• Annals of Clinical Neurophysiology
• /
• 제11권1호
• /
• pp.16-23
• /
• 2009

Background: The intermittent delta activity in electroencephalographies (EEGs) of patients with focal brain lesions has been reported to be a marker of an epileptogenic focus. This study investigated the concordance between the current source distribution (CSD) of the interictal epileptiform discharges (IEDs) and that of the background delta frequency bands (DFBs) of the scalp EEG. Methods: We collected scalp EEGs of 13 patients with focal epilepsy that contained uniregional IEDs and unilateral delta to theta slow waves. We applied a distributed source model using LORETA$^{(R)}$ to determine the CSD of the peak points of the IEDs and the DFBs of the background activity. Results: The CSDs of the DFBs were ipsilateral to the CSDs of the peak point of the averaged IEDs in ten patients, and bilateral with ipsilateral predominance in three patients. In the cases with an ipsilateral CSD of the DFB, 8 of 10 patients had concordance of the CSD localization between the averaged IED and the DFB. In the cases with bilateral CSD of the DFB, 2 of 3 patients had concordance of the CSD localization between the averaged IED and the DFB. Conclusions: The CSD localization and lateralization appear to be concordant between the IEDs and the DFB of background activity in epileptic patients. Therefore, the CSD of the DFB in EEGs with visually observable slow activities may predict those of IEDs.

• 대한의생명과학회지
• /
• 제18권4호
• /
• pp.428-434
• /
• 2012

Epilepsy is a chronic neurological disease showing a symptom of repeated seizures without any other physical disorders. Among the diagnostic examination for epilepsy, the electroencephalogram (EEG) has been known as an important test. This study aimed to investigate the EEG with photic stimulation in the pediatric epilepsy patients. They underwent digital sleep and waking EEGs or waking EEGs with photic stimulation. Epilepsy type, seizure history, and season of occurring seizure were analyzed. Epilepsy patients showed more response during the period of photic-on and eye close at the frequency of 10~20 Hz during the EEG activation procedure. Photoparoxysmal response (PPR) was shown in 206 patients out of total 1,551 epilepsy patients. PPR was appeared more frequently during summer and winter seasons, and especially in the patients who had a history of seizure. During the PPR, EEG pattern showed spike (77.18%), theta (9.71%), and spike + theta (13.11%). On the other hand, beta and theta waves were not significantly changed by photic stimulation. However, alpha wave was decreased and delta wave was increased by photic stimulation (P<0.05). These changes may be due to temporarily altered electrophysiological function of the epileptic patient's brain by the photic stimulation. There was no difference in the EEG pattern between the left and right side in the brain. In conclusion, condition of photic-on with closed eyes and frequency of 10~20 Hz during the procedure of EEG activation could be appropriate for obtaining a definite photoparoxysmal response in the electroencephalogram of the pediatric epilepsy patients.

• 대한의용생체공학회:의공학회지
• /
• 제36권5호
• /
• pp.169-176
• /
• 2015

Implantable closed-loop epilepsy controllers require ideally both accurate epileptic seizure detection and low power consumption. On-chip oscillators can be used in implantable devices because they consume less power than other oscillators such as crystal oscillators. In this study, we investigated the tolerable error range of a lower power on-chip oscillator without losing the accuracy of seizure detection. We used 24 ictal and 14 interictal intracranial electroencephalographic segments recorded from epilepsy surgery patients. The performance variations with respect to oscillator frequency errors were estimated in terms of specificity, modified sensitivity, and detection timing difference of seizure onset using Generic Osorio Frei Algorithm. The frequency errors of on-chip oscillators were set at ${\pm}10%$ as the worst case. Our results showed that an oscillator error of ${\pm}10%$ affected both specificity and modified sensitivity by less than 3%. In addition, seizure onsets were detected with errors earlier or later than without errors and the average detection timing difference varied within less than 0.5 s range. The results suggest that on-chip oscillators could be useful for low-power implantable devices without error compensation circuitry requiring significant additional power. These findings could help the design of closed-loop systems with a seizure detector and automated stimulators for intractable epilepsy patients.

