• 수면정신생리
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• 제5권1호
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• pp.54-70
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• 1998

연구배경 : 본 연구는 정신분열병에서 뇌의 해부학적 변화가 있는가를 관찰하고 이런 변화와 인지기능, 신경학적변화, 임상증상과의 상관관계를 알아보기 위해 시도하였다. 방법 : 편집형 정신분열병 환자군 20명(남15, 여5)과 성별, 연령을 조합한 정상대조군 23명(남15, 여8)을 대상으로하여 뇌자기공명촬영의 면적측정을 하여 비교하였다. 또한 환자군을 대상으로 신경심리학적검사, 연성신경학적 증후, 그리고 임상증상을 평가하여 뇌자기 공명 촬영 측정치와 상관관계를 보았다. 결과 : 1) 정신분열병 환자군에서 대조군에 비해 모든 뇌설계와 기저핵의 크기가 유의하게 커져 있었으며, 통계적으로 유의하지는 않았으나 환자군에서 대조군에 비해 우측 전두엽이 작아져 있는 경향을 보였고(p=0.057), 좌측 측두엽의 크기가 환자군에서 작아져 있는 경향을 보였다(p=0.089). 2) 뇌실의 크기 증가가 이전의 입원 횟수의 증가와 정상관관계를 보였고(p<0.01), 이외에 다른 구조물에 대한 측정치와 임상적 요인들 사이에는 유의한 상관관계를 보이지 않았다. 3) 위스콘신 카드 분류검사 점수와 유의한 상관을 보인 구조물은 좌측 측두엽과 좌측 피각이었다. 이중 좌측 측두엽의 크기와 위스콘신 카드 분류 검사의 보속 오류검사 점수사이에는 정상관관계를 보였고(r=0.5636, p<0.05), 피각은 역상관관계를 보였다.(r=-0.5733, p<0.01). 대조군과의 유의한 차이를 보였던 구조물 중 웩슬러 지능검사 점수와 유의한 상관을 보이는 구조물은 하나도 없었고, 좌측 편도(r=0.5727, p<0.05)와 좌측 피각(r=0.4686, p<0.05) 이 각각 언어성 지능 점수와 정상관관계를 보여 주었다. 벤톤 신경심리검사의 유의한 상관을 보여 주었던 구조물은 우측 전두엽과 좌측 편도이었다. 이외에 좌우측 측두엽은 촉각형태 지각 검사 점수(각각 r=0.4998, p<0.05; r=0.5018, p<0.05)와 유의한 정상관관계를 보였고 좌우측 미상핵(각각 r=0.4611, p<0.05; r=0.4726, p<0.05) 및 좌측 피각(r=0.5370, p<0.05)은 직선지남력 검사와 유의한 정상관관계를 보였다. 이상에서 뇌실 측정치는 어떠한 신경심리 검사와도 유의한 상관을 보이지 않았다. 4) 우측 전두엽의 크기가 작을수록 연성 신경학적 징후 총점수도 높은 경향을 보였으며(r=-0.6174, p<0.01), 복합적 연성 신경학적 징후 점수와 유의한 상관을 보이는 구조물은 좌우측 편도(r=-0.4548, p<0.05; r=-0.4597, p<0.05)와 우측 담창구(r=- 0.4646, p<0.05) 이었다. 뇌실 측정치는 연성 신경학적 징후와 유의한 상관을 보이지 않았다. 5) 우측 측두엽은 간이정신상태 검사상의 양성 증상 척도 점수와 역 상관관계를(r=-0.4483, p<0.05) 보였고 좌측 해마는 양성 및 음성 증상척도의 양성 증상점수(r=0.5028, p<0.05)와 일반증상점수(r= 0.5696, p<0.01) 및 간이 정신상태 검사의 총점수(r=0.6050, p<0.01)와 유의한 정상관관계를 보였다. 이외에 우측 측뇌실의 측두각은 간이 정신상태 검사 상의 양성증상과 유의한 정상관관계를(r=0.4729, p<0.05) 를 보였다. 기저핵중에서는 우측 담창구가 양성 및 음성 증상 척도의 음성 증상 점수(r=-0.6062, p<0.01), 간이 정신상태 검사상의 음성 증상 척도(r=-0.5016, p<0.05) 와 유의한 역상관관계를 보였고 좌측 담창구가 간이 정신상태 검사상의 음성 증상 척도 (r=-0.4683, p<0.05) 와 유의한 역상관관계를 보였다. 결론 : 이상과 같은 결과를 통해 정신분열병 환자에서 뇌의 구조 변화는 임상적 경과에 따른 변화인 뇌실 확장 및 뇌의 신경발달학적 이상에 기인하는 기저핵의 증가, 우측 전두엽 및 좌측 측두엽의 크기 감소와 같은 이원적인 변화를 포함한다. 이러한 변화 중 우측 전두엽의 크기 변화는 전두엽 자체의 기능보다는 전체적인 다양한 신경 기능상의 변화와 연관 이 있으며 좌측 측두엽의 크기 변화는 언어 기능의 변화와 연관이 있다. 또한 측두엽 주위의 구조물의 크기 변화는 양성증상 및 일반증상의 형성과 상관이 있으며 피질하 구조인 기저핵의 크기 변화는 음성증상의 형성과 상관이 있다.

