• 제목/요약/키워드: status epilepticus

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Controversies in Usefulness of EEG for Clinical Decision in Epilepsy: Pros. (간질 치료에서 뇌파의 임상적 유용성에 관한 논란: 긍정적 관점에서)

  • Shon, Young-Min;Kim, Yeong In
    • Annals of Clinical Neurophysiology
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    • v.9 no.2
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    • pp.63-68
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    • 2007
  • The EEG plays an important diagnostic role in epilepsy and provides supporting evidence of a seizure disorder as well as assisting with classification of seizures and epilepsy syndromes. There are a variety of electroclinical syndromes that are really defined by the EEG such as Lennox-Gastaut syndrome, benign rolandic epilepsy, childhood absence epilepsy, juvenile myoclonic epilepsy and also for localization purposes, it is vitally important especially for temporal lobe epilepsy. The sensitivity of first routine EEG in diagnosis of epilepsy has been known about 20-50%, but this proportion rises to 80-90% if sleep EEG and repetitive recording should be added. Convincing evidences suggest that the EEG may also provide useful prognostic information regarding seizure recurrence after a single unprovoked attack and following antiepileptic drug (AED) withdrawal. Moreover, patterns in the EEG make it possible to disclose an ictal feature of nonconvulsive status epilepticus, separate epileptic from other non-epileptic episodes and clarify the clues predictive of the cause of the encephalopathy (i.e., triphasic waves in metabolic encephalopathy). Therefore, regardless of its low sensitivity and other pitfalls, EEG should be considered not only in the situation of new onset episode such as a newly developed, unprovoked seizure or a condition manifesting decreased mentality from obscure origin, but also as a barometer of the long-term outcome following AED withdrawal.

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Muscular and collagenous cerebellar choristoma in a dog

  • Ripplinger, Angel;de Melo, Stella Maris Pereira;Ferrarin, Denis Antonio;Schwab, Marcelo Luis;Wrzesinski, Mathias Reginatto;Rauber, Julia da Silva;Flores, Mariana Martins;Kommers, Glaucia Denise;Mazzanti, Alexandre
    • Journal of Veterinary Science
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    • v.23 no.2
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    • pp.30.1-30.6
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    • 2022
  • This report aims to describe the first case of muscular and collagenous choristoma in a dog. A 10-yr-old female mixed-breed dog presented with lateral recumbence, vocalization, positional vertical nystagmus, divergent strabismus, anisocoria, and status epilepticus. The clinical condition evolved to stupor and ultimately, death. Necropsy revealed a white mass causing an irregular increase in the volume of the cerebellar vermis. In histological analysis, a well circumscribed, unencapsulated mass was observed in the cerebellum, consisting of fibers of striated skeletal muscle and collagen fibers, mostly mineralized. Based on the histopathological and histochemical findings, a diagnosis of muscular and collagenous cerebellar choristoma was made.

Neurotoxicity by Cefepime: Case-Control Study (Cefepime에 의해 발생한 신경독성에 관한 환자대조군연구)

  • Kang, Joong Koo;Kim, Soon Bae
    • Journal of Neurocritical Care
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    • v.7 no.2
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    • pp.104-110
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    • 2014
  • Background: Cefepime is a fourth-generation cephalosporin widely used for empiric treatment of severe infections. Neurotoxicity by cefepime have been reported due to γ-aminobutyric acid A receptor inhibition or other mechanisms. The aim of this study was to evaluate the risk factors for cefepime-induced neurotoxicity between group showing cefepime-induced neurotoxicity and group without neurotoxicity. Methods: From Jan 2005 to June 2010, a total of 2,461 patients (older than 20) who used cefepime were considered in this study. We compared patients who developed cefepime-induced neurotoxicity (patient group, n=21) to patients who had no cefepime-induced neurotoxicity (control group, n=31). We analyzed demographic, underlying diseases, and metabolic parameters before cefepime treatment and during cefepime treatment between the two groups. Statistical analysis was performed using SPSS 18 software. Results: Of the total 2461 patients, 21 (0.85%) were diagnosed with cefepime-induced neurotoxicity. Impaired glomerular filtration rate (GFR at 15-30 ml/min) before cefepime use were significantly (P<0.05) higher risk for developing cefepime-induced neurotoxicity in patient group compared to that in the control group. Age, sex, and other metabolic parameters except GFR before and during, usage of cefepime did not show any statistical difference between the two groups. Conclusion: The present study revealed that cefepime-induced neurotoxicity was prone to develop in patients with impaired renal function before cefepime usage.