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

• Clinical and Experimental Pediatrics
• /
• 제51권2호
• /
• pp.162-169
• /
• 2008

목 적 : Oxcarbazepine(OXC)은 대표적인 부분간질의 치료제로 2001년 미국 식약청으로 부터 승인을 받았으며 1970년대 말부터 임상 보고가 시작되었고 소아를 대상으로 OXC의 효용성 및 안전성에 대한 다수의 보고가 있다. 국내에는 1999년부터 임상적 적용이 시작되었으나 국내 소아 대상의 연구 보고가 제한적이다. 방 법 : 2001년 1월부터 2006년 12월까지 6년간 고려대학교 의료원 구로병원 소아과에 내원하여 OXC 투약을 시행하였던 환자 144명을 대상으로 후향적 자료 분석을 통해 효용성과 안전성을 연구하였다. 결 과 : OXC 투약 6개월 후 회복군은 77명(53.5%, n=144), 호전군은 48명(33.3%), 유지군은 14명(9.7%), 그리고 악화군은 5명(3.5%)이었고, 치료 12개월 후에는 회복군은 88명(61.1%, n=133), 호전군은 27명(18.8%), 유지군은 8명(5.6%), 그리고 악화군은 8명(5.6%)이었다. 단일요법 군의 회복군은 6개월 치료 후에 63명(66.3%, n=95), 12개월 치료 후에는 86명(90.5%, n=95)였으며 복합요법 군에서 6개월 투약 후에 회복군은 14명(28.6%, n=49), 치료 12개월 후에는 45명(91.8%, n=49)으로 유의한 차이를 보였다. OXC 투약 기간동안 부작용이 발생한 경우는 73명으로, 그 중 졸림(20.1%), 두통(12.5%), 어지러움(9.7%), 발진(8.3%), 피로함(4.2%) 등이 관찰되었으며 나이, 성별 및 약물 용량과는 유의한 인과관계가 없었다. 혈액 검사상 저나트륨혈증이 관찰된 경우는 총 24명(16.7%)이며 그 외 투약 후 검사 상 이상소견은 유의하게 관찰되지 않았다. 반면 투약 이후 빈혈의 빈도가 감소하였는데 혈색소와 체중 간에 유의한 상관관계는 없었다. 결 론 : 본 연구 결과 OXC 의 효용성은 국외 보고와 비교하여 우수하거나 큰 차이가 없었으며, 위중한 부작용 사례는 없었다. 소아 간질 환자의 OXC 치료 시 참고가 되는 자료가 될 수 있을 것이다.

• Clinical and Experimental Pediatrics
• /
• 제48권4호
• /
• pp.406-410
• /
• 2005

목 적 : 항경련제는 여러 가지 부작용을 갖고 있으며, 그 중 일부는 혈청 내 미량 원소의 항상성 장애이다. 미량 원소는 신체 내에 낮은 농도로 존재하며, 조직의 작은 부분을 구성하지만 중추와 말초 신경계에서 중요한 역할을 한다. 저자들은 6개월 이상 항경련제를 복용하고 있는 간질 환아의 혈청 구리와 아연농도를 측정하여 항경련제가 신체 내 미량 원소의 항상성에 미치는 영향을 알아보고자 하였다. 방 법 : 1997년 1월부터 2003년 12월까지 충남대학교병원 소아과에서 간질 진단 하에 항경련제를 복용 중인 환아 64명(남 : 29, 여 : 35)과 정상 대조군 20명(남 : 12, 여 : 8)을 대상으로 하였고 정맥혈을 채취하여 혈청 구리와 아연의 농도를 측정하였다. 항경련제를 복용하고 있는 간질 환아 군을 VPA 단일 복용군, VPA를 포함하는 복합 복용군, VPA 외의 항경련제 복용군의 세 군으로 나누어 비교하였다. 결 과 : 혈청 구리 농도는 VPA 단일 복용군에서 $81.56{\pm}20.92{\mu}g/dL$, VPA를 포함하는 복합 복용군에서 $80.89{\pm}19.31{\mu}g/dL$, VPA 외의 항경련제 복합 복용군에서 $82.14{\pm}25.74{\mu}g/dL$로서 세 군 모두 대조군의 혈청 구리 농도 $102.13{\pm}32.80{\mu}g/dL$에 비하여 유의하게 낮은 양상을 보였다(P<0.05). 혈청 아연 농도는 항경련제 종류에 따라 분류한 상기 세 군에서 대조군보다 낮았으나, 유의한 차이는 없었다(P>0.05). 혈청 구리와 아연 농도는 항경련제의 종류 및 복용 기간에 의한 차이를 보이지 않았다(P>0.05). 결 론 : 항경련제 복용 환아군에서 정상 대조군보다 혈청 구리의 농도는 유의하게 낮았고, 혈청 아연의 농도는 정상 대조군과 유의한 차이를 보이지 않았다. 항경련제로 치료받는 간질 환아의 경우 혈청 구리 농도가 낮아질 수 있다.

