• 제목/요약/키워드: structural epilepsy

검색결과 27건 처리시간 0.024초

Surgical Strategies in Patients with the Supplementary Sensorimotor Area Seizure

  • Oh, Young-Min;Koh, Eun-Jeong;Lee, Woo-Jong;Han, Jeong-Hoon;Choi, Ha-Young
    • Journal of Korean Neurosurgical Society
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    • 제40권5호
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    • pp.323-329
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    • 2006
  • Objective : This study was designed to analyze surgical strategies for patients with intractable supplementary sensorimotor area[SSMA] seizures. Methods : Seventeen patients who had surgical treatment were reviewed retrospectively. Preoperatively, phase I [non-invasive] and phase II [invasive] evaluation methods for epilepsy surgery were done. Seizure outcome was assessed with Engel's classification. The mean follow-up period was 27.2 months [from 12 months to 54 months]. Results : An MRI identified structural abnormality in eight patients and 3D-surface rendering revealed abnormal gyration in three. PET, SPECT, and surface EEG could not delineate the epileptogenic zone. Video-EEG monitoring with a subdural grid or depth electrodes verified the epileptogenic zone in all patients. Surgical procedures consisted of a resection of the SSMA and simultaneous callosotomy in two patients, a resection of the SSMA extending to the adjacent area in seven, a resection of a different area without a SSMA resection in seven, and a callosotomy in one. Seizure outcomes were class I in 11 [65%]. class II in five [29%], class III in one [6%]. Conclusion : In patients with intractable SSMA seizure, surgery was an excellent treatment modality. Precise delineation of the epileptogenic zone based on multimodal diagnostic methods can provide good surgical outcomes without neurological complications.

전측두엽 절제술시 해마체 절제 범위와 경련 예후 (The Seizure Outcome and Extent of Hippocampal Resection in Anterior Temporal Lobectomy)

  • 이완수;이정교;이상암;강중구;고태성
    • 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.

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마우스 간질 동물모델에서 소부혈 자침이 해마 치상회의 신경세포증식에 미치는 영향 (Acupuncture Stimulation to HT8 Enhances Cell Proliferation in Hippocampus on an Epilepsy Mouse Model)

  • 김승태;박해정;홍미숙;김승남;두아름;인창식;이혜정;정주호;박히준
    • Korean Journal of Acupuncture
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    • 제27권2호
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    • pp.49-56
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    • 2010
  • 목적 : 뇌의 신경세포 증식은 해마 치상회와 뇌실하영역에서만 나타나는 현상이다. Kainic acid(KA)를 이용한 간질 동물모델을 연구하던 중 침이 해마 치상회의 신경세포증식을 촉진하는 현상을 발견하여 이를 보고하고자 한다. 방법 : 수컷 ICR계 생쥐를 Saline(n=8), KA(n=8), KA+Acu(n=8)의 세 군으로 나누고, 모든 생쥐들에게 KA 주입 3일 전부터 1일 1회씩 5'-bromodeoxyuridine(BrdU)을 3일간 주입하였다. Saline군에는 멸균된 생리식염수를 뇌실 내에 주입하였고, KA군 및 KA+Acu군에는 $0.1{\mu}g$의 KA를 뇌실 내에 주입하였으며, KA+Acu군에 속한 쥐들에게는 KA 주입 2일전, 1일전, 주입 직후에 양쪽 소부(少府)(HT8)에 자침하였다. KA 주입 3시간 후 쥐의 뇌를 적출하고 해마 치상회부위의 BrdU 및 neuropeptide Y (NPY)의 발현을 측정하였다. 결과 : 소부(少府) 자침이 KA의 독성으로 인한 신경세포의 파괴를 줄여주었으며, BrdU 양성 세포 및 NPY를 유의하게 증가시켰다. KA 주입시 세포증식이 일어나긴 하나, 3시간 안에는 거의 일어나지 않는다. 결론 : 소부(少府) 자침이 해마 치상회의 신경세포증식을 촉진하며, 이는 KA의 효과가 아닌 KA 투여 전 소부(少府) 자침으로 인한 것으로 사료된다.