Ginsenosides Inhibit NMDA Receptor-Mediated Epileptic Discharges in Cultured Hippocampal Neurons

  • Kim, Sun-Oh;Rhim, Hye-Whon
    • Archives of Pharmacal Research
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    • v.27 no.5
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    • pp.524-530
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    • 2004
  • Epilepsy or the occurrence of spontaneous recurrent epileptiform discharges (SREDs, seizures) is one of the most common neurological disorders. Shift in the balance of brain between excitatory and inhibitory functions due to different types of structural or functional alterations may cause epileptiform discharges. N-Methyl-D-aspartate (NMDA) receptor dysfunctions have been implicated in modulating seizure activities. Seizures and epilepsy are clearly dependent on elevated intracellular calcium concentration ([C $a^{2+}$]$_{i}$ ) by NMDA receptor activation and can be prevented by NMDA antagonists. This perturbed [C $a^{2+}$]$_{i}$ levels is forerunner of neuronal death. However, therapeutic tools of elevated [C $a^{2+}$]$_{i}$ level during status epilepticus (SE) and SREDs have not been discovered yet. Our previous study showed fast inhibition of ginseng total saponins and ginsenoside R $g_3$ on NMDA receptor-mediated [C $a^{2+}$]$_{i}$ in cultured hippocampal neurons. We, therefore, examined the direct modulation of ginseng on hippocampal neuronal culture model of epilepsy using fura-2-based digital $Ca^{2+}$ imaging and neuronal viability assays. We found that ginseng total saponins and ginsenoside R $g_3$ inhibited $Mg^{2+}$ free-induced increase of [C $a^{2+}$]$_{i}$ and spontaneous [C $a^{2+}$]$_{i}$ oscillations in cultured rat hippocampal neurons. These results suggest that ginseng may playa neuroprotective role in perturbed homeostasis of [C $a^{2+}$]$_{i}$ and neuronal cell death via the inhibition of NMDA receptor-induced SE or SREDs.d SE or SREDs..

Simple Digital EEG System Utilizing Analog EEG Machine (아날로그 뇌파기를 응용한 간단한 디지털 뇌파 시스템)

  • Jung, Ki-Young;Kim, Jae-Moon;Jung, Man-Jae
    • Annals of Clinical Neurophysiology
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    • v.2 no.1
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    • pp.8-12
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    • 2000
  • Purpose : The rapid development and wide popularity of Digital EEG(DEEG) is due to its convenience, accuracy and applicability for quantitative analysis. These advantages of DEEG make one hesitate to use analog EEG(AEEG). To assess the advantage of DEEG system utilizing AEEG(DAEEG) over conventional AEEG and the clinical applicability, a DAEEG system was developed and applied to animal model Methods : Sprague-Dawley rat as status epilepticus model were used for collecting the EEG data. After four epidural electrodes were inserted and connected to 8-channel analog EEG(Nihon-Kohden, Japan), continous. EEG monitoring via computer screen was done from two rats simultaneously. EEG signals through analog amplifier and filters were digitized at digital signal processor and stored in Windows-based pentium personal computer. Digital data were sampled at a rate of 200 Hz and 12 bit of resolution. Acquisition software was able to carry out 'real-time view, sensitivity control and event marking' during continuous EEG monitoring. Digital data were stored on hard disk and hacked-up on CD-ROM for off-line review. Review system consisted of off-line review, saving and printing out interesting segment and annotation function. Results: This DAEEG system could utilize most major functions of DEEG sufficiently while making a use of an AEEG. It was easy to monitor continuously compared to Conventional AEEG and to control sensitivity during ictal period. Marking the event such as a clinical seizure or drug injection was less favorable than AEEG due to slowed processing speed of digital processor and central processing unit. Reviewing EEG data was convenient, but paging speed was slow. Storage and management of data was handy and economical. Conclusion : Relatively simple digital EEG system utilizing AEEG can be set-up at n laboratory level. It may be possible to make an application for clinical purposes.

