• 대한핵의학회지
• /
• 제32권1호
• /
• pp.20-31
• /
• 1998

수술로서 간질 병소가 확인된 환자들을 대상으로 한 이 연구에서 발작기-발작간기 SPECT를 비교 판독하여 간질병소를 국소화한 것과 영상을 위치 이동하여 좌표를 일치시키고 정규화 하여 감산하여 얻은 감산 SPECT로 국소화한 것이 대등한 진단성능을 지니고 있으며 감산 SPECT로부터 MR이나 PET과 같은 수준의 정보를 얻을 수 있음을 확인하였다. 감산 SPECT에서 발작기 혈류 증가를 범위와 강도를 고려한 적절한 역치를 설정하여 발작기-발작간기 SPECT에 더하여 감산 SPECT가 얼마나 부가적 진단가치를 가지는지 확립하여야 한다고 생각하였다.

• 생물정신의학
• /
• 제8권2호
• /
• pp.233-238
• /
• 2001

The routine interictal electroencephalogram(EEG) continues to play an important role in the diagnosis and treatment of epilepsy. The clinical investigation of brain disease in the last decade has been marked by dramatic advances in functional imaging, magnetic resonance scanning and digitized EEG. Epilepsy is a disorder of electrical hyperirritability of cerebral cortex and the interictal EEG remains the most convenient means available to demonstrate cortical hyperirritability. The sensitivity and specificity of the EEG in the diagnosis of epilepsy have been disputed. In this review, the type of EEG findings in epilepsy are reviewed and the sensitivity and specificity of interictal epileptiform discharge are discussed. And also the role of EEG in various clinical situations are summarized.

• 정신신체의학
• /
• 제5권2호
• /
• pp.205-213
• /
• 1997

The aim of this study is to find the relationship between interictal psychiatric symptoms and seizure-related variables such as structural changes, regional interictal perfusion changes, the number of interictal epileptic discharges and the presence of accompanying generalized tonic clonic seizure(GTC). The subjects were 75 patients (47 males : mean age $28.3{\pm}7.7$) with intractable epilepsy, Interictal psychiatric symptoms were rated by Symptom Checklist-90-R(SCL-90-R). Each of 4 seizure variables was measured by MRI, $^{99m}TC-HMPAO$ SPECT and the prolonged EEG monitoring. The mean SCL-90-R subscale T-scores and the ratio of the patients with definite psychiatric symptoms(T-score > 65 at any one subscale of SCL-90-R) were compared among the groups with different seizure variables. Demographic variables and clinical variables were not statistically different among the groups with different seizure variables. The patients with right mesial temporal sclerosis had higher mean SCL-90-R scores for obsessive compulsive symptom, interpersonal sensitivity, depression, hostility and psychotic symptoms than the patients with left mesial temporal sclerosis, and they also showed higher ratio of definite psychiatric symptoms. The presence of interictal epileptic discharges was related with higher T-scores of paranoid subscale. The areas of hypoperfusion, the presence of the GTC, and other clinical seizure variables showed no significant influences on the mean SCL-90-R subscale T-scores. from these results, the authors speculated that interictal subictal epileptic dischrages may be related with psychiatric symptoms of the intractable epileptic patients, especially with right mesial temporal sclerosis.

• 한국의학물리학회:학술대회논문집
• /
• 한국의학물리학회 2002년도 Proceedings
• /
• pp.335-337
• /
• 2002

The aim of this study was investigate the epileptogenic zone in temporal lobe epilepsy (TLE). We evaluated the subtraction image of interictal SPECT from ictal SPECT coregistered to 3-dimensional (3D) MRI, and compared with the normal healthy SPECT using a SPM99. Forty-nine patients with TLE (M:F=28:21, mean age: 33${\pm}$2.1 years) underwent a pairs of ictal and interictal SPECT. We performed subtraction interictal SPECT from ictal SPECT in TLE patients. In addition, using SPM methods and t-statistics, SPECT images of the TLE patients were compared with normal healthy SPECT on a voxel by voxel basis. The voxels with a p-value of less than 0.05, 0.005, 0.001 were considered to be significantly different. The subtraction results by ictal and interictal SPECT coincided with the significant rCBF changes when compare of the normal healthy SPECT using a SPM99. The results suggested that analysis of difference of the two methods using healthy normal SPECT with SPM99 is useful tool in evaluation of seizure focus in epilepsy.

• Journal of Korean Neurosurgical Society
• /
• 제52권5호
• /
• pp.466-471
• /
• 2012

Objective : The aim of this study was to devise an objective clustering method for magnetoencephalography (MEG) interictal spike sources, and to identify the prognostic value of the new clustering method in adult epilepsy patients with cortical dysplasia (CD). Methods : We retrospectively analyzed 25 adult patients with histologically proven CD, who underwent MEG examination and surgical resection for intractable epilepsy. The mean postoperative follow-up period was 3.1 years. A hierarchical clustering method was adopted for MEG interictal spike source clustering. Clustered sources were then tested for their prognostic value toward surgical outcome. Results : Postoperative seizure outcome was Engel class I in 6 (24%), class II in 3 (12%), class III in 12 (48%), and class IV in 4 (16%) patients. With respect to MEG spike clustering, 12 of 25 (48%) patients showed 1 cluster, 2 (8%) showed 2 or more clusters within the same lobe, 10 (40%) showed 2 or more clusters in a different lobe, and 1 (4%) patient had only scattered spikes with no clustering. Patients who showed focal clustering achieved better surgical outcome than distributed cases (p=0.017). Conclusion : This is the first study that introduces an objective method to classify the distribution of MEG interictal spike sources. By using a hierarchical clustering method, we found that the presence of focal clustered spikes predicts a better postoperative outcome in epilepsy patients with CD.

