• Clinical and Experimental Pediatrics
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• 제46권12호
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• pp.1253-1259
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• 2003

목 적 : 신생아 경련은 일반적으로 임상적 양상이 소아나 성인과는 크게 다르며 그 빈도도 드물지 않다. 그러나 국내에서는 이에 대한 연구 및 자료가 부족하여 저자들은 신생아 경련으로 입원한 환자를 대상으로 이들의 임상양상, 치료 및 예후에 관해 알아보고자 본 연구를 시행하였다. 방 법 : 2000년 1월부터 2003년 4월까지 경북대학교병원 소아과에서 신생아 경련으로 치료받았던 41명(남 24, 여 17, 재태연령 $38.4{\pm}3.6$주)을 대상으로 후향적 연구를 시행하였으며 이들의 병력상에 나타난 위험인자, 신경학적 진찰소견, 검사실 소견, 뇌 영상소견, 뇌파소견, 경련의 양상, 치료에 대한 반응 및 예후를 비교하였다. 결 과 : 경련시작 당시의 나이는 $6.1{\pm}4.6$일이었고 경련의 양상은 다발성 간대가 17례(42%), 비정형적 발작이 10례(24%)로 가장 많았다. 병력상 위험인자로서는 비정상적 분만력 및 신생아 가사가 11례(27%), 전해질 이상이 11례(27%), 경련의 가족력이 3례(7%), 뇌의 구조적 이상이 3례(7%), 기타 저혈압 2례(5%) 핵황달, 청색형 선천성 심장병으로 인한 저산소증, 선천성대사이상 등이 3례(7%)였으며 나머지 8례(20%)에서는 위험인자가 발견되지 않았다. 뇌영상 촬영상 21례(51%)에서 비정상적인 소견을 보였으며 이중 뇌출혈이 9례(22%)였으며 뇌백질연화증이 2례(5%), 뇌경색이 2례(5%)였고 그 외 선천성 수두증, cortical dysplasia, dural sinus thrombosis, 시상부위 음영증가 등의 소견을 보였다. 뇌파는 전체 41례 중 33례에서 시행되었고 17례(52%)에서 이상소견을 보였다. 치료는 저혈당이나 전해질이상이 동반된 경우 이를 교정해 주었으며 항경련제로는 phenobarbital을 1차 약제로 사용하였고 반응이 없는 경우 phenytoin을 추가하였다. 경련이 재발하거나 나쁜 예후를 보인 환아들은 많은 수에서 신생아 가사에 의한 뇌손상이나 뇌의 선천성 기형이 있었으며 뇌파상에 비정상적인 배경파나 뇌영상소견상 이상을 보이는 경우가 많았다. 결 론 : 신생아 경련의 많은 경우가 비정상적인 출산력과 미숙아, 기타 전해질이상과 관련된 문제가 많았고 전반적으로 약물에 대한 반응이 좋았으며 경련 발생 당시의 임상적 소견이나 검사소견 특히 뇌파나 뇌영상 촬영 소견상 큰 이상이 없었던 경우에는 예후가 좋았다. 따라서 신생아 경련의 위험요소를 잘 이해하고 분만 및 경련발생 시 적절한 대처를 해주는 것이 환아의 예후에 중요한 요인으로 작용하는 것 같다.

• Clinical and Experimental Pediatrics
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• 제45권5호
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• pp.629-636
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• 2002

목 적 : 고체온에 의하여 유발된 반복성 열성경련에서 경련의 양상과 해마부의 nNOS 발현을 비교관찰하고 열성경련과 nNOS의 관계를 알아보기 위하여 연구를 시행하였다. 방 법 : 생후 20일된 Spraque-Dowley rat을 이용하여 1주일에 2회씩 4주간 모두 8회 온수에 노출시켜 고체온에 의한 반복적인 열성경련을 유발하였다. 실험에 이용된 쥐는 모두 82마리로서 이중 52마리는 실험군으로서 항온조에서 4분간 $45^{\circ}C$ 정도의 온수에 노출시켰고, 30마리는 대조군으로서 4분간 $37^{\circ}C$에 노출시켰다. 입수 후 경련이 발생할 때까지를 잠복기로 정하였고, 경련의 첫 증상으로서 근간대성 경련이 보이고 난 후 의식을 회복하여 정상적인 활동을 보이는 시점까지를 경련 지속시간으로 정하였다. 대조군과 고체온에 노출될 때마다 경련을 보였던 hyperthermic seizure group 및 경련이 전혀 발생하지 않았던 hyperthermic non-seizure group 간의 nNOS 발현을 관찰하기 위하여 western blot을 시행하였다. 결 과 : 고체온에 노출되었던 쥐의 87%에서 전신성 강직-간대 발작을 보였고, 고체온 노출횟수에 따른 경련 발생률은 통계적으로 유의성이 없었다(P>0.05). 입수 후 경련이 나타날 때까지의 잠복기는 158에서 240초였고 평균 204초였으며, 고체온 노출횟수에 따른 잠복기는 통계적으로 유의하지 않았다(P>0.05). 경련 지속시간은 12에서 145초였고 평균 55초로 측정되었으며, 고체온 노출에 따른 경련 지속시간은 통계적으로 유의하게 나타났다(P<0.05). 결과적으로 고체 온 노출횟수가 증가할수록 경련 지속시간은 의미있게 증가하였으나 경련 발생률 및 잠복기는 차이가 없었다. 쥐 해마부에서 nNOS 단백질의 발현을 조사하기 위하여 대조군의 해마부, 대뇌피질 및 소뇌, hyperthermic non-seizure group 및 hyperthermic seizure group의 해마부와 대뇌 피질을 대상으로 하여 western blot을 한 결과 대뇌 피질에서는 각 그룹간에 nNOS 발현에 변화가 없었으나 각 그룹의 해마부에서의 nNOS 단백질 발현은 대조군에 비하여 hyperthermic non-seizure group과 hyperthermic seizure group에서 약하게 나타났고, 이 두 군간에는 차이가 없었다. 결 론 : 고체온에 의한 반복성 열성경련에서 nNOS 는 경련유발에 영향을 주지 않을 것으로 추정되며 앞으로 열성경련에 의한 해마부의 형태학적인 변화와 함께 많은 연구가 병행되어야 할 것으로 생각된다.

