Scale(ARS), serum cholesterol level, serum triglyceride level, serum high-density-lipoprotein level, serum WBC, serum Hb, serum platelet level, prothrombin time and partial thromboplastin time were also analyzed before and after 2 weeks and 4 weeks risperidone administration. Results : 1) Risperidone treatment resulted in a significantly decreased heart rate and increased QT interval after 4 weeks administration(p<0.005 respectively). 2) The scores of BPRS and CGI were significantly decreased after 2 weeks and 4 weeks risperidone administration as compared with baseline(p<0.001 respectively). The scores of ESRS and ASRS were significantly increased after 2 weeks and 4 weeks risperidone administration as compared with baseline(p<0.001 respectively). 3) There were positive correlations between heart rate after 4 weeks and total dose(P<0.05). Blood pressure was significantly(p<0.05) correlated with sex(higher in male) and significantly(p<0.05) positive correlated with body weight. QT interval was significantly(p<0.05) correlated with sex(longer in female) and smoking history(shorter in smokers). Conclusions : Risperidone could induce significant change in heart rate and Q-T interval. Therefore, the cardiovascular safety for risperidone should be reconsidered according to the duration and dosage increase.

• Clinical and Experimental Pediatrics
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• v.51 no.4
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• pp.415-419
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• 2008

Purpose : Herbal medicine is thought to be widely used by children with epilepsy, but there have been few studies. This study aimed to investigate the perceptions and the actual conditions of usage of herbal medicine by children with epilepsy. Methods : From July to August 2007, three hundred seventy eight questionnaires were completed by parents of epileptic children who visited pediatric neurology clinic of Korea University hospital and Kwangmyung-Sungae hospital. Demographic data and patterns of usage of herbal medicine were investigated. Results : Among 378 patients, sixty five (17.2%) reported using herbal medicine. Major reasons for using herbal medicine were 'to enhance general health' and 'belief that it has fewer side effects'. Majority of respondents did not notify their physician about using herbal medicine because 'they did not need to share this with doctor' and 'they thought their doctor would disapprove'. After taking herbal medicine, 33.3% of patients reported that it did not benefit their seizure but they felt healthier. Usage of herbal medicine was significantly related to number of AEDs (antiepileptic drugs), duration of AED treatment, association with psychosomatic disorders and motivation by other people or by mass media. Conclusion : Considerable numbers of epileptic children were using herbal medicine during treatment with AED and did not inform their physician about usage of it. Physicians should be aware of benefits and harms of herbal medicine and actively intervene in the usage of herbal medicine by epileptic patients.

• Pediatric Infection and Vaccine
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• v.7 no.1
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• pp.94-107
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• 2000

Purpose : The purpose of this study is to know the clinical manifestations and the severity of adenoviral lower respiratory tract infections(LRTI) in Korean children. Methods : Adenoviral respiratory infection was diagnosed by viral culture in HEp-2 cell and indirect immunofluorescent technique with nasal aspirates. Isolated adenoviruses were typed by neutralization test. Retrospective chart review was done in patients with adenoviruses were typed by neutralization test. Retrospective chart review was done in patients with adenoviral lower respiratory tract infection, who were brought to Seoul National University Children's Hospital from November 1990 through February 1998. Results : Adenovirus was isolated in 87 cases. Of 84 cases serotyped, type 1 was recovered in 3 cases, type 2 in 13 cases, type 3 in 13, type 4 and 5 in 4 cases each other, type 6 in 1 cases, type 7 in 36 cases, type 11 in 1 case and the other types in 9 cases. Adenoviral lower respiratory infection occurred sporadically throughout the year but from November 1995 through February 1998, an outbreak of adenovirus type 7 lower respiratory infection was observed in number upto 36 case. The incidence of adenoviral infection peaked in young children between 6 months and 5 years of age and the mean age was 1 year 11 months old. There were 10 cases of mixed infection with another pathogen. Clinical diagnosis were pneumonia(88%), acute broncholitis(5.4%), acute tracheobronchitis(5.4%), croup(1.3%). The clinical features of adenoviral lower respiratory infection were severe especially in type 3 and 7 infections in aspect of fever duration, ventilator care. Extrapulmonary manifestations were gastrointestinal symptoms in 23 cases(31%), hepatomegaly in 36 cases(53%), seizure and mental alteration in 13 cases(20.3%). In chest radiographic findings, parahilar and peribronchial infiltration were in 49 cases(67%), hyperaeration in 21 cases(29%), atelectasis in 14 cases(19%), consolidation in 39 cases(53%) and bilateral pneumonic infiltration in 28 cases(38%). Among thirty six adenovirus type 7 LRTI, 15 patients(41.6%) had pleural effusion and 3 patients had chest tube insertion. Number of fetal cases related to adenovirus were 9 cases(12%) and fetal cases due to ventilatory failure were 7(11%). Conclusion : During 7 year period of studying adenoviral lower respiratory infection, we identified the serotypes of adenovirus. Among the serotypes, adenovirus type 7 were epidemically isolated. Adenovirus were isolated in severe lower respiratory infection of young children aged between 6 months and 5 years and related to death of the patients, especially when the patients had underlyng diseases or were infected by adenovirus type 7.

• Clinical and Experimental Pediatrics
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• v.51 no.5
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• pp.512-517
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• 2008

Purpose : Syncope is relatively common in children and adolescents. Among the etiologies of syncope, neurocardiogenical syncope is the most common, but it is often confounded with seizure. We investigated the clinical features of patients under the age of 15 with neurocardiogenical syncope, compared to patients with neurologic disorders including epilepsy. Methods : Among the children who visited the Department of Pediatrics at Cheongju St. Mary's Hospital and Chungbuk National University Hospital from March 2005 to February 2007, we retrospectively analyzed 69 patients whose chief complaint was syncope. We classified the patients by syncope etiology and made comparisons between the neurocardiogenical syncope (NCS) group and the neurological disorders (ND) group regarding to age; location; time and season in which syncope occurred; associated symptoms, including seizures, provocation factors; prodromes; duration of syncope; frequency of previous syncope; birth history; associated disease; past medical history; family history; neurological exam; physical exam; laboratory findings; electrocardiography; electroencephalography (EEG); head-up tilt test; brain CT; and MRI. Results : Among 69 syncope patients, 53 (76.8%) were in the NCS group and 11 (15.9%) were in the ND group. There were no statistically significant differences between the two study groups except for the presence of prodromes and EEG abnormalities. The presence of prodromes in the NCS group was more common than in the ND group [46.9% (23/49) vs. 9.1% (1/11), (P=0.038)]. The EEG abnormality in the ND group was more common than in the NCS group [90% (9/10) vs. 5.8% (3/52), (P<0.01)]. Conclusion : Our study suggests that detailed history-taking, including that concerning prodromes, is important for the accurate diagnosis of neurocardiogenical syncope, and EEG should be obtained if neurological disorders are suggested.