• Clinical and Experimental Pediatrics
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• v.49 no.11
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• pp.1180-1185
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• 2006

Purpose : The aims of this study were to verify the incidence of hypohidrosis and to determine the predictive value of noninvasive indicator test ($Neurocheck^{TM}$) for sweating after administration of topiramate in newly diagnosed pediatric epileptic patients. Methods : A total of 46 epileptic patients (22 boys; 24 girls) on topiramate treatment were evaluated in this study at the Department of Pediatrics, Chonbuk National University Hospital, from October 2004 to July 2005. We measured sweating functions using a noninvasive sweating test ($Neurocheck^{TM}$) before topiramate medication, and after 3 months when topiramate reached its target dosage. We performed a direct questionnaire survey for the hypohidrosis related symptoms during topiramate treatment. Results : The mean age was $7.8{\pm}3.2year$. The mean dosage of topiramate was $4.5{\pm}0.8mg/kg/day$. Among the patients, there were 40 complex partial seizures, one simple partial seizure, two partial seizures with secondarily generalization, two generalized seizures, and one Lennox-Gastaut syndrome case. Of the 46 epileptic patients, 17 patients (37.0 percent) experienced hypohidrosis and hypohidrosis related symptoms, 12 (26.1 percent) had facial flushing, four (8.7 percent) had heat intolerance, one (2.2 percent) had lethargy, but no one had anhidrosis. Among the 17 patients, the mild group numbered 12 and the severe group totalled five. Hypohidrosis by $Neurocheck^{TM}$ was diagnosed in 16 patients. The overall measures of agreement between $Neurocheck^{TM}$ and the survey was 76.5 percent. The specificity of this test was 89.7 percent. Patients who showed a time delay after medication, especially over 3 minutes, were seen only in the severe group. Conclusion : $Neurocheck^{TM}$ could be clinically useful to detect and predict topiramate induced hypohidrosis in pediatric epileptic patients. We recommend that patients who show a delay over 3 minutes in $Neurocheck^{TM}$ test after topiramate initiation should be monitored for hypohydrosis.

• 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.

• 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.

• The Korean Journal of Pain
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• v.14 no.1
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• pp.98-103
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• 2001

Neuropathic pain originating from multiple condition of nerve cell injury is common, but is difficult to treat. Even though many drugs such as anti-convulsants, anti-depressants, NSAIDs, opioids have been used, their clinical analgesic action were not satisfactory due to occur severe side effects. Gabapentin was introduced in 1994 as a novel antiepileptic drug and has been used to treat partial seizure. After 1995 gabapentin treatment for reflex sympathetic dystrophy (RSD) started, 45% of the reports about the analgesic efficacy of gabapentin were restricted to the treatments of non-epileptic pain syndrome. This drug is preferred to treat neuropathic pain because of a lower incidence of its side effects than those of other anti-convulsants and anti-depressants. For evaluating it's analgesic efficacy, the changes in the patients' subjective pain intensity was measured by the score on the visual analogue scale (VAS) and patient's objective pain intensity by measuring the skin temperature via infrared thermography were investigated respectively. Side effects of gabapentin were look into. We observed successful relief of neuropathic pain in the three patients which included post-herpetic neuraligia, complex regional pain syndrome (CRPS) and diabetic neuropathic pain, and the side effects of gabapentin were at acceptable levels.

• Journal of Yeungnam Medical Science
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• v.5 no.2
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• pp.205-211
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• 1988

Insulinoma is a rare tumor, occurring more often in women and in the older age range. Eighty percent of patients have a single benign tumor, usually 2cm in diameter, located with about equal frequency in body, head or tail of pancreas and amenable to surgical cure. About 10% have multiple tumors. The remaining 10% of patients have metastatic malignant insulinoma. The symptom of insulinoma is characterized by the periodic attack of hypoglycemia of blood sugar level below 50mg%, by fasting or exertion, and rapid relief of symptom by oral or intravenous administration of glucose. Symptom often lead to misdiagnosis as a neurologic or psychiatric disorder. A case described by authors was 44-year old female with the chief complaints of the loss of consciousness, epileptic seizure although she has been treated by anticonvulsants. Serum blood sugar and insulin level during fasting sugested insulinoma but abdominal computed tomography shows no definitive mass in pancreas. Celiac angiography revealed insulinoma. She transfered to the defartment of General Surgery and was performed enucleation. Microscopic findings shows the islet cell tumor of pancreas. A brief review of the literature was made.

