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

• 대한핵의학회지
• /
• 제37권1호
• /
• pp.24-33
• /
• 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.

• 대한소아신경학회지
• /
• 제26권4호
• /
• pp.240-245
• /
• 2018

목적: 병원 외 심정지 후 회복된 혼수 상태의 소아 환자에서 신경학적 예후를 예측하는 것은 어렵다. 본 연구는 병원 외 심정지 후 자발순환회복 된 소아 환자에서 뇌파와 혈액 검사를 통해 신경학적 예후를 예측할 수 있는지 알아보았다. 방법: 2006년부터 2015년까지 병원 외 심정지로 가천대학교 의과대학 길병원에 방문한 1개월 이상 18세 미만의 소아 환자를 대상으로 하였다. 뇌파 분석은 배경파 점수화(background scoring), 자극에 대한 반응성(reactivity)의 유무 및 뇌파 상 경련(electrographic seizures)의 유무를 포함하였다. 배경파는 0점(nomal/organized), 1점(slow and disorganized), 2점(discontinuous or burst suppression), 3점(suppressed and featureless)으로 분류하였다. 신경학적 예후는 심정지 발생 후 최소 6개월 후에 PCPC에 따라 분류하였다. 결과: 좋은 신경학적 예후군(PCPC 1-3점) 9명과 불량한 신경학적 예후군(PCPC 4-6점) 17명으로 총 26명의 환자를 분석하였다. 불량한 예후군 환자의 88.2%, 좋은 예후군 환자의 44.4%에서 suppressed and featureless 소견을 보여 두 군간의 차이가 있었다(P=0.028). non-convulsive status epilepticus를 제외한 electrographic ictal discharges는 좋은 예후군의 44.4%, 불량한 예후군의 5.9%에서 보여 두 군간의 차이가 있었다(P=0.034). 불량한 예후군에서 산혈증, 젖산혈증, 고암모니아혈증이 좋은 예후군에 비해 의미있게 증가되어 있었다. 결론: 병원 외 심정지 후 회복된 소아 환자에서 뇌파 배경파가 suppressed and featureless 패턴을 보이는 경우 불량한 예후와 관련이 있고 electrographic ictal discharges 가 있는 경우 좋은 신경학적 예후와 관련이 있다.

• Clinical and Experimental Pediatrics
• /
• 제53권8호
• /
• pp.779-785
• /
• 2010

In pre-surgical evaluation of pediatric epilepsy, the combined use of multiple imaging modalities for precise localization of the epileptogenic focus is a worthwhile endeavor. Advanced neuroimaging by high field Magnetic resonance imaging (MRI), diffusion tensor images, and MR spectroscopy have the potential to identify subtle lesions. $^{18}F$-FDG positron emission tomography and single photon emission tomography provide visualization of metabolic alterations of the brain in the ictal and interictal states. These techniques may have localizing value for patients which exhibit normal MRI scans. Functional MRI is helpful for non-invasively identifying areas of eloquent cortex. These advances are improving our ability to noninvasively detect epileptogenic foci which have gone undetected in the past and whose accurate localization is crucial for a favorable outcome following surgical resection.

• Annals of Clinical Neurophysiology
• /
• 제9권2호
• /
• pp.63-68
• /
• 2007

The EEG plays an important diagnostic role in epilepsy and provides supporting evidence of a seizure disorder as well as assisting with classification of seizures and epilepsy syndromes. There are a variety of electroclinical syndromes that are really defined by the EEG such as Lennox-Gastaut syndrome, benign rolandic epilepsy, childhood absence epilepsy, juvenile myoclonic epilepsy and also for localization purposes, it is vitally important especially for temporal lobe epilepsy. The sensitivity of first routine EEG in diagnosis of epilepsy has been known about 20-50%, but this proportion rises to 80-90% if sleep EEG and repetitive recording should be added. Convincing evidences suggest that the EEG may also provide useful prognostic information regarding seizure recurrence after a single unprovoked attack and following antiepileptic drug (AED) withdrawal. Moreover, patterns in the EEG make it possible to disclose an ictal feature of nonconvulsive status epilepticus, separate epileptic from other non-epileptic episodes and clarify the clues predictive of the cause of the encephalopathy (i.e., triphasic waves in metabolic encephalopathy). Therefore, regardless of its low sensitivity and other pitfalls, EEG should be considered not only in the situation of new onset episode such as a newly developed, unprovoked seizure or a condition manifesting decreased mentality from obscure origin, but also as a barometer of the long-term outcome following AED withdrawal.

• 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.