• Clinical and Experimental Pediatrics
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• 제51권12호
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• pp.1346-1349
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• 2008

배뇨 유발 반사발작은 매우 드물며, 문헌상에서 단지 8례가 보고되었으며, 발작기 뇌파로 진단한 예는 국내에서 보고된 바 없다. 7세 남아가 이차전신화 부분발작을 주소로 내원하였다. 발작은 단지 배뇨 수초 후에 시작되었으며 손의 자동증과 함께 비틀거리며 쓰러지면서 의식소실과 함께 이차적으로 전신 강직 발작을 하였다. 발작기 뇌파에서 왼측 전두부와 측두부에서 다극서파가 보이다가 오른쪽 전두부와 측두부로 퍼져나가는 소견을 보여 배뇨 유발성 이차 전신화 부분발작으로 진단되어 보고하는 바이다.

• Annals of Clinical Neurophysiology
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• 제13권1호
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• pp.26-30
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• 2011

Although the pathophysiologic mechanism is unknown, there has been long-running debate on whether periodic discharges such as periodic lateralized epileptiform discharges (PLEDs) and generalized periodic epileptiform discharges are an ictal or interictal EEG pattern. The goal of this review is to give evidence that such periodic discharges on EEG are not ictal phenomenon and just represent underlying acute brain damage. This review includes coma with epileptiform EEG pattern and its prognostic and therapeutic implications. Based on previous reports, rather than taking the view PLEDs represent either an underlying ictal process or an electrographic correlate of neuronal injury, it would be more reasonable that PLEDs are considered as a dynamic pathophysiological state in which unstable neurobiological processes create an ictal-interictal continuum.

• Clinical and Experimental Pediatrics
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• 제59권sup1호
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• pp.129-132
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• 2016

Ictal tachycardia and bradycardia are common arrhythmias; however, ictal sinus pause and asystole are rare. Ictal arrhythmia is mostly reported in adults with temporal lobe epilepsy. Recently, ictal arrhythmia was recognized as a major warning sign of sudden unexpected death in epilepsy. We present an interesting case of a child with ictal sinus pause and asystole. A 27-month-old girl was hospitalized due to 5 episodes of convulsions during the past 2 days. Results of routine electroencephalography (EEG) were normal, but she experienced brief generalized tonic seizure for 3 days. During video-monitored EEG and echocardiography (ECG), she showed multiple myoclonic seizures simultaneously or independently, as well as frequent sinus pauses. After treatment with valproic acid, myoclonus and generalized tonic seizures were well controlled and only 2 sinus pauses were seen on 24-hour Holter ECG monitoring. Sinus dysfunction should be recognized on EEG, and it can sometimes be treated successfully with only antiepileptic medication.

• 대한핵의학회지
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• 제29권4호
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• pp.445-450
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• 1995

신피질성 간질에서 발작기 뇌혈류 SPECT는 발작기 표면뇌파도를 기준으로 국소화했을때 67%의 국소화성능을 보였다. MR에 병변을 찾지 못한 57%(12예)에서도 혈류증가부위를 9예에서 찾을 수 있었다. 그리드삽입을 위한 수술부위 결정에 도움을 받은 경우가 MR에 나타난 병변유무와 상관없었다. 반면 MR에서는 43%에서 병변을 찾았다. 일부예에서 혈류증가부위의 확산을 관찰할 수 있었고 드물게 확산이 반대쪽 반구를 포함하는 경우가 있으나 대부분 국소화에 도움이 되는 자료로 사용할 수 있었다. 수술후 간질발작이 가라앉는 것을 확인한 결과를 준거로 성능비교 연구를 확장하여야 한다고 생각하였다.

• Annals of Clinical Neurophysiology
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• 제13권1호
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• pp.21-25
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• 2011

Periodic lateralized epileptiform discharges (PLEDs) had been debated whether it is ictal or non-ictal phenomenon. As most of PLEDs occur in patients with acute structural lesions, some epileptologists prefer PLEDS as a non-ictal phenomenon, rather an obscure epiphenomenon of etiological diseases. But, almost half of the patients with PLEDs do not have acute structural lesions in the brain and metabolic disorders or old CNS lesions may cause PLEDs and even more, no brain lesion was identified in some patients. There are many data supporting PLEDs as ictal phenomena. Occurrence of PLEDs usually accompanied by decreased mentality and is improved as PLEDs disappeared. Current SPECT study showed marked hyperperfusion in the lesion side of PLEDs, that is striking evidence of PLEDs as ictal phenomena. Also careful review of EEG with PLEDs revealed it is a dynamic process rather than a static state. Despite of these evidences, as PLEDs are an end-stage of animal status epilepticus models, it may be a transition of ictal to interictal state.