• 정신신체의학
• /
• 제4권1호
• /
• pp.64-70
• /
• 1996

The prevalence rate of psychiatric symptoms of the refractory epileptic patients was evaluated according to the location of the epileptic focus. The subjects were 91 patients admitted to Epilepsy Monitoring Unit of Seoul National University Hospital. The psychiatric symptoms were assessed by Korean version of Symptom Checklist-90-R(SCL-90-R). The locus of epileptic focus was assessed by clinical features, 2-hour interictal EEG, long-term video-EEG monitoring, brain MRI, interictal and ictal brain SPECT, and interictal brain PET The subjects were divided into three groups according to the epileptic focus, non-temporal(N=29), left temporal (N=26), and right temporal(N=32). There were no statistical differences in demographic and seizure-related variables among groups. The number of patients with $T-score {\geq} 65$ at any subscale of the SCL-90-R were compared by $X^2-test$ among groups. The mean T-scores of each subscale of the SCL-90-R were compared by oneway-ANOVA among groups. The prevalence rate of psychiatric symptoms of the refractory epileptic patients was 38.5%. There was no statistical difference in the prevalence rate of psychiatric symptoms among groups. However, the patients with non-temporal or right temporal epileptic foci showed statistically significant higher mean T-scores of interpersonal sensitivity, depression, hostility, and phobic subscales than the patients with left temporal epileptic foci. These results suggest that the epileptic focus plays an important role in the production of interictal psychiatric symptoms of the refractory epileptics.

• 반도체디스플레이기술학회지
• /
• 제19권2호
• /
• pp.92-95
• /
• 2020

In this paper, the new architecture of seizure prediction using CNN and LSTM and DWT was presented. In the proposed architecture, EEG data was labeled into a preictal and interictal section, and DWT was adopted to the preprocessing process to apply the characteristics of the time and frequency domain of the processed EEG signal. Also, CNN was applied to extract the spatial characteristics of each electrode used for EEG measurement, and LSTM neural network was applied to verify the logical order of the preictal section. The learning of the proposed architecture utilizes the CHB-MIT Scalp EEG dataset, and the sliding window technique is applied to balance the dataset between the number of interictal sections and the number of preictal sections. As a result of the simulation of the proposed architecture, a sensitivity of 81.22% and an FPR of 0.174 were obtained.

• Annals of Clinical Neurophysiology
• /
• 제9권2호
• /
• pp.69-74
• /
• 2007

Electroencephalogram (EEG) is a representative diagnostic tool in epilepsy. However, there are several points of debate on the role of EEG in diagnosis and management of epilepsy. We suggest that EEG has some limitations for differential diagnosis from nonepileptic episodic diseases, classification of epilepsy, prediction of recurrence, and evaluation of treatment response. Interictal EEG cannot diagnose or exclude epilepsy because interictal epileptic discharge (IED) is frequently absent in epilepsy and can appear in nonepileptic conditions. Although EEG is helpful in classification of epilepsy, focal spikes in generalized epilepsy and secondary bilateral synchrony in localization related epilepsy cause interrater disagreement. It is controversial whether EEG predicts recurrence after the first seizure in adults. The predictive value of EEG in antiepileptic drug (AED) withdrawal is not absolute. The prognosis after AED withdrawal depends on epilepsy syndrome. Many studies could not confirm the value of EEG in assessing the treatment response. After all, epilepsy is clinically diagnosed and assessed. Interictal EEG alone does not provide decisive information and routine follow-up of EEG is not recommended.

• 대한핵의학회지
• /
• 제33권3호
• /
• pp.262-272
• /
• 1999

목적: 후두엽 간질에서 발작간기 F-18-FDG PET와 발작기 SPECT의 간질원인병소 굴소화 및 편측화 진단성능을 조사하였다. 대상 및 방법: 침습적 뇌파검사와 수술과 수술 후 경과를 관찰하여 후두엽 간질로 진단된 17명의 환자를 대상으로 발작간기 F-l8-FDG PET (15명)와 발작기 뇌관류 Tc-99m-HMPAO SPECT를 시행하였다. 대사가 감소된 부분과 관류가 가장 증가된 곳을 간질원인병소로 진단하고 후두엽 병소를 제대로 진단한 경우 국소화에 병소쪽 반구의 다른 엽 또는 여러 엽을 지칭한 경우에 편측화에 성공하였다고 보아 국소화율과 편측화율을 조사하였다. 결과: F-18-FDG PET는 15명 중 9명(60%)에세 병측 후두엽을 국소화하였고 14명 (93%)을 편측화하였다. 발작기 뇌관류 SPECT는 17명 중 3명(18%)에서 국소화하였고 13명(76%)에서 편측화하였다. 자기공명영상에 병변이 발견되지 않았거나 발작기 SPECT가 정화하게 국소화하지 못한 경우에 추가적인 국소화 및 편측화 정보를 F-18-FDG PET에서 얻을 수 있었던 경우가 각각 5명, 8명이었다. 결론: 후두엽간질에서 발작기 뇌관류 SPECT로 병변쪽 반구를 편측화할 수 있었으나 F-18-FDG PET는 국소화와 편측화에 뛰어나 자기 공명영상에 병변이 발견되지 않는 경우를 포함하여 간질원인 병소를 찾는 데 크게 도움이 되었다.

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