• Clinical and Experimental Pediatrics
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• v.53 no.4
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• pp.571-578
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• 2010

Purpose : To evaluate the efficacy and safety of levetiracetam adjunctive therapy for reducing the rate of seizure frequency in children with intractable pediatric epilepsy. Methods : We reviewed the medical records of 86 patients with intractable pediatric epilepsy who visited our hospital between March 1989 and February 2009. Levetiracetam was included in the previous anticonvulsant regimen for at least 6 months and the reduction in the rate of seizure frequency was determined in follow-up examinations. We analyzed demographic data, seizure types, antiepileptic drug history, levetiracetam dose, adverse effects of levetiracetam therapy, treatment outcome, electroencephalogram findings, etc. Results : More than 50% reduction in the seizure frequency was observed in 62 of the 86 (72.1%) patients; 44 patients (51.1%) became seizure free, while the seizure frequency increased in 5.8% patients. The associations between seizure reduction rate and age, associated diseases, seizure types, and seizure frequency before treatment were not significant. However, the duration of disease, dose of levetiracetam, duration and frequency of anticonvulsant administration before levetiracetam therapy were significantly correlated. Electroencephalogram findings and the cause of epilepsy showed partial correlation. Forty (46%) patients showed adverse symptoms; the symptoms in the order of their frequency were somnolence, hyperactivity, irritability, aggressiveness, tiredness, etc. Conclusion : The findings of our study provide the evidence that levetiracetam adjunctive therapy is efficacious and well tolerated in various refractory childhood epilepsy cases.

• Korean Journal of Clinical Laboratory Science
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• v.48 no.4
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• pp.388-393
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• 2016

Epilepsy, characterized by enduring the predisposition to generate epileptic seizures, was conceptually defined in 2005 as a disorder of the brain. According to the international league against epilepsy in 2014 that there is a high risk of recurrence within 10 years. The existence of interictal epileptiform discharges (IEDs) at the Electroencephalography (EEG) is an important risk factor for a possible recurrence of seizures, disproving that the seizures may increase. The purpose of this study was to analyze the correlation between recurrent seizures and epilepsy EEG findings in patients with IEDs, which was carried out to serve as the basis for the EEG to predict the prognosis of patients with epilepsy. This study included 432 adults older than 20 years of age who care for patients with epilepsy at Seoul National University Hospital, between June 2007 and December 2010. The results showed no difference between men and women in the EEG epilepsy disease, but there was a difference between various age groups. Correlation analysis showed a negative correlation between recurrence of seizures and age; it showed a positive correlation between recurrence and IEDs. In addition, age was associated with a predictive power of 10.9% and IEDs showed a predictive power of 15% on recurrent seizures. Therefore, EEG is considered as a very important test in epilepsy diagnosis. Therefore, further studies are necessary on the relationship between seizure recurrence and EEG.

• Clinical and Experimental Pediatrics
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• v.50 no.7
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• pp.672-677
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• 2007

Purpose : To assess the prevalence and characteristics of headache comorbidity with epilepsy in children and adolescents in a specialty epilepsy clinic. Methods : Two hundred twenty nine consecutive patients attending the Chosun University Hospital Pediatric Epilepsy Clinic (mean age $10.0{\pm}4.1\;years$, range 4-17, M:F ratio 1.1:1.0) were interviewed with a standardized headache questionnaire. Headache was classified according to the International Classification of Headache Disorders, 2nd Edition and epilepsy was classified according to the International League Against Epilepsy. Disability was assessed using pediatric migraine disability assessment (PedMIDAS). Results : Of the 229 epilepsy patients, 86 (37.6%) had co-morbid headache. Of the headache patients, 64 (74.4%) had migraine (65.6%- migraine without aura, 20.3% - migraine with aura, 14.1% - probable migraine). The mean headache frequency was $7.2{\pm}8.4$ per month, mean duration was $2.2{\pm}4.0$ hours, mean severity was $5.2{\pm}2.2$ out of 10, and mean PedMIDAS score was $13.0{\pm}35.4$. The proportion of females was not higher in epilepsy with headache patients (48.8%) compared to epilepsy patients alone (48.0%). In the patients with migraine, 48.4% had complex partial seizures, 17.2% had simple partial seizures, and 34.4% had generalized seizures (P=0.368). A postictal association of migraine was reported in 18.8% with 17.2% reporting a preictal headache, and 7.8% reporting an ictal headache. Conclusion : The prevalence of headache in pediatric epilepsy is higher than that in general pediatric population, suggesting a co-morbidity of headache in epilepsy patients with migraine being the most frequent headache disorder. Altered cerebral excitability resulting in an increased occurrence of spreading depression may explain the headache comorbidity with epilepsy. Further studies are needed to assess the etiology of this co-morbidity as well as assess the frequency, duration, severity and disability response to antiepileptic drugs.