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Effects of Ethosuximide on the Pilocarpine Induced Seizure in Rat Model of Neuronal Migration Disorder

  • Kim, Byung-Kon;Choi, In-Sun;Cho, Jin-Hwa;Jang, Il-Sung;Lee, Maan-Gee;Choi, Byung-Ju
    • The Korean Journal of Physiology and Pharmacology
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    • v.10 no.5
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    • pp.235-242
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    • 2006
  • Cortical malformation-associated epileptic seizures are resistant to conventional anticonvulsant drugs. Relatively little research has been conducted on the effects of antiepileptic drugs (AEDs) on seizure activity in a rat model of dysplasia. We have used rats exposed to methylazoxymethanol acetate (MAM) in utero, an animal model featuring nodular heterotopia, to investigate the effects of ethosuximide (ETX) in the dysplastic brain. Pilocarpine was used to induce acute seizure in MAM-exposed and age-matched vehicle-injected control animals. Field potential recordings were used to monitor the amplitude and number of population spikes, and paired pulse inhibition in response to stimulation of the commissural pathway. Pharmaco-resistance was tested by measuring seizure latencies after pilocarpine administration (320 mg/kg, Lp.) with and without pre-treatment with ETX. Pre-treatment with 300 mg of ETX significantly prolonged the latency to the status epilepticus (SE) in both control and MAM-treated groups. Pre-treatment with ETX 100mg and ETX 200 mg had little effect in MAMexposed rats. However, ETX 200 mg prolonged the latency to the SE in control groups. Spontaneous field potential and secondary after-discharges were higher for MAM-treated rat in comparison with control rats injects with ETX. The main findings of this study are that acute seizures initiated in MAM-exposed rats are relatively resistant to standard ETX assessed in vivo. These data suggest that ETX do not prolong seizure latencies in MAM-rats exposed to pilocarpine.

DEVELOPMENTAL DISTURBANCE OF PRIMARY INCISORS IN PRETERM INFANTS WITH ENDOTRACHEAL INTUBATION : A CASE REPORT (기관 삽관을 시행한 조산아에서 발생한 상악 유전치의 발육이상 : 증례보고)

  • Lim, So Young;Kim, Seong Oh;Lee, Jae-Ho;Kim, Ik Hwan
    • The Journal of Korea Assosiation for Disability and Oral Health
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    • v.15 no.1
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    • pp.89-93
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    • 2019
  • Preterm infants have higher possibility of undergoing endotracheal intubation after birth than normal children due to medical conditions. Developmental disturbances of primary incisors following intubation can occur as crown malformation, enamel defects, delayed eruption, displacement of dental follicle in crypt, groove formation of palate or alveolar ridge, acquired cleft palate, and dental arch distortion. This clinical report presents the effect of intubation on primary dentition of preterm infants. A 2-year-old girl with cerebral palsy and premature birth history visited our clinic with chief complaint of unerupted primary upper incisor. A 1-year-old boy with cerebral palsy, status epilepticus and premature birth history visited our clinic due to crown malformation. Developmental disturbances of primary incisors in these cases were not related to the patients' systemic disease, and there were no history of dental trauma. A long term endotracheal intubation prior to tooth eruption might have caused local trauma on alveolar ridge. It is very important to monitor dental problems of preterm infants who had experienced endotracheal intubation during neonatal period. Due to influences on both primary and permanent teeth, periodic re-evaluation of affected areas and establishment of comprehensive treatment plans are necessary.