• 생물정신의학
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• 제8권1호
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• pp.167-174
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• 2001

A 54-year old male patient who was suffering from bipolar I disorder for 19 years and was admitted to the National Bugok Mental Hospital due to a depressive episode, was referred to the Kosin University Gospel Hospital. On arrival at the emergency room, he had confused mentality with disorientation, memory impairment, hypomania, marked anxiety and hyperirritability. The change of neuromuscular activity such as ataxia, gait disturbance, tremor, shivering, myoclonus and epileptic seizures was also shown. In addition, the symptoms and signs of autonomic instability including diaphoresis, tachycardia, hypotension, fever and facial flushing were noticed. The above symptoms developed after the administration of sertraline successive to the discontinuation of fluoxetine without any washout period. The degree of severity seemed to be severe because he had epileptic seizures, fever and hypotension. He was recovered from the severe serotonin syndrome by the supportive symptomatic treatment with sodium valproate, clonazepam, lorazepam and cyproheptadine after cessation of the selective serotonin reuptake inhibitors during hospitalization. Therefore, this rare case of severe serotonin syndrome was reported and related literatures were also reviewed.

• Clinical and Experimental Pediatrics
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• 제56권7호
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• pp.271-274
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• 2013

Brain insults, including neurotrauma, infection, and perinatal injuries such as hypoxic ischemic encephalopathy, generate inflammation in the brain. These inflammatory cascades induce a wide spectrum of cytokines, which can cause neuron degeneration, have neurotoxic effects on brain tissue, and lead to the development of seizures, even if they are subclinical and occur at birth. Cytokines are secreted by the glial cells of the central nervous system and they function as immune system mediators. Cytokines can be proinflammatory or anti-inflammatory. Interleukin (IL)-$1{\beta}$ and IL-8 are proinflammatory cytokines that activate additional cytokine cascades and increase seizure susceptibility and organ damage, whereas IL-1 receptor antagonist and IL-10 act as anti-inflammatory cytokines that have protective and anticonvulsant effects. Therefore, the immune system and its associated inflammatory reactions appear to play an important role in brain damage. Whether cytokine release is relevant for the processes of epileptogenesis and antiepileptogenesis, and whether epileptogenesis could be prevented by immunomodulatory treatment should be addressed in future clinical studies. Furthermore, early detection of brain damage and early intervention are essential for the prevention of disease progression and further neurological complications. Therefore, cytokines might be useful as biomarkers for earlier detection of brain damage in high-risk infants.

• Journal of Ginseng Research
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• 제33권1호
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• pp.48-54
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• 2009

Epileptifrom discharges were induced in the telencephalon of the adult zebrafish via perfusion with pentylenetetrazole (PTZ), bicuculline methiodide, kainic acid-treated artificial cerebrospinal fluid (aCSF), and $Mg^{2+}$-free aCSF. Ginseng total saponin [GTS ($50{\mu}g/ml$)] was shown to attenuate the occurrence rate of epilpetiform discharges by 50-75%, compared to the control. Ginsenoside $Rg_1$ ($130{\mu}M$) reduced the epileptiform discharges in the isolated telencephalon and delayed the occurrence of behavioral seizures observed from the adult zebrafish placed in the PTZ (10 mM)-containing aquarium water. However, Re was not effective in the suppression of epileptiform discharges and behavioral seizures. These results indicate that $Rg_1$ may be useful in the control of epileptiform discharges and effective in controlling behavioral seizures, and that the zebrafish can be used as a model animal for the testing of potential anticonvulsant drugs.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제14권1호
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• pp.81-85
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• 2011

16세 여아에서 복통, 구토, 고혈압, 경련 및 고지혈증을 보였던 급성 간헐성 포르피린증 1예를 경험하였기에 보고하는 바이다. 소아에서 원인을 알 수 없는 복통에 고혈압, 경련 등 특징적 포르피리아 증상이 동반된 경우에 반드시 급성 간헐성 포르피린증을 고려해야 한다.