• Journal of Acupuncture Research
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• v.24 no.5
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• pp.185-195
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• 2007

목적 : 부신피질 스테로이드약을 포함한 약물치료에도 조절되지 않았던 기관지천식 환자 6 증례에 대하여 침구치료를 행하여，연구방법의 하나인 조건반전법(N-of-1)을 이용하여 침치료의 효과를 검토하였다. 방법 : 연구디자인 : 조건반전법으로 침치료 기간(A기간)과 침치료 휴지기간(B기간)을 서로 반복하였다. A기간은 10주간으로 하고 1주간에 1회의 침치료를행하였다. 실시장소 : 메이지 침구대학부속병원 내과와 부속침구센터 대상 : 기관지천식의 표준적인 약물치료를 행하여도 천식발작이 충분히 개선되지 않았던 중등증에서 중증의 천식환자 6 증례를 대상으로 하였다. 평가 기관치천식에 대한 침치료의 효과를 아래의 항목을 이용하여 평가하였다. (1) 발작상태를 천식일지에 의해 평가 (2) 호흡곤란감을 VAS(Visual Analogue Scale)에 의해 평가 (3) 호흡기능검사 (4) 말초혈호산구수 (5) 스테로이드약의 투여량 (6) 중증도 효과 : A기간에 동시적으로 모든 예에서 천식발작과 호흡곤란감의 개선이 인정되었다. 한편 B기간에서는 6례 중 5례에서 천식발작의 재연이 확인되었다. 또한 천식발작의 개선에 수반하여 모든 예에서 중증도의 개선도 인정되었으며，6례 중 4례에서 스테로이드약의 감량이 가능하게 되었다. 결론 : 약물치료로 조절되지 않았던 기관지천식 환자에 대하여 침치료를 행한 결과, 환자의 천식발작, 자각증상, 호흡기능의 개선에 유효하였다고 생각된다.

• Clinical and Experimental Pediatrics
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• v.48 no.11
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• pp.1225-1231
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• 2005

Purpose : This study compares the first epileptic seizures between preterm and term-born children with periventricular leukomalacia and epilepsy. Methods : From 108 cases having lesions of high signal intensity around the ventricles in T2 weighted imaging of a brain magnetic resonance study, we selected 37 cases that showed epileptic seizures two times or more and divided them into the group of preterm-born(27 cases) and term-born children(10 cases). A retrospective study was made by comparing the two groups with regard to age, type of the first epileptic seizures, EEG findings and responsiveness to anticonvulsants. Results : The age of the first epileptic seizure was $22.2{\pm}18.3$ months in the preterm-born group and $26.9{\pm}21.1$ months in the term-born group(P=0.505). As for the first epileptic seizure, 11 out of the 27 cases in the preterm-born group had infantile spasms. Out of the 10 cases in the term-born group, 7 had complex partial seizures. In the preterm group, hypsarrhythmias were found in 11 cases, focal epileptiform discharges in 6 cases. In term-born group, focal epileptiform discharges were found in 5 cases but no epileptiform discharge was found in 3 cases. Intractable epilepsies were diagnosed in 6 cases and all of them belonged to the preterm-born group. Conclusion : More severe epilepsies such as infantile spasm and intractable epilepsies seem to be more common in preterm-born epileptic children with PVL as well as more severely abnormal EEG finding compared to term-born epileptic children.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.11 no.1
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• pp.144-149
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• 2000

A psychogenic seizure is a disorder which is occasionally met by neurologists and psychiatrists. The most important thing that clinicians should do is differential diagnosis with true epileptic seizures. Especially psychiatrists are expected to be able to diagnose psychogenic seizures through a thorough history taking and an observation of clinical features to some degree before the confirmatory diagnoses. We experienced a case of 11-year-old girl with psychogenic seizure which was characterized by obvious psychological and environmental stress, clinical features, and good outcome by prompt a loboratoy examination and psychiatric intervention. To diagnose and treat childhood psychogenic seizures, we suggest that it is very important to examine the familial background and take a thorough history, and perform psychoeducational intervention in addition to electroencephalogram.