기질적 뇌병변에 의한 간질환자에서 수면이 간질파의 발생에 미치는 영향 : 통상적 뇌파 분석 (Effect of Sleep on Epileptiform Discharges in Epileptic Patients with Structural Lesion : Based on Routine EEG)

  • 이세진;하정상
    • Journal of Yeungnam Medical Science
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    • 제24권2호
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    • pp.107-118
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    • 2007
  • 기질적 뇌병변에 의한 부분 간질환자에서 수면이 간질파의 발생에 미치는 영향을 밝히기 위하여 본 연구를 시행하였다. 기질적 뇌병변에 의한 부분 간질환자 16명과 뇌병변이 없는 34명을 대상으로 50% 수면박탈 후에 통상적인 각성뇌파와 수면뇌파를 동시에 기록하였다. 각성 간질파 지수, 수면 간질파 지수 및 수면에 의한 간질파 지수의 증가율을 구한 후에 기질적 병변의 유무, 발작 및 간질의 종류, 야간 수면 발작의 유무, 이차적 전신성 발작의 유무, 항경련제의 복용 여부, 환자의 나이 및 간질의 발병 연령과 유병 기간에 따른 유의한 차이가 있는지 분석하였다. 1. NREM 수면 기간에 간질파의 발생이 유의하게 증가하였으나 기질적인 뇌병변의 유무에 따른 차이는 없었다(p<0.05). 2. 수면 기간 중 간질파의 증가는 이차적 전신발작의 빈도, 간질 및 발작의 종류, 야간 수면 발작의 빈도, 항경련제 복용에 따른 유의한 차이가 없었다. 3. 전체 50명 가운데 13명(26%) 에서는 수면 상태에서만 간질파가 관찰되었고, 1명(2%) 에서는 각성 상태에서만 간질파가 관찰되었다. 4. 대상 환자 50명 가운데 44명(88%)에서 수면 간질파 지수가 높았고, 5명(10%)에서는 각성 간질파 지수가 높았다(p<0.01). 이상의 결과로 볼 때 기질적 뇌병변을 가진 부분 간질환자에서 통상적인 외래 뇌파검사의 진단율을 높이고 간질파를 활성화시키기 위해서는 수면박탈 후에 각성 상태뿐만 아니라 NREM 수면 상태의 뇌파를 기록하여야 할 것이다.

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Neuronal injury in AIDS dementia: Potential treatment with NMDA open-channel blockers and nitric oxide-related species

  • Lipton, Stuart A.
    • 한국응용약물학회:학술대회논문집
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    • 한국응용약물학회 1996년도 춘계학술대회
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    • pp.19-29
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    • 1996
  • The neurological manifestations of AIDS include dementia, encountered even in the absence of opportunistic superinfection or malignancy. The AIDS Dementia Complex appears to be associated with several neuropathological abnormalities, including astrogliosis and neuronal injury or loss. How can HIV-1 result in neuronal damage if neurons themselves are only rarely, if ever, infected by the vitus\ulcorner In vitro experiments from several different laboratiories have lent support to the existence of HIV- and immune-related toxins. In one recently defined pathway to neuronal injury, HIV-infected macrophages/microglia as well as macrophages activated by HIV-1 envelope protein gp120 appear to secrete excitants/neurotoxins. These substances may include arachidonic acid, platelet-activating factor, free radicals (NO - and O$_2$), glutamate, quinolinate, cysteine, cytokines (TNF-${\alpha}$, IL1-B, IL-6), and as yet unidentified factors emanating from stimulated macrophages and possibly reactive astrocytes. A final common pathway for newonal suscepubility appears to be operative, similar to that observed in stroke, trauma, epilepsy, and several neurodegenerative diseases, including Huntington's disease, Parkinson's disease, and amyotrophic lateral sclerosis. This mechanism involves excessive activation of N-methyl-D-aspartate (NMDA) receptor-operated channels, with resultant excessive influx of Ca$\^$2+/ leading to neuronal damage, and thus offers hope for future pharmacological intervention. This chapter reviews two clinically-tolerated NMDA antagonists, memantine and nitroglycerin; (ⅰ) Memantine is an open-channel blocker of the NMDA-associated ion channel and a close congener of the anti-viral and anti-parkinsonian drug amantadine. Memantine blocks the effects of escalating levels of excitotoxins to a greater degree than lower (piysiological) levels of these excitatory amino acids, thus sparing to some extent normal neuronal function. (ⅱ) Niuoglycerin acts at a redox modulatory site of the NMDA receptor/complex to downregulate its activity. The neuroprotective action of nitroglycerin at this site is mediated by n chemical species related to nitric oxide, but in a higher oxidation state, resulting in transfer of an NO group to a critical cysteine on the NMDA receptor. Because of the clinical safety of these drugs, they have the potential for trials in humans. As the structural basis for redox modulation is further elucidated, it may become possible to design even better redox reactive reagents of chinical value. To this end, redox modulatory sites of NMDA receptors have begun to be characterized at a molecular level using site-directed mutagenesis of recombinant subunits (NMDAR1, NMDAR2A-D). Two types of redox modulation can be distinguished. The first type gives rise to a persistent change in the functional activity of the receptor, and we have identified two cysteine residues on the NMDARI subunit (#744 and #798) that are responsible for this action. A second site, presumably also a cysteine(s) because <1 mM N-ethylmaleimide can block its effect in native neurons, underlies the other, more transient redox action. It appears to be at this, as yet unidentified, site on the NMDA receptor that the NO group acts, at least in recombinant receptors.