• Clinical and Experimental Pediatrics
• /
• 제51권4호
• /
• pp.415-419
• /
• 2008

목 적 : 한약은 그 효과 여부를 막론하고 한국인의 기본 의료 추구에 아직까지도 큰 부분을 차지하고 있다. 특히 간질과 같이 장기적인 치료가 필요한 경우 국민 정서상 많은 환자들이 한약 복용을 고려한다고 판단된다. 본 연구는 소아 간질 환자에서 한약에 대한 인식과 복용 실태 등을 조사하여 향후 환자의 치료 및 관리에 도움이 되고자 하였다. 방 법 : 2007년 7월부터 8월까지 고려대학교 안암, 구로, 안산병원 및 광명성애병원 소아청소년과 신경클리닉에 내원한 간질 환자의 보호자 중 설문지를 통해 응답한 378명을 대상으로 소아 간질의 치료와 관련한 한약 복용에 대한 인식과 복용 실태를 분석하였다. 결 과 : 한약을 복용한 적이 없는 경우가 313명(82.8%)이었는데, 복용하지 않은 주된 이유는 '병원에서 처방하는 항간질약제 치료에 나쁜 영향을 끼칠 수 있다고 생각이 되어서'로 30.5%에 해당하였다. 한약을 복용한 적이 없는 환자도 53.4%에서 '담당 의사가 한약에 대해 객관적인 자료 제시나 긍정적인 태도를 보인다면 한약을 복용하겠다'라고 응답하였다. 한약을 복용한 적이 있는 경우는 65명(18.2%)이었는데, 이 중 42.4%가 항간질약제를 복용하는 중에 한약을 병용하였다. 한약 복용 전 담당 의사와 상의를 한 경우는 18명(27.7%)에 불과하였는데, 그 이유로 18명 중42.1%가 '한약을 먹는 것이 별로 문제될 것이 없다고 생각해서', 32.8%가 '평소 담당 의사가 한약에 대해 부정적인 태도를 취해서'라고 응답하였다. 한약을 먹는 이유는 '몸을 보하고 기를 채워야 치료가 더 잘 될 것 같아서'(25.3%), '간질 치료의 보조제라고 생각해서'(15.8%) 등이 많았다. 한약 복용 후 보호자가 느끼는 효과는 '간질 치료에 도움이 되지는 않으나 몸이 건강해진 것 같음' 20명(33.3%), '아무런 반응이 없음' 19명(31.8%) 등으로 답하였다. 부작용을 경험한 경우는 10명(15.4%)이었고 간기능 이상, 구토, 설사, 발진, 어지러움 등이 있었다. 결 론 : 항간질약제로 치료중이거나 치료 종료 후 정기적인 외래 방문을 하고 있는 간질 환자 중 18.2%가 한약을 복용하였으며 복용 행태에 있어서 담당 의사의 태도에 영향을 받았다. 따라서 간질 환자의 한약 복용에 대해 무조건 거부 반응을 보일 것이 아니라 객관적인 자료를 조사하여 충분한 설명과 교육이 필요하다고 생각된다.