• Clinics in Shoulder and Elbow
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• v.12 no.1
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• pp.98-101
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• 2009

Purpose: These case reports have been prepared to highlight the uncommon occurrence of anterior shoulder dislocation after an epileptic seizure, the recognition of which is important as this type of injury is associated with bony lesions and a high incidence of recurrence. Materials and Methods: We report two cases of recurrent anterior dislocation of the shoulder due to grand mal epilepsy. These cases were treated as usual anterior dislocations of the shoulder, and were regularly followed to detect any recurrence of shoulder instability. Results: Outcome of the surgery in the two cases was different because of the differences in seizure control. In the patient in whom seizures were well-controlled, there was no recurrence of instability, while the patient with poorly controlled seizures developed a recurrence of the dislocation following shoulder repair. Conclusion: The authors emphasize the need to control seizures in order to prevent injury recurrence in this subset of patients.

• Journal of Korean Neurosurgical Society
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• v.30 no.6
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• pp.705-710
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• 2001

Objective : Postoperative seizure is a well documented complication of aneurysm surgery. The purpose of the present study was to analyze risk factors for postoperative seizure. Methods : Between January 1990 and December 1996, we performed craniotomy for ruptured cerebral aneurysms in 321 patients. Among them 206 patients who could be followed up for more than 1 year(range, 1 to 4.6 years) were enrolled to present study. All patients were treated with anticonvulsants for 3 to 18 months postoperatively. We analyze the incidence of postoperative seizure in different sex and age groups, and risk factors associated with postoperative seizures following aneurysm rupture. For statistical processing chi-square test and Fisher's exact test were used. Results : In the follow-up period of 1 to 4.6 years(mean, 1.8 years) postoperative seizure appeared in 18 out of 206 patients(8.7%). Mean latency between the operation and the first seizure was 6 months(range, 3 weeks to 18 months). The age of the patients has significant influence on the risk of seizure, it occurred more often in younger patients(p =0.0014). Aneurysm location in the MCA was associated with a significantly a higher risk of seizure(p = 0.042). Eight patients(19%) out of 42 patients who suffered delayed ischemic neurologic deficit(DID) developed seizure. Delayed ischemic neurologic deficit was associated with significantly a higher risk of seizure(p =0.019). Infarct and hypertension were associated with significantly a higher risk of seizure(p <0.05). pre- or postoperative intracranial hematoma(intracerebral or epidural hematoma) was associated with significantly a higher risk of seizure(p <0.0001). H-H grade, Fisher grade, Glasgow Outcome Scale of patients and timing of operation after subarachnoid hemorrhage had no significant relation with the risk of seizure. Conclusion : Factors associated with the development of postoperative seizure were middle cerebral artery aneurysm, delayed ischemic neurologic deficit, infarct on late postoperative CT scan, hypertension, pre or postoperative intracranial hematoma(intracerebral or epidural hematoma). Identification of the risk factors may be help to focus the antiepileptic drug threapy in cases prone to develop seizures. Prospective evaluation is indicated.

• Clinical and Experimental Pediatrics
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• v.51 no.3
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• pp.286-292
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• 2008

Purpose : We performed EEG and PET on children with epilepsy concomitantly in order to evaluate the effects of epileptiform and non-epileptiform discharge of EEG on glucose metabolism. Methods : Seventy three children with epilepsy who had PET and EEG simultaneously were included in our study. The subjects were classified in two ways: (1) based on the frequency of epileptiform discharge and (2) the severity of non-epileptiform discharge. We evaluated the clinical aspects of their seizures, the severity of focal slow waves during the interictal period with the frequency of spikes or sharp waves in order to compare with the PET results. Results : The subjects were divided by the frequency of epileptiform discharge, with 13 in the no/rare group, 7 in the occasional group, and 53 children in the frequent group. The concordant rates with PET in each group were 0%, 42.9%, and 67.9%, respectively, showing high correlations with the frequency of epileptiform discharge (P<0.05, r=0.491). The subjects as divided by the severity of non-epileptiform discharge were 15 in the no group, 25 in the infrequent group, 17 in the intermediate group, and 16 in the continuous group. The concurrence rates with PET for each group were 13.3%, 52.0%, 64.7%, and 68.8%, respectively, also showing a high correlation with the severity of non-epileptiform discharge (P<0.05, r= 0.365). Conclusion : Epileptiform discharge and non-epileptiform discharge in EEG showed a certain association with hypometabolism in PET. We recommend EEG to reduce false lateralization and to localize lesions in cases of high frequency and severity.

• Investigative Magnetic Resonance Imaging
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• v.17 no.4
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• pp.312-315
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• 2013

When cerebral cortical hyperintensities on diffusion-weighted image are seen in patients with suspected acute stroke accompanying seizure, it is necessary to differentiate whether they are caused by infarction or seizure-related change. We report a case of seizure-related cortical hypertensities in a patient with suspected acute infarction. With perfusion MR imaging, we could differentiate from acute infarction.