• 전기전자학회논문지
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• 제22권4호
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• pp.1175-1179
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• 2018

본 논문에서는 뇌파 신호를 이용하여 환자의 경련을 감지하는 순환 CNN (Convolutional Neural Networks)을 제안한다. 제안 된 방법은 뇌파 신호의 스펙트럼 특성과 전극의 위치를 보존하기 위해 영상으로 데이터를 매핑하여 처리하였다. 스펙트럼 전처리 과정을 거친 후 CNN에 입력하고 공간 및 시간 특성을 웨이블릿 변환(wavelet transform)없이 추출하여 발작을 검출하였다. 여기에 사용된 보스턴 매사추세츠 공과 대학 (Boston Massachusetts Institute of Technology, CHB-MIT) 아동 병원의 데이터셋 결과는 시간당 0.85의 민감도와 90 %의 위양성 비율 (FPR)을 보였다.

• 대한임상검사과학회지
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• 제48권4호
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• pp.388-393
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• 2016

뇌전증의 개념은 간질발작이 지속적으로 발생하는 뇌변병으로 2005년에 정의 되었다. 2014년 국제항뇌전증연맹에서는 새로운 정의를 내렸으며, 10년 이내 재발 위험이 높다고 하였다. 뇌전증 발작재발의 중요한 위험인자로서 뇌파에서 IEDs의 존재는 발작 증상이 높게 나타날 수 있다는 것을 반영한다. 본 연구는 뇌전증 환자에서 뇌파검사 소견과 IEDs에 따른 발작재발의 상관관계를 분석하여 뇌전증 환자의 예후를 예측하기 위한 뇌파검사의 기초자료로 활용하고자 실시하였다. 연구결과, 뇌전증 질환의 남녀 차이는 없었으며, 연령의 분포 차이는 있었다. 상관관계 분석결과 연령에 따라 발작재발은 음의 상관관계였으며, IEDs에 따라 발작재발은 양의 상관관계를 나타내었다. 또한 통계적으로 연령은 발작재발에 10.9%의 영향을 나타내었고, IEDs는 발작재발에 15%의 설명력을 나타내었다. 따라서 뇌파검사는 임상에서 사용하는 뇌전증 진단에 매우 중요한 검사로 판단되며, 향후 보다 의미 있는 임상 자료가 되기 위하여 발병률에 따른 뇌파결과와 치료 중 뇌파결과와 발작재발 그리고 치료 후 발작재발 등을 지속적으로 연구해야 할 것으로 생각된다.

• Korean Journal of Acupuncture
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• 제24권4호
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• pp.99-110
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• 2007

Objectives : Epilepsy is one of the most common serious brain disorders that affect people of all ages, and it is characterized by recurrent unprovoked seizures. We examined whether acupuncture can reduce both the incidence of seizures and hippocampal cell death in dentate gyrus (DG) using a mouse model of kainic acid (KA)-induced epilepsy. Methods : ICR mice ($20{\sim}25$ g) were given acupuncture once a day at acupoint HT8 (sobu) bilaterally during 2 days before KA injection. After an intracerebroventricular injection of 0.1${\mu}g$ of KA, acupuncture treatment was subsequently administered once more (total 3 times), and the degree of seizure was observed for 20 min. Three hours after injection, we confirmed the neural cell death using cresyl violet staining and silver impregnation staining, and determined the expressions of c-Fos and glutamate decarboxylase (GAD)-67 using immunohistochemistry techniques in the DG. Results : KA induced epileptic seizure, neural cell death, increased c-Fos expression and decreased GAD-67 expression in the DG. Acupuncture treatment at HT8 reduced the severity of the epileptic seizure and inhibited neural cell death from KA. In addition, acupuncture normalized the expressions of c-Fos and GAD-67 in the same areas. Conclusions : These results demonstrated that acupuncture treatment at HT8 may reduce the KA-induced epileptic seizure and neural cell death in the DG possibly by normalizing c-Fos expressions and the gamma-aminobutyric acid neurons.