• 대한상한금궤의학회지
• /
• 제14권1호
• /
• pp.1-26
• /
• 2022

Objectives: We aimed to confirm the safety and effectiveness of the decoction of Sibjo-tang, which is a powder type purgative. In addition, we checked whether the '發作' of 『Shanghanlun』 can be interpreted to have the same meaning as "seizure" in English. By confirming these objectives, we intend to lead the progress in the application of Sibjo-tang and to expand the clinical application of the 152nd provision and Sibjo-tang. Methods: We analyzed the medical records of patients who visited Apgujeongjeongin Oriental Clinic and Almyeon Oriental Clinic for seizures. We confirmed side effects in patients who took Sibjo-tang for a long time. Sibjo-tang was prepared as a hot water extract by using 5 g each of Euphorbiae Pekinensis Radix, Eurphobiae Kansui Radix, and Genkwae Flos and 15 g of Zizyphi Fructus. The "seizure" recorded in the 152nd provision was interpreted through the shape analysis of Oracle bone scripts. The seizure frequency of patients diagnosed with epilepsy after taking Sibjo-tang was compared, and we analyzed other symptoms and psychosocial conditions associated with seizures at the first episode. Results: No side effects were found in 7 patients who took Sibjo-tang for 16.57 ± 14.10 months. Seizures were eliminated in 6 cases while taking Sibjo-tang and significantly decreased in 1 case. Frequent indigestion (in 7 cases), mild exhaustion (in 5 cases), and inferiority complex (in 5 cases) were identified as accompanying pathogenic conditions. The "seizure" in the 152nd provision was interpreted as "a state of being stabbed by a sharp substance in clothes", confirming a deep connection with epileptic seizures. Conclusions: The results suggest that using a decoction of Sibjo-tang is safe and efficacious. In addition, the necessity of conducting an advanced study on epileptic seizures accompanied by frequent indigestion using Sibjo-tang was confirmed.

• 대한임상검사과학회지
• /
• 제38권2호
• /
• pp.141-146
• /
• 2006

Vagal nerve stimulation (VNS) has been proposed as a possible way to improve the control of refractory epilepsy. We report the effects following VNS treatment in patients with refractory epilepsy. Seventeen patients with a mean age of 12.8 years, ranging from 5 to 29 years, underwent the implantation of vagal nerve stimulation (Cyberonics, Houston, TX). We reviewed the clinical findings before and after VNS in seizure frequency, number of antiepileptic drugs (AED), and quality of life (QOL). All of the patients had intractable seizures, eleven of the patients had additional medical complications, three had hippocampus atrophy, one had encephalomalacia, five had encephalitis, one had pachygyria, and one had schizencephaly. Thirteen patients had symptomatic partial epilepsies, three patients had Lennox-Gastaut syndrome and one had cryptogenic partial epilepsy. The mean follow up duration was 35 months. The mean reduction of seizure frequency compared with baseline before VNS was 26.1% after 3 months (p<0.005), 41.9% after 6 months (p<0.001), 46.9% after 1 year (p<0.001), and 53% at the latest follow-up (p<0.001). Twelve patients showed an improvement of QOL such as mood, language, alertness, expression, and motor function. The most common side effects were transient hoarseness or voice change or cough, which was detected in six patients (35%) and wound infection in one patient (5%). This study has shown a good anti-seizure effect of VNS, decrease in seizure frequency and improvements in QOL. We concluded that VNS is a beneficial therapy in refractory epilepsy with a non-resectable epileptic focus. Further studies should be focused on the prediction of unresponsiveness and the adjustment of VNS parameters for maximum efficacy in patients with various medical histories.

• 대한간호학회지
• /
• 제47권3호
• /
• pp.289-304
• /
• 2017

Purpose: The purpose of this study was to understand and describe the illness experience of married Korean women with epilepsy. Methods: Data were collected during 2015~2016 through individual in-depth interviews with 12 married women with epilepsy. Verbatim transcripts were analyzed using Giorgi's phenomenological analysis to uncover the meaning of the illness experience of the participants. Results: The study results showed that the illness experience of married Korean women with epilepsy was clustered into a specific description of situated structure and a general description of situated structure. Six themes from 20 meaning units were identified: 1) Undermined self-esteem with stigma of being epileptic; 2) Limited social interaction; 3) Suffering sorrow as a 'disqualified being'; 4) Shuttling back and forth across the boundary between healthy and epileptic; 5) Desperate struggle to meet the expectation of given role; 6) Self-empowering through self-restriction and realization. Conclusion: The findings from this study show that both the enacted and felt stigma of epilepsy impact on the life of married Korean women with epilepsy. Although the participants face social and interpersonal restriction and prejudices, they try their best to fulfill their role rather than to be cared for as patients. As the stigma and hardships of the participants are related to lack of knowledge, health professionals should focus not just on clinical intervention but also on providing targeted educational programs and counseling for these women to dispel the stigma of the disease and to increase their quality of life.