• 센서학회지
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• 제13권3호
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• pp.199-206
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• 2004

Epileptic seizures result from a temporary electrical disturbance of the brain. In this paper, a method of discriminating EEG for diagnoses of temporal lobe epilepsy is proposed. The proposed method for classification of epilepsy and sleep EEG is based on the wavelet transform and the fuzzy c-means. The magnitude and mean of wavelet coefficients for each EEG band are applied to the cluster of the FCM classifier. The proposed system show a little more accurate diagnosis for EEG by analysis of frequency for Wavelet and the success rate of 95% classification using FCM. From the simulation results by the implemented system, we demonstrated this research can be reduce doctor's labors and realize quantitative diagnosis of EEG.

• Annals of Clinical Neurophysiology
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• 제17권2호
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• pp.82-85
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• 2015

A 59-year old man was admitted for drowsiness and stiff neck. CSF examination showed lymphocytic pleocytosis and PCR for herpes simplex virus (HSV)-1 was positive in CSF. Brain MRI revealed enhanced lesions in left temporal lobe. His symptom improved with acyclovir. Follow-up studies showed red blood cells in CSF and a hematoma in the left temporal lobe. There was no additional symptom related to the hematoma. He was discharged after conservative care. Although rare, hematoma can develop in HSV-1 meningoencephalitis.

• Journal of Korean Neurosurgical Society
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• 제29권12호
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• pp.1650-1656
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• 2000

Objective : Little consensus exists concerning which temporal lobe structures need to be resected or how much resection should be done during hippocampal resection. The purpose of this study is to identify whether the extent of hippocampal resection influences seizure after anterior temporal lobectomy. Materials and Methods : The extent of hippocampal resection was assessed in 96 patients who underwent temporal lobectomy for medically intractable complex partial seizures originating from a unilateral seizure focus in the anteromesial temporal lobe. Patients who had structural lesion were excluded from the study. Postoperative magnetic resonance imaging in the coronal and saggital planes were used to quantify the extent of the hippocampal and lateral cortical resection. The patients were divided into two groups. Patients who underwent hippocampal resection to the level of the cerebral peduncle were included in the partial resection group, and those who had resection to the level of the colliculus were assigned to total resection group. Seizure outcomes were defined according to the Engel classification and compared between the two groups. Neuropsychologic outcomes in the selected cases were reviewed. Results : The over-all seizure-free outcome(Engel classification 1) was accomplished in 75%(72/96) of the patients (mean duration of follow-up, 36.8 months). The total hippocampectomy group had a statistically superior seizure outcome than the partial hippocampectomy group(87.3% versus 58.5% seizure-free, p-value=0.001). Also, younger patients had a more favorable outcome. Other variables such as laterality, the extent of lateral cortical resection, age at onset and gender were not significant. The pre- and postoperative memory functions were evaluated in 24 patients. A worse postoperative memory outcome was associated with partial hippocampectomy. However this was not acceptable due to a former bias. Conclusion : The result of this study conforms that aggressive hippocampectomy resulted in a better seizure outcome.

• 수면정신생리
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• 제4권1호
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• pp.39-48
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• 1997

Memory disorder is the most consistent neuropsychological finding in schizophrenia and seems to be a stable trait in it. It is suggested that memory dysfunction found in patients with schizophrenia is primary to biological abnormalities, not secondary to attention deficits they have. Although temporal lobe structures including hippocampus and thalamus have traditionally been thought to be implicated regions for memory disorder in schizophrenia, recent studies indicate the possibility of abnormalities in the frontal lobe and the neural circuits between brain regions. Advanced research methods such as functional imaging technique are expected to produce more detailed informations about memory function in schizophrenia.

• Journal of Korean Neurosurgical Society
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• 제66권2호
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• pp.199-204
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• 2023

It is critical to identify the ruptured cerebral arteriovenous malformations (AVMs) for secondary prevention. However, there are rare cases unidentified on the radiological evaluation. We report on a patient with the delayed appearance of radiologically occult AVM as a probable cause of the previous intracerebral hemorrhage (ICH). An 18-year-old male patient presented with a right temporal ICH. The preoperative radiological examination did not reveal any causative lesions. Because of the intraoperative findings suggesting an AVM, however, only hematoma was evacuated. Disappointedly, there were no abnormal findings on postoperative and follow-up radiographic examinations. Eleven years later, the patient presented with an epileptic seizure, and an AVM was identified in the right temporal lobe where ICH had occurred before. The patient underwent partial glue embolization followed by total surgical resection of the AVM and anterior temporal lobe. Based on the literature review published in the era of magnetic resonance imaging, common clinical presentation of radiologically occult AVMs included headache and seizure. Most of them were confirmed by pathologic examination after surgery. In cases of the ICH of unknown etiology in young patients, long-term follow-up should be considered.

