• Korean Journal of Clinical Laboratory Science
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• v.49 no.3
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• pp.294-299
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• 2017

The aim of this study was to detect the status of epilepticus and seizure based on the initial patterns observed in the first 30 minutes of continuous electroencephalogram (cEEG) monitoring. An cEEG was recorded digitally using electrodes applied according to the International 10~20 System. The EEG data were reviewed from January 2014 to December 2015. The baselines of the EEG patterns were characterized by lateralized periodic discharges, generalized periodic discharges, burst suppression, focal epileptiform, asymmetric background, generalized slowing, and generalized periodic discharges with a triphagic wave. The etiology was classified into five categories. The subjects of this study were 128 patients (age: $56.9{\pm}17.5years$, male:female, 74:54). The mean cEEG monitoring duration was $5.5{\pm}5.1$ (min:max, 1:33) days. The EEG pattern categories included lateralized periodic discharges (N=7), generalized periodic discharges (N=10), burst suppression (N=6), focal epileptiform (N=19), asymmetric background (N=24), generalized slowing (N=51), and generalized periodic discharges with a triphagic wave (N=11). The etiological classifications of the patients with status epilepticus were remote symptomatic (N=4), remote symptomatic with acute precipitant (N=9), acute symptomatic (N=6), progressive encephalopathy (N=2), and febrile seizure (N=1). cEEG monitoring was found to be useful for the diagnosis of non-convulsive epileptic seizures or status epilepticus. The seizure was confirmed by the EEG pattern.

• Clinical and Experimental Pediatrics
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• v.50 no.9
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• pp.891-895
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• 2007

Purpose : Acute disseminated encephalomyelitis (ADEM) is a demyelinating disease of the central nervous system and mostly develops after viral illness or vaccinations. We investigated the clinical differences and neurologic outcomes according to the distribution of the lesions on brain MRI. Methods : The study group was composed of 21 patients from January 1995 to August 2003 in Kyunghee University hospital. We grouped the patients according to the MRI findings as follows. Group I (14 cases): Multi- or unifocal lesions only in the cerebral white matter. Group II (7 cases): lesions in the gray matter with or without white matter involvement. Results : 1. Preceding events were as follows: no defined prodrome (38.1%), upper respiratory tract infection (28.6%), nonspecific febrile illness (19.0%), gastointestinal disturbance and vaccination. 2. Presenting symptoms were as follows: seizures (76.2%), headache/vomiting (47.6%), altered consciousness (38.1%), hemiparesis, cerebellar ataxia, visual disturbance and facial nerve palsy. 3. Laboratory findings were as follows: CSF pleocytosis (76.2%), leucocytosis (38.1%) and elevated CSF protein (28.6%). 4. Fifteen patients were recovered completely without neurological sequelae. Three patients in group I and 1 patient in group II had intractable seizures. Two patients in group I and 2 patients in group II had motor disturbance. Conclusion : There were no statistically significant differences in preceding events, presenting symptoms, and neurological outcomes according to the distribution of the lesions on brain MRI. However, the ADEM have quite diverse clinical manifestations and neuroimage findings. MRI plays an important role in making diagnosis of the patients who are suspected of ADEM.

• Journal of the Korean Child Neurology Society
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• v.26 no.4
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• pp.205-209
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• 2018

Purpose: Several studies have shown that magnesium plays an important role in modulating N-methyl-D-aspartate (NMDA)-related seizures by blocking NMDA ion channel receptors. Clinicians usually measure total serum magnesium levels instead of biologically active ionized magnesium levels. We compared the serum ionized magnesium ($iMg^{2+}$) level between epileptic children with and without a history of fever-triggered seizure (FTS). Methods: All epileptic children who visited the outpatient clinic or pediatric emergency department at Korea University Guro Hospital between January 2015 and July 2017 were included. Only epileptic children aged 1-8 years who were newly diagnosed within 2 years were included. Results: There were 12 children with FTS and 16 without FTS. Median serum $iMg^{2+}$ level was 0.93 (0.85-1.14, quartile) mEq/L. Serum $iMg^{2+}$ level was significantly lower in epileptic children with FTS (0.86 mEq/L) compared to those without FTS (1.10 mEq/L) (P=0.005). No difference was noted in clinical variables between the two groups. Lower serum $iMg^{2+}$ level significantly increased the risk of having FTS in epileptic children based on multivariable logistic regression analysis (odds ratio [OR]=0.028). Conclusion: Serum $iMg^{2+}$ level was significantly lower in epileptic children with FTS than in those without FTS. Measurement of biologically active serum $iMg^{2+}$ level could be considered in epileptic children with recurrent FTS. A large-scale prospective study is warranted.

• Clinical and Experimental Pediatrics
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• v.46 no.10
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• pp.1008-1012
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• 2003

Purpose : We aimed to ascertain whether lumbar punctures should be done to prove febrile seizure, and to study what conditions can delay or abolish lumbar puncture. Methods : This retrospective study was done for four years, from January, 1996 to December, 1999. The subjects were the patients who visited Masan Samsung Hospital for the first convulsion with fever, and whose age ranged from 1-month to 5-years old. The total number of patients was 197. We investigated the rate of meningitis, which was classified by age, season, convulsion type, associated symptoms, and results of blood test. All data were tested chi-square. Results : The diagnosis rate of meningitis among all 197 patients was 7.6%, and of these only one patient was proved to have bacterial meningitis. The rate was high in the young(below 6 month), in males and in summer and autumn. Although the general appearance was good after resolution of the fever, the rate of meningitis was 6.5%. Patients with nausea and vomiting totalled 11%; 9.1% of them were diagnosed with meningitis. The diagnosis rate of meningitis in cases in which additional seizures took place were 33.3%. Conclusion : The ultimate goal of lumbar punctures in seizure patients with accompanying fever is to rule out bacterial meningitis, which, has been demonstrated to be rare. So we think that lumbar puncture can be postponed by close observation of pediatrics specialists and skilled nurses.

• Clinical and Experimental Pediatrics
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• v.49 no.6
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• pp.659-664
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• 2006

Purpose : To evaluate the morbidity and mortality of children with status epilepticus(SE) as an initial seizure and to compare these according to age groups. Methods : The 78 cases(38 cases <2 years and 38 cases ${\geq}2$ years) with SE as an initial seizure admitted to the Chonnam national university hospital from Jan. 2000 to Jan. 2004 were reviewed. Developmental profiles, laboratory findings, etiologies and seizure types of SE and outcomes were compared in between two age groups, under and over 2 years. Results : SE occurred predominantly in less than 5 years old. Febrile causes were the most common, which is significantly more in those under 2 years than over 2 years(P<0.05). whereas idiopathic and acute symptomatic causes were more common in those over 2 years(P<0.05). Generalized tonic-clonic seizures was the most common type. The mortality rate was 6.4 percent(5 cases : 1 case <2 years and 4 cases ${\geq}2$ years). The estimated occurrence of epilepsy after SE was 24.4 percent(19 cases : 8 cases <2 years and 11 cases ${\geq}2$ years). The neurologic sequelae after SE in cases that had developed normally before SE(62 cases : 32 cases <2 years and 30 cases ${\geq}2$ years) were observed in 20 cases(32.3 percent), and were more frequent over 2 years(21.9 percent vs. 43.3 percent, P<0.05). Conclusion : In this study death was less common and the neurologic sequelaes of SE as an initial seizure were less severe in children under 2 years of age. The reason seemed to be the difference in the etiology of SE with age.