• Annals of Clinical Neurophysiology
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• v.4 no.1
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• pp.51-55
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• 2002

Background : An increased frequency of reproductive endocrine disorders and polycystic ovary(PCO) has been reported in women with epilepsy. A possible role of the seizure disorder or, of the use of antiepileptic drugs(AEDs) has been suggested as the pathogenic mechanism. The objective of the present study was to assess the prevalence of reproductive endocrine disorders, such as PCO or menstrual abnormalities, in a series of women with epilepsy, examining the possible relationships of these disturbances with different epilepsy syndromes and AED treatment. Methods : Thirty epileptic women, all of reproductive age and none pubertal, pregnant, or lactating, were evaluated by clinical endocrinological assessment, and pelvic ultrasonography. Seven patients were on valproic acid(VPA), nineteen on carbamazepine(CBZ), and four on diphenylhydantoin(DPH) treatment, respectively. Results : Menstrual irregularity was observed in 8 women(26.7%), dysmenorrhea in 7(23.3%), and premenstrual syndrome in 1(3.3%). Ultrasonographic examination revealed that one women(3.3%) showed polycystic ovary, 4(13.3%) had ovarian cyst(s), and 2(6.7%) had uterine myoma, respectively. There was no difference in the prevalence of menstrual abnormalities or polycystic ovary according to the different preparations of AEDs. Conclusions : Data from this investigation suggest that, in Korean reproductive age women, the treatment of AEDs and the kind of medication may not have a significant effect on the prevalence of menstrual abnormalities or ultrasonographic polycystic ovary.

• Journal of Korean Neurosurgical Society
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• v.47 no.1
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• pp.17-25
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• 2010

Objective: The focus of this study is brain plasticity associated with semantic aspects of language function in patients with medial temporal lobe epilepsy (mTLE) Methods: Using longitudinal functional magnetic resonance imaging (fMRI), patterns of brain activation were observed in twelve left and seven right unilateral mTLE patients during a word-generation task relative to a pseudo-word reading task before and after anterior temporal section surgery. Results: No differences were observed in precentral activations in patients relative to normal controls (n = 12), and surgery did not alter the phonological-associated activations. The two mTLE patient groups showed left inferior prefrontal activations associated with semantic processing (word-generation>pseudo-word reading), as did control subjects. The amount of semantic-associated activation in the left inferior prefrontal region was negatively correlated with epilepsy duration in both patient groups. Following temporal resection, semantic-specific activations in inferior prefrontal region became more bilateral in left mTLE patients, but more left-lateralized in right mTLE patients. The longer the duration of epilepsy in the patients, the larger the increase in the left inferior prefrontal semantic-associated activation after surgery in both patient groups. Semantic activation of the intact hippocampus, which had been negatively correlated with seizure frequency, normalized after the epileptic side was removed. Conclusion: These results indicate alternation of semantic language network related to recruitment of left inferior prefrontal cortex and functional recovery of the hippocampus contralateral to the epileptogenic side, suggesting an intra- and inter-hemispheric reorganization following surgery.

• Journal of Yeungnam Medical Science
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• v.35 no.2
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• pp.192-198
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• 2018

Background: Chronic inflammation can lower the seizure threshold and have influence on epileptogenesis. The components of red ginseng (RG) have anti-inflammatory effects. The abundance of peripherally derived immune cells in resected epileptic tissue suggests that the immune system is a potential target for anti-epileptogenic therapies. The present study used continuous electroencephalography (EEG) to evaluate the therapeutic efficacy of RG in intrahippocampal kainic acid (IHKA) animal model of temporal lobe epilepsy. Methods: Prolonged status epilepticus (SE) was induced in 7-week-old C57BL/6J mice via stereotaxic injection of kainic acid (KA, 150 nL; 1 mg/mL) into the right CA3/dorsal hippocampus. The animals were implanted electrodes and monitored for spontaneous seizures. Following the IHKA injections, one group received treatments of RG (250 mg/kg/day) for 4 weeks (RG group, n=7) while another group received valproic acid (VPA, 30 mg/kg/day) (VPA group, n=7). Laboratory findings and pathological results were assessed at D29 and continuous (24 h/week) EEG monitoring was used to evaluate high-voltage sharp waves on D7, D14, D21, and D28. Results: At D29, there were no differences between the groups in liver function test but RG group had higher blood urea nitrogen levels. Immunohistochemistry analyses revealed that RG reduced the infiltration of immune cells into the brain and EEG analyses showed that it had anticonvulsant effects. Conclusion: Repeated treatments with RG after IHKA-induced SE decreased immune cell infiltration into the brain and resulted in a marked decrease in electrographic seizures. RG had anticonvulsant effects that were similar to those of VPA without serious side effects.