• Annals of Clinical Neurophysiology
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• 제4권1호
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• pp.16-20
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• 2002

Background and Objective : Epileptic seizures are frequent complication of lobar hemorrhage. We investigated the factors affecting development of epilepsy following spontaneous lobar ICH. Methods : From January 1986 to July 1999, 114 patients were admitted to Chungnam National University Hospital with spontaneous lobar ICH. We analyzed 75 patients. Excluded were no follow-up(8 patients) and patients died within few days(31 patients). All the patient was followed up at least two years aside from two patients who underwent epileptic seizure and died five and eight months later each. Medical history was obtained through medical record and by telephone interview. Statistical analyses were performed using Chi-square test, Student's t - test, Fisher's exact test. Results : Seizure occurred in 19 patients. As three patients had previous history of seizures, 16 patients(22.2%) showed first onset early- and late-seizures. Early seizure occurred in 14 patients(19.4%). Three out of 14 were heavy alcoholics. Five patients developed late recurrent seizure 61 days to 800 days after the early seizure. Late seizure with no acute seizure occurred in two patients. The types of seizure were diverse as generalized tonic clonic seizure(10), partial seizure with secondary generalization(5), and complex partial seizure(1). The common risk factors for lobar ICH were hypertension(HT), arteriovenous malformation(AVM), and excessive use of alcohol. We could not find any causes in 23 patients. Although size of hematoma, age of onset, sex, incidence of HT or AVM were not different between patients with seizure and without seizure, the history of excessive alcohol drinking was more frequent in patients with seizure. Five patients with late recurrent seizure had ICH involving temporal area. Conclusions : This study suggests that the risk of seizure in patients with lobar ICH was increase in chronic alcoholics and patient with late recurrent seizure had ICH frequently involving temporal area.

• Annals of Clinical Neurophysiology
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• 제4권2호
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• pp.137-139
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• 2002

Background : Subtle status epilepticus (SE) is an end-stage of convulsive SE. This phenomenon might be a clinical expression of neuronal exhaustion caused by sustained electrical discharges. As subtle SE may show diverse clinical features, early detection depends on clinical suspicion. Case : A 68-year-old woman was presented with repetitive involuntary movement of right limbs after two generalized tonic-clonic seizures. She experienced right middle cerebral artery infarction 4 months ago, and after the event, left side hemiplegia sustained. These seizures were first-ever after the cerebral infarction. Orientation and verbal responses were fairly preserved but general cognitive function was minimally slowed. During the video-EEG monitoring, repetitive sharp waves were noted in the right hemisphere and these sharp waves occasionally spread to the contralateral side. Her right side involuntary movement was identifiable when the epileptic discharges were found on her right hemisphere. Conclusion : We suggested that this unexpected convulsive movement is a reflection of earlier exhaustion in the right hemisphere or deefferentation of right hemisphere because of preexisting neuronal damage.

• Journal of Korean Neurosurgical Society
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• 제62권3호
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• pp.344-352
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• 2019

Epilepsy is one of the major chronic neurological diseases affecting many patients. Resection surgery is the most effective therapy for medically intractable epilepsy, but it is not feasible in all patients. Vagus nerve stimulation (VNS) is an adjunctive neuromodulation therapy that was approved in 1997 for the alleviation of seizures; however, efforts to control epilepsy by stimulating the vagus nerve have been studied for over 100 years. Although its exact mechanism is still under investigation, VNS is thought to affect various brain areas. Hence, VNS has a wide indication for various intractable epileptic syndromes and epilepsy-related comorbidities. Moreover, recent studies have shown anti-inflammatory effects of VNS, and the indication is expanding beyond epilepsy to rheumatoid arthritis, chronic headaches, and depression. VNS yields a more than 50% reduction in seizures in approximately 60% of recipients, with an increase in reduction rates as the follow-up duration increases. The complication rate of VNS is 3-6%, and infection is the most important complication to consider. However, revision surgery was reported to be feasible and safe with appropriate measures. Recently, noninvasive VNS (nVNS) has been introduced, which can be performed transcutaneously without implantation surgery. Although more clinical trials are being conducted, nVNS can reduce the risk of infection and subsequent device failure. In conclusion, VNS has been demonstrated to be beneficial and effective in the treatment of epilepsy and various diseases, and more development is expected in the future.

• 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.

• Clinical and Experimental Pediatrics
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• 제49권11호
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• pp.1180-1185
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• 2006