• Clinical and Experimental Pediatrics
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• 제52권7호
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• pp.804-810
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• 2009

목 적 : 영아연축은 이차성 전신간질중의 하나로 간질 병소를 발견하기 힘든 질환중의 하나이다. 이에 저자들은 $^{99m}Tc-ECD$ 추적자의 느린 점적 주사를 이용한 발작기 SPECT를 통하여 영아 연축 환아에서 간질 병소를 찾아보고자 하였다. 방 법 : 2005년 3월부터 2007년 2월까지 연세대학교 의과대학 소아과에 내원한 영아 연축 14명의 환아를 대상으로 첫 연축이 발생하는 시점에 $^{99m}Tc-ECD$ 를 2분에 걸쳐 천천히 같은 속도로 주입하였다. 발작간기와 발작기 간의 SPECT 의 차이를 비교하였으며 객관적인 비교를 위하여 SISCOM기법을 사용하였다. 또한 간질 병소를 발견할 수 있는 진단기법인 뇌파, 자기공명영상, 양전자단층촬영(PET) 등과 비교 분석하였다. 결 과 : 전체 14례의 추적자의 느린 점적 주사를 이용한 발작기 SPECT 중 10례에서 간질 병소의 혈류가 증가하였다. 비디오 뇌파와 발작기 SPECT에서 간질병소의 일치율은 Kappa=0.57, 95% confidence interval: 0.18-0.96로 높게 나왔다. 이 중 6례에서 발작기 SPECT와 비디오 뇌파에 근거하여 간질 수술을 시행하였으며 수술적 예후가 Engle class I으로 좋은 결과를 보였다. 결 론 : 추적자의 느린 점적 주사를 이용한 발작기 SPECT는 간질 병소를 찾기 어려운 영아 연축 환아에서 간질 병소를 찾아내는데 중요한 역할을 하는 것을 알 수 있었다. 그러나 보다 큰 규모의 전향적인 연구가 필요할 것으로 사료된다.

• 대한핵의학회지
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• 제26권2호
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• pp.244-250
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• 1992

Both interictal and ictal $^{99m}Tc-HMPAO$ brain SPECT were performed in 22 patients with medically intractable epilepsy. Localization of epileptic foci in our patients was made by combined results of EEG and other tests, including Wada test, magnetic resonance imaging, and neuropsychometric test. Among them, ictal $^{99m}Tc-HMPAO$ SPECT, localized epilptic foci in 20 of 22 patients and provided evidence of epileptic focus in 12 patients by demonstrating maximally increased regional cerebral perfusion (rCP) in epileptic foci during the ictal study with decreased rCP in interictal study. Ictal $^{99m}Tc-HMPAO$ SPECT was particularly useful for investigating epileptic foci, and when correlated with simultaneously recorded ictal EEG, provided further insight for localizing epileptic foci. Conclusively, $^{99m}Tc-HMPAO$ SPECT is. a useful, noninvasive method of localizing epileptic activity which may be particularly important for presurgical investigations, especially in those patients without large morphological lesions.

• Annals of Clinical Neurophysiology
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• 제13권2호
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• pp.93-96
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• 2011

We present a recordings of 37-year-old woman with simultaneous ictal scalp and subdural electrodes. The ictal rhythm on subdural electrocorticography (ECoG) started earlier (median 24.5 sec) and ended later (median 2.0 sec) compared to ictal rhythm on scalp EEG. Eight ictal ECoG recordings were well localized to left temporal area, whereas ictal scalp EEG recordings were not. Our case shows the obvious timing relations between two recordings, and different electrophysiologic information about localization of ictal onset zone.

• 대한핵의학회지
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• 제37권1호
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• pp.24-33
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• 2003

Finding epileptogenic zone is the most important step for the successful epilepsy surgery. F-18 fluorodeoxyglucose positron emission tomography (FDG-PET) and single photon emission computed tomography (SPECT) can be used in the localization of epileptogenic foci. In medial temporal lobe epilepsy, the diagnostic sensitivity of FDG-PET and ictal SPECT is excellent. However, detection of hippocampal sclerosis by MRI is so certain that use of FDG-PET and ictal SPECT in medial temporal lobe epilepsy is limited for some occasions. In neocortical epilepsy, the sensitivities of FDG-PET or ictal SPECT are fair. However, FDG-PET and ictal SPECT can have a crucial role in the localization of epileptogenic foci for non-lesional neocortical epilepsy. Interpretation of FDG-PET has been recently advanced by voxel-based analysis and automatic volume of interest analysis based on a population template. Both analytical methods can aid the objective diagnosis of epileptogenic foci. Ictal SPECT was analyzed using subtraction methods and voxel-based analysis. Rapidity of injection of tracers, ictal EEG findings during injection of tracer, and repeated ictal SPECT were important technical issues of ictal SPECT. SPECT can also be used in the evaluation of validity of Wada test.

• 대한핵의학회지
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• 제29권3호
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• pp.287-293
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• 1995

Anterior temporal lobectomy has become a widely used resective surgery in patients with medically intractable temporal lobe epilepsies. Prerequisites of this resection include the accurate localization of the epileptogenic focus and the determination that the proposed resection would not result in unacceptable postoperative memory or language deficits. The purpose of this study was to evaluate the performance of ictal SPECT compared to MRI findings for localization of epiletogenic foci in this group of patients. 11 patients who had been anterior temporal lobectomy were evaluated with ictal $^{99m}Tc$-HMPAO SPECT and MRI. MRI showed 8/11(73%) concordant lesion to the side of surgery and ictal SPECT also showed 8/11(73%) concordant hyperperfusion. In 3 cases with incorrect or nonlocalizing findings of MRI, ictal SPECT showed concordant hyperperfusion. In 2 cases confirmed by pre-resectional invasive EEG, MRI showed bilateral and contralateral lesion but ictal SPECT showed concordant hyperperfusion. 3 delayed injection of ictal SPECT showed discordant hyperperfusion. Thus, ictal SPECT was a useful method for localizing epileptogenic foci in temporal lobe epilepsis and appeared complementay to MRI.