• Journal of Korean Neurosurgical Society
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• 제45권6호
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• pp.329-335
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• 2009

Objective : Determining language lateralization is important for the presurgical evaluation of patients with medically intractable epilepsy. The Wada test has been the gold standard for lateralization of language dominance before epilepsy surgery. However, it is an invasive test with risk, and have some limitations. Methods : We compared the volumetric analysis with Wada test, and studied the clinical potential of volumetric analysis to assess language laterality in large surgical candidates with temporal lobe epilepsy (TLE). To examine the efficacy of volumetric analysis to determine language lateralization during presurgical evaluation, we compared the volumetric analysis of the bilateral planum temporale with the results of Wada test in 59 patients with chronic intractable TLE (rTLE, n=32; lTLE, n=27) who underwent epilepsy surgery. We measured the gray matter volumes of planum temporale (PT) of each patients using the VoxelPlus2 program (Mevisys, Daejeon, Korea). Results : Overall congruence of the volumetric analysis with the Wada test was 97.75% in rTLE patients and 81.5% in lTLE patients. There were more significant leftward asymmetry of the PT in rTLE patients than lTLE patients. In lTLE patients, relatively high proportion (37%) of the patients showed bilateral or right hemispheric language dominance. Conclusion : These results provide evidence that the volumetric analysis of the PT could be used as an alternatives in language lateralization. Also, the results of the Wada test suggested that there was considerable plasticity of language representation in the brains of patients with intractable TLE and it was associated with an earlier age of brain injury.

• 생물정신의학
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• 제15권2호
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• pp.118-125
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• 2008

Objectives : The purpose of this study was to find brain regions in which gray matter volume was reduced and to show the capability of voxel-based morphpmetry(VBM) analysis for lateralizing clinically significant brain regions in dementia of Alzheimer's type patients compared to healthy group. Methods : MR T1-weighted images of the 20 dementia of Alzheimer's type patients were compared with those of the 20 normal controls. Images were transformed to standard MNI space. In order to observe gray matter volume change. Gray matter was smoothed with a Gaussian kernel. After these preprocessing, statistical analysis was performed using statistical parametric mapping software(SPM2). Results : Gray matter volume was significantly reduced in the bilateral parahippocampal gyri, Lt. anterior cingulate gyrus, Lt. posterior cingulate gyrus, bilateral superior temporal gyri Lt. middle temporal gyrus, Lt. superior, bilateral middle, Rt. anterior frontal gyri and Rt. precuneus in dementia of Alzheimer's type patient group. Conclusions : These VBM results confirm previous findings of temporal lobe and limbic lobe atrophic changes in dementia of Alzheimer's type, and suggest that these abnormalities may be confined to specific sites within that lobe, rather than showing a widespread distribution.

• Journal of Yeungnam Medical Science
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• 제35권2호
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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.

• Journal of Korean Neurosurgical Society
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• 제30권11호
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• pp.1300-1307
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• 2001

Purposes : This study reports the possible causes of seizure recurrence in patients underwent previous epilepsy surgery, and surgical strategy for resection of the additional epileptogenic zone locating at the distant area to the site of first resection. Methods : A total of 10 patients with previous surgery due to intractable epilepsy were studied. Five of these underwent standard temporal lobectomy, four extratemporal resection, and one corticoamygdalectomy. Seizure outcome of these were class III-IV. Evaluation methods for reoperation included MRI, 3D-surface rendering of MRI, PET, prologned video-EEG recording with surface electrodes and subdural grid electrodes. Additional resection was done in the frontal lobe in two, in the temporal lobe in three, in the parietal lobe in two, and in the supplementary sensori-motor area in two. Tumor in the superior frontal gyrus in the left hemisphere was removed in one patient. Extent of resection was decided based on the results of ictal subdural grid EEGs and MRI findings. Awake anesthesia and electrocortical stimulation were performed in the two patients for defining the eloquent area. Results : Histopathologic findings revealed extratemporal cortical dysplasia in six, hippocampal sclerosis and cortical dysplasia of the temporal neocortex in one, neuronal gliosis in two, and meningioma in one. Previous pathology of the five patients with cortical dysplasia in the second operation was hippocampal sclerosis plus cortical dysplasia of the temporal neocortex. After reoperation, seizure outcomes were class I in six, class II in three, class III in one at the mean follow-up period of 17.5 months. Characteristically, patients in class II-III after reoperation showed histopathologic findings of hippocampal sclerosis plus temporal neocortical cortical dysplasia plus extratemporal cortical dysplasia. Conclusions : Seizure recurrence after epilepsy surgery was related with the presence of an additional epileptogenic zone distant to the site of first operation, and the majority of the histopathology of the surgical specimens was cortical dysplasia. In particular, hippocampal sclerosis plus temporal neocortical cortical dysplasia was highly related with seizure recurrence in patients with previous operation. In these patients, multimodal evaluation methods were necessary in defining the additional epileptogenic zone.