• Clinical and Experimental Pediatrics
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• v.45 no.12
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• pp.1559-1570
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• 2002

Purpose : There has been no exact answer to the question of when to discontinue antiepileptic drugs(AEDs) in children with well-controlled epilepsy for a long period. This study is about the risk factors of relapse after withdrawal of AEDs in seizure(Sz)-free patients to show a guideline for discontinuation of AEDs. Methods : One hundred and sixty-nine children were diagnosed as epileptic at the Pediatric Dept. of Kyung-Hee Univ. between 1993 to 1998, in whom AEDs had been withdrawn after at least two years of Sz-free period. Univariate analysis using Kaplan-Meier survival analysis and multivariate analysis using Cox-proportional hazard model were performed for sixteen risk factors. Results : Forty-nine of the 169 patients(28.9%) had recurrence of Szs. The mean follow-up after withdrawal of AEDs was 4.1 years, mean treatment period was 4.1 years, and the mean Sz-free period was 3.3 years. Factors associated with an increased risk of relapse were young age at onset, symptomatic Sz, Sz type in West and Lennox-Gastaut syndrome, neurologic deficit, longer Sz-controlling period, shorter total treatment period, number of AEDs used(more than one drug), age at withdrawal of AEDs, and Sz-free period less than two years in univariate analysis using Kaplan-Meier mothod. From multivariate analysis, the factors indicating a significantly higher relapse risk were pre-treatment period after first Sz attack, Sz-controlling period, Sz-free period, number of AEDs used, neurologic abnormalities. Conclusion : For epileptic children who were Sz-free for more than two years, and were more than six-years-old, the discontinuation of AEDs should be considered positively, according to age of onset, Sz type, age at withdrawal of AEDs, total treatment period, Sz-controlling period, number of AEDs used, etiology, neurologic deficit, and the wishes of the patients and the their parents.

• The Korean Journal of Nuclear Medicine
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• v.34 no.3
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• pp.169-182
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• 2000

Purpose: To investigate the various ictal perfusion patterns and find the relationships between clinical factors and different perfusion patterns. Materials and Methods: Interictal and ictal SPECT and SPECT subtraction were performed in 61 patients with partial epilepsy. Both positive images showing ictal hyperperfusion and negative images revealing ictal hypoperfusion were obtained by SPECT subtraction The ictal perfusion patterns of subtracted SPECT were classified into focal hyperperfusion, hyperperfusion-plus, combined hyperperfusion-hypoperfusion, and focal hypoperfusion only. Results: The concordance rates with epileptic focus were 91.8% in combined analysis of ictal hyperperfusion and hypoperfusion images of subtracted SPECT, 85.2% in hyperperfusion images only of subtracted SPECT, and 68.9% in conventional ictal SPECT analysis. Ictal hypoperfusion occurred less frequently in temporal lobe epilepsy (TLE) than extratemporal lobe epilepsy. Mesial temporal hyperperfusion alone was seen only in mesial TLE while lateral temporal hyperperfusion alone was observed only in neocortical TLE. Hippocampal sclerosis had much lower incidence of ictal hypoperfusion than any other pathology. Some patients showed ictal hypoperfusion at epileptic focus with ictal hyperperfusion in the neighboring brain regions where ictal discharges propagated. Conclusion: Hypoperfusion as well as hyperperfusion in ictal SPECT should be considered for localizing epileptic focus. Although the mechanism of ictal hypoperfusion could be an intra-ictal early exhaustion of seizure focus or a steal phenomenon by the propagation of ictal discharges to adjacent brain areas, further study is needed to elucidate it.