목 적 : TPM를 복용중인 간질 환아들에서 소한증 관련 증상 발생률을 확인함과 더불어, 뉴로체크($Neurocheck^{TM}$) 발한 검사를 시행하여 비침습적으로 발한 감소 관련 증상을 비교 확인하고자 하였다. 방 법 : 2004년 10월부터 2005년 7월까지 전북대학병원 소아과에 내원한 환자 중 간질로 진단받고 TPM를 투여 시작한 환자 55명중 자료가 불충분한 9명을 제외하고 46명을 대상으로 하였다. 대상 환자는 약물 투여 전과 목표 용량에 도달 한 직후 가능한 빠른 시간에 뉴로체크를 이용한 발한 기능 검사를 시행하였고, 2005년 여름 소한증과 관련된 증상 발현 유무를 면담을 통해 확인하였다. 결 과 : 저자들은 전북대학교병원 소아과에서 부분발작으로 진단 받고 TPM를 복용중인 46명의 환아들을 대상으로 비침습적인 검사인 뉴로체크를 이용하여 TPM 유발성 발한 감소 증상을 예측하고자 하였으며 더불어 TPM으로 인한 발한 감소 증상의 유병률을 알아보고자 하였으며 다음과 같은 결과를 얻었다. 1) 설문조사상 여름 기간 동안 TPM 사용 중 소한증 관련 증상 발생률은 37.0% 였으며 완전 무한증은 없었고 경증의 비율은 26.1%, 중증의 비율은 10.9% 였다. 2) 뉴로체크 발한 검사상 발한 지연은 34.8% 였으며 변화 없는 경우는 54.3%, 발한이 증가한 경우는 10.9% 였다. 3) 설문조사 결과 발한 감소 관련 증상을 보인 환아들에서 뉴로체크 검사상 발한 감소를 보이는 경우는 46명 중 13명으로 76.5% 였으며 이중 설문조사 상 경증인 경우는 75.0%, 중증인 경우는 80%의 양성률을 보였다. 4) 뉴로체크 발한 검사상 TPM 사용전보다 3분 이상 지연된 경우 3분 이하에서보다 상대적으로 중증의 비율이 높았다. 결 론 : 소아연령에서 비침습적인 뉴로체크 발한 검사 방법으로 손쉽게 발한감소를 측정할 수 있었다. 뉴로체크 검사를 이용하여 TPM 유발성 발한 감소 관련 증상을 예측 할 수 있었으며, 특히 TPM 사용 전보다 3분 이상 지연된 경우 소한증 증상 발현이 현저하여 열감 불내성, 기면 혹은 열사병에 대한 주의가 필요할 것으로 생각된다.

• The Korean Journal of Physiology and Pharmacology
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• 제18권3호
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• pp.269-278
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• 2014

Various antiepileptic drugs (AEDs) especially enzyme-inducing AEDs might be associated with increased vascular risk, through impairment of the endogenous antioxidative ability which may trigger oxygen-dependent tissue injury. Lamotrigine (LTG) a non-enzyme-inducing AED has scarce information regarding its effects on oxidative stress. The present study aimed to study the possible modulation of vascular risk factors of epileptogenesis by LTG, in a rat model of kindling seizure induced by pentylenetetrazole (PTZ). Four groups of male Wister rats were used; vehicle control group, PTZ group (alternate day PTZ, 30 mg/kg, i.p), LTG/PTZ group (LTG 20 mg/kg/day p.o and alternate day PTZ) and LTG group. The study period was 5 weeks. Lipoproteins and total homocysteine (tHcy), malondialdehyde (MDA) and reduced glutathione (GSH) were measured. Aortic endothelial function study and histopathological examination of the rats' brains, aortas and coronaries were conducted. Serum total cholesterol (TC), triglyceride (TG) and low-density lipoprotein cholesterol (LDL-C), tHcy, MDA, GSH levels were significantly higher in epileptic rats than normal controls rats. A decrease in HDL-cholesterol with high atherosclerotic index was also demonstrated. The administration of LTG improved the PTZ-kindled seizures. It produced a significant decrease in TC, TG and LDL-cholesterol, MDA, aortic GSH and increase in HDL-cholesterol with no significant effect on serum GSH and tHcy levels. LTG improved endothelium-dependent relaxation, decreased hippocampal neurodegenerative changes and atherosclerotic changes of aortas and coronaries. LTG decreased seizures severity, hippocampal damage and improved vascular risk markers in this rat model of kindling seizures.

• Clinics in Shoulder and Elbow
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• 제12권1호
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• pp.98-101
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• 2009

목적: 본 증례 보고는 드물게 보고되고 있는 간질 발작과 동반된 견관절 전방 불안정성에서 발견되는 골병변을 기술하고 고빈도의 재발 요인을 파악하고자 하였다. 대상 및 방법: 저자들은 전간 발작과 동반된 2례의 재발성 전방 탈구를 경험하였으며 본 증례 통하여 일반적인 재발성 견관절 탈구에 준하여 치료하면서 정기적으로 경과를 관찰하였다. 결과: 본 두 증례에서 수술의 경과는 전간 발작의 조절 여부에 따라 경과가 결정됨을 알 수 있었다. 즉 간질 조절이 잘된 환자에서는 안정성을 유지할 수 있었으나 발작이 조절되지 않은 전방 불안정성의 경우 결국 재발성 탈구가 유발되게 되었다. 결론: 전간 발작과 동반된 견관절 불안정성에서 재발 방지를 위해서는 경련 조절이 필수적인 인자임을 인지하게 되었다.