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열다한소탕(熱多寒少湯)이 kainic acid에 의해 유발된 mouse의 해마체 손상에 미치는 영향 (Effects of Yuldahansotang after kainate administration in the mouse hippocampus area)

  • 김일환;김경요
    • 사상체질의학회지
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    • 제11권2호
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    • pp.283-299
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    • 1999
  • 1. 연구목적 kainic acid를 실험동물에 주입할 경우 간질발작을 일으키고 변연계 특히 해마체 부위에서 조직의 손상이 일어나게 되는데 이는 사람에 있어 측두엽성 간질에서 보이는 구조적 변화와 유사한 것이다. 본 실험은 신경독성 물질인 kainic acid로 마우스의 해마체에 손상을 유발하고 이 경우에 열다한소탕이 신경보호효과가 있는지의 여부를 알고자한 것이다. 2. 연구방법 kainic acid를 경구투여하고 열다한소탕을 3주일간 복용시키면서 각각 1, 2, 3일과 1주, 3주에 조직을 관찰하였다. 조직손상은 해마체의 CA1, CA3과 thalamus, amygdala 등에서 c-fos 와 DNA fragmentation의 출현 율로 지표를 삼았으며 광학현미경하에서 육안적 관찰을 병행하였다. 3. 결과 및 결론 kainic acid만을 투여한 대조 군에서는 실험 3주째에도 손상지표인 c-fos 와 DNA fragmentation이 발견되었으나 열다한소탕을 투여한 실험 군에서는 실험 약 3일 째부터 손상지표의 발현이 줄어 7일째에는 나타나지 않음을 알 수 있었다. 또한 현미경 하의 육안적 관찰에서도 실험초기 많은 손상을 보였던 신경세포가 2주일 후 어느 정도 회복되는 것을 볼 수 있었다. 이로써 열다한소탕이 kainic acid로 유발된 실험동물의 해마체손상에 대하여 신경세포 보호 효과 및 손상 억제 효과가 있음을 알 수 있었다.

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가바펜틴 400밀리그람 캡슐의 생물학적동등성시험 (Bioequivalence Test of Gabapentin 400 mg Capsules)

  • 김세미;강현아;조혜영;신새벽;류희두;윤화;이용복
    • 약학회지
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    • 제52권3호
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    • pp.195-200
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    • 2008
  • Gabapentin, [1-(aminomethyl) cyclohexaneacetic acid], a structural analog of $\gamma$-aminobutyric acid (GABA), is being developed for the treatment of epilepsy. Unlike GABA, gabapentin crosses the blood-brain barrier after systemic administration. Gabapentin is an effective antiepileptic drug in patients with partial and secondarily generalized seizures who are uncontrolled with use of existing anticonvulsant drug therapy. The purpose of the present study was to evaluate the bioequivalence of two gabapentin 400 mg capsules, $Neurontin^{(R)}$ capsule 400 mg (Pfizer Inc.) and Gabatin capsule 400 mg (Korean Drug Co. Ltd), according to the guidelines of the Korea Food and Drug Administration (KFDA). The release of gabapentin from the two gabapentin formulations in vitro was tested using KP VIII Apparatus II method with various dissolution media (pH 1.2, 4.0, 6.8 buffer solution and water). Twenty six healthy male subjects, 23.58$\pm$1.50 years in age and 66.74$\pm$8.31 kg in body weight, were divided into two groups and a randomized 2$\times$2 cross-over study was employed. After one capsule containing 400 mg as gabapentin were orally administered, blood was taken at predetermined time intervals and the concentrations of gabapentin in serum were determined using HPLC with fluorescence detector. The dissolution profiles of two formulations were similar at all dissolution media. In addition, the pharmacokinetic parameters such as $AUC_t$, $C_{max}$ and $T_{max}$ were calculated and ANOVA test was utilized for the statistical analysis of the parameters using logarithmically transformed $AUC_t$, $C_{max}$ and untransformed $T_{max}$. The results showed that the differences between two formulations based on the reference drug, $Neurontin^{(R)}$ capsule 400 mg, were 2.04, -3.68 and 16.79% for $AUC_t$, $C_{max}$ and $T_{max}$, respectively. There were no sequence effects between two formulations in these parameters. The 90% confidence intervals using logarithmically transformed data were within the acceptance range of log 0.8 to log 1.25 (e.g., log 0.91$\sim$log 1.16 and log 0.87$\sim$log 1.11 for $AUC_t$ and $C_{max}$, respectively). Thus, the criteria of the KFDA bioequivalence guideline were satisfied, indicating Gabatin capsule 400 mg was bioequivalent to $Neurontin^{(R)}$ capsule 400 mg.