• 대한한방소아과학회지
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• 제34권3호
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• pp.37-54
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• 2020

Objectives The purpose of this study is to analyze the treatment and treatment's effect for seizures disease in children by reviewing Korean clinical studies. Methods 13 articles which were published from August, 2002 to August, 2016 were obtained from the National discovery for science leader (NDSL), Research information sharing service (RISS), Google Scholar, and Oriental medicine advanced searching integrated system (OASIS) by using keyword 'Seizure', 'Convulsion', and 'Epilepsy'. Results Most of the study cases were with epilepsy children. The most frequently used herbal medicine was Gwakhyangjeonggi-san gami, and the most commonly used acupoints were LI4 and LR3. Treatment periods range from 13 days to 14 months, and all of the seizures were completely cured or relieved after the treatments. Conclusions This study shows that there are common symptoms and treatments for seizures in children. The reported different treatments can be used in primary medical care. Developing guideline standards of the seizure treatments can be possible with further studies.

• Annals of Clinical Neurophysiology
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• 제1권2호
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• pp.147-153
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• 1999

Hippocampal slice models can be a powerful tool to study the mechanism of partial epilepsy. Despite the loss of connection with the rest of the brain, in vitro hippocampal slice preparations allow detailed physiological and pharmacological studies, which would be impossible, in vivo. There are several methods to induce electrographic seizures on hippocampal slice models. Those are electrical pulse train stimulation, 0 $Mg^{2+}$ artificial cerebrational fluid and high concentration of extracelluar $K^+$ on bath. Among them, the electrically triggered seizure may mimic the physiological communication between neuronal populations without any deterioration of normal physiologic and chemical status of the hippocampal slice models. Presumably, such communication from hyperexcitable areas to other neuronal populations is involved in the development of epilepsy. Electrographic seizures in hippocampal slice models occur in the network of neurons that are involved in epileptic seizures in the hippocampus in vivo. Because these models have many advantages and are very valuable to research of epileptogenesis on partial epilepsy, I would like to introduce the electrophysiological methods to induce electrographic seizure or epilepsy on hippocampal slice models briefly in this paper.

• Clinical and Experimental Pediatrics
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• 제64권6호
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• pp.251-259
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• 2021

Psychogenic nonepileptic seizures (PNES) is a neuropsychiatric condition that causes a transient alteration of consciousness and loss of self-control. PNES, which occur in vulnerable individuals who often have experienced trauma and are precipitated by overwhelming circumstances, are a body's expression of a distressed mind, a cry for help. PNES are misunderstood, mistreated, under-recognized, and underdiagnosed. The mind-body dichotomy, an artificial divide between physical and mental health and brain disorders into neurology and psychiatry, contributes to undue delays in the diagnosis and treatment of PNES. One of the major barriers in the effective diagnosis and treatment of PNES is the dissonance caused by different illness perceptions between patients and providers. While patients are bewildered by their experiences of disabling attacks beyond their control or comprehension, providers consider PNES trivial because they are not epileptic seizures and are caused by psychological stress. The belief that patients with PNES are feigning or controlling their symptoms leads to negative attitudes of healthcare providers, which in turn lead to a failure to provide the support and respect that patients with PNES so desperately need and deserve. A biopsychosocial perspective and better understanding of the neurobiology of PNES may help bridge this great divide between brain and behavior and improve our interaction with patients, thereby improving prognosis. Knowledge of dysregulated stress hormones, autonomic nervous system dysfunction, and altered brain connectivity in PNES will better prepare providers to communicate with patients how intangible emotional stressors could cause tangible involuntary movements and altered awareness.

• Biomolecules & Therapeutics
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• 제28권2호
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• pp.137-144
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• 2020

Epilepsy is a brain disorder that affects millions of people worldwide and is usually managed using currently available antiepileptic drugs, which result in adverse effects and are ineffective in approximately 20-25% of patients. Thus, there is growing interest in the development of new antiepileptic drugs with fewer side effects. In a previous study, we showed that a Rehmannia glutinosa (RG) water extract has protective effects against electroshock- and pentylenetetrazol (PTZ)-induced seizures, with fewer side effects. In this study, the objective was to identify the RG components that are responsible for its anticonvulsant effects. Initially, a number of RG components (aucubin, acteoside, catalpol, and mannitol) were screened, and the anticonvulsant effects of different doses of catalpol, mannitol, and their combination on electroshock- and chemically (PTZ or strychnine)-induced seizures in mice, were further assessed. Gamma-aminobutyric acid (GABA) receptor binding assay and electroencephalography (EEG) analysis were conducted to identify the potential underlying drug mechanism. Additionally, treated mice were tested using open-field and rotarod tests. Catalpol, mannitol, and their combination increased threshold against electroshock-induced seizures, and decreased the percentage of seizure responses induced by PTZ, a GABA antagonist. GABA receptor binding assay results revealed that catalpol and mannitol are associated with GABA receptor activity, and EEG analysis provided evidence that catalpol and mannitol have anticonvulsant effects against PTZ-induced seizures. In summary, our results indicate that catalpol and mannitol have anticonvulsant properties, and may mediate the protective effects of RG against seizures.