Antiepileptic and anti-neuroinflammatory effects of red ginseng in an intrahippocampal kainic acid model of temporal lobe epilepsy demonstrated by electroencephalography

  • Kim, Ju Young;Kim, Jin Hyeon;Lee, Hee Jin;Kim, Sang Hoon;Jung, Young Jin;Lee, Hee-Young;Kim, Hee Jaung;Kim, Sae Yoon
    • 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.

Therapeutic effects of stiripentol against ischemia-reperfusion injury in gerbils focusing on cognitive deficit, neuronal death, astrocyte damage and blood brain barrier leakage in the hippocampus

  • Shin, Myoung Cheol;Lee, Tae-Kyeong;Lee, Jae-Chul;Kim, Hyung Il;Park, Chan Woo;Cho, Jun Hwi;Kim, Dae Won;Ahn, Ji Hyeon;Won, Moo-Ho;Lee, Choong-Hyun
    • The Korean Journal of Physiology and Pharmacology
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    • v.26 no.1
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    • pp.47-57
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    • 2022
  • Stiripentol is an anti-epileptic drug for the treating of refractory status epilepticus. It has been reported that stiripentol can attenuate seizure severity and reduce seizure-induced neuronal damage in animal models of epilepsy. The objective of the present study was to investigate effects of post-treatment with stiripentol on cognitive deficit and neuronal damage in the cornu ammonis 1 (CA1) region of the hippocampus proper following transient ischemia in the forebrain of gerbils. To evaluate ischemia-induced cognitive impairments, passive avoidance test and 8-arm radial maze test were performed. It was found that post-treatment with stiripentol at 20 mg/kg, but not 10 or 15 mg/kg, reduced ischemia-induced memory impairment. Transient ischemia-induced neuronal death in the CA1 region was also significantly attenuated only by 20 mg/kg stiripentol treatment after transient ischemia. In addition, 20 mg/kg stiripentol treatment significantly decreased ischemia-induced astrocyte damage and immunoglobulin G leakage. In brief, stiripentol treatment after transient ischemia ameliorated transient ischemia-induced cognitive impairment in gerbils, showing that pyramidal neurons were protected and astrocyte damage and blood brain barrier leakage were significantly attenuated in the hippocampus. Results of this study suggest stiripentol can be developed as a candidate of therapeutic drug for ischemic stroke.

A Case Report of Central Nervous System Disorder Induced Intractable Hiccups Treated with Korean Medicine (중추신경계 질환자에게 이환된 난치성 딸꾹질의 한방치험1례)

  • Moon, Jiseong;Min, Seonwoo;Kim, Yeseul;Park, Jiyoon;Hong, Junghwa;Choi, Dong-jun
    • The Journal of Internal Korean Medicine
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    • v.43 no.2
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    • pp.191-200
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    • 2022
  • Intractable hiccups are those which persist for more than one month and can often occur in patients with disorders of the central nervous system, such as stroke, epilepsy, or brain tumor. An 80-year-old male patient undergoing conservative hemodialysis for diabetic nephropathy, recently developed paralysis and dysphagia due to central nervous system complications including stroke and epilepsy. He was admitted to the ◯◯ Oriental Medicine Hospital, and treated with herbal medicine (Gyulpijugyeo-tang, Jeonssiigong-san, and Ijin-tang) and electrical acupuncture for 30 days. No side effects were observed during hospitalization. The frequency and duration of hiccups were measured daily and found to reduce, and the effect persisted during his admission. The patient took no other nervous system drugs. In conclusion, Korean medicine like gyulpijugyeo-tang and acupuncture can be effective for patients with intractable hiccups who cannot use alternative drugs or treatment, because of other complications.