• The Journal of Pediatrics of Korean Medicine
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• v.27 no.4
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• pp.1-9
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• 2013

Objectives The purpose of this study is to report the cases of two pediatric patients diagnosed as Sik-gan (食癎), a kind of epileptic seizure thought to be caused by uncontrolled consumption of food, treated by formula variation of Samchulkunbi-tang (蔘朮健脾湯). Methods Two pediatric patients diagnosed as Sik-gan (食癎) according to traditional Korean medical terms were administered by variety of Samchulkunbi-tangs (蔘朮健脾湯) while correcting unhealthy eating habit. To measure the degree of the patients' process, the number and exact symptoms of seizure events, and gastrointestinal symptoms were recorded. Results The treatment of various Samchulkunbi-tang (蔘朮健脾湯) was not only extended remission period of seizure, but also improved gastrointestinal symptoms on both of the patients. Conclusions Pediatric patients who have past medical conditions for epileptic seizure as well as unhealthy eating habits or gastrointestinal malfunctions are prone to have a specific form of seizure called the Sik-gan (食癎). In this report, we have proven that variety of Samchulkunbi-tang (蔘朮健脾湯) can considerably be effective in improving the patients' gastrointestinal symptoms and preventing recurring seizure events.

• Clinical and Experimental Pediatrics
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• v.64 no.8
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• pp.384-392
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• 2021

Paroxysmal nonepileptic events (PNE) comprise of a variety of nonepileptic behaviors and are divided into various types. A more accurate diagnosis is possible by examining the video clip provided by the caregiver. In infants, physiologic PNE accounts for the majority of the PNE. It is important to exclude epilepsy, for which blood tests, electroencephalography, and imaging tests can facilitate differential diagnosis. Since most PNE have a benign progress, symptoms often improve with age and without special treatment. Therefore, it is important to reassure the caregivers after making an accurate diagnosis.

• The Journal of Pediatrics of Korean Medicine
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• v.30 no.3
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• pp.61-68
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• 2016

Objectives The purpose of this study is to report a case of one infant patient diagnosed as Sik-Gan (食癎) who was treated by Korean medical treatment. Methods We diagnosed an infant patient as Sik-Gan (食癎) and treated him with herbal medicine, acupuncture, moxa and chuna therapy while correcting his eating habit. To measure the degree of the patient's progress, the frequency and exact symptoms of seizure events, and gastrointestinal symptoms were recorded. Results Korean medical treatment reduced the patient's the frequency of seizure, and improved gastrointestinal symptoms. Conclusions A patient who has past medical history of epileptic seizures, unhealthy eating habits and gastrointestinal malfunctions is prone to have a specific form of seizure called the Sik-Gan (食癎). In this report, we have proven that variety of Korean medical treatment can considerably be effective in preventing recurring seizure events and improving the patients' gastrointestinal symptoms.

• Clinical and Experimental Pediatrics
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• v.62 no.7
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• pp.269-273
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• 2019

Purpose: There is limited data on the use of perampanel in children under 12 years of age. We evaluated the efficacy and tolerability of adjunctive perampanel treatment in children under 12 years of age with refractory epilepsy. Methods: This retrospective observational study was performed in Kyungpook National University Hospital from July 2016 to March 2018. A responder was defined as a patient with ${\geq}50%$ reduction in monthly seizure frequency compared with the baseline. Adverse events and discontinuation data were obtained to evaluate tolerability. Results: Twenty-two patients (8 males, 14 females) aged 3.1-11.4 years (mean, $8.0{\pm}2.5years$) were included in this study. After an average of 9.2 months (range, 0.5-19 months) of follow-up, 15 patients (68%) showed a reduction in seizure frequency, including 5 patients (23%) with seizure freedom. The age at epilepsy onset was significantly lower (P=0.048), and the duration of epilepsy was significantly longer (P=0.019) in responders than in nonresponders. Nine patients (41%) experienced adverse events, including somnolence (23%), respiratory depression (9%), violence (4.5%), and seizure aggravation (4.5%). The most serious adverse event was respiratory depression, which required mechanical ventilation in 2 patients (9%). Eight patients (36%) discontinued perampanel due to lack of efficacy or adverse events. Three out of 4 patients (75%) who discontinued perampanel due to adverse events had an underlying medical condition. Conclusion: Perampanel offers a treatment option for refractory epilepsy in children. Adjunctive treatment with perampanel requires special consideration in those with underlying medical conditions to prevent serious adverse events.

• The Korean Journal of Physiology and Pharmacology
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• v.23 no.2
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• pp.131-139
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• 2019

Manually reviewing electroencephalograms (EEGs) is labor-intensive and demands automated seizure detection systems. To construct an efficient and robust event detector for experimental seizures from continuous EEG monitoring, we combined spectral analysis and deep neural networks. A deep neural network was trained to discriminate periodograms of 5-sec EEG segments from annotated convulsive seizures and the pre- and post-EEG segments. To use the entire EEG for training, a second network was trained with non-seizure EEGs that were misclassified as seizures by the first network. By sequentially applying the dual deep neural networks and simple pre- and post-processing, our autodetector identified all seizure events in 4,272 h of test EEG traces, with only 6 false positive events, corresponding to 100% sensitivity and 98% positive predictive value. Moreover, with pre-processing to reduce the computational burden, scanning and classifying 8,977 h of training and test EEG datasets took only 2.28 h with a personal computer. These results demonstrate that combining a basic feature extractor with dual deep neural networks and rule-based pre- and post-processing can detect convulsive seizures with great accuracy and low computational burden, highlighting the feasibility of our automated seizure detection algorithm.

• The Journal of Pediatrics of Korean Medicine
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• v.30 no.3
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• pp.78-96
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• 2016

Objectives The purpose of this study is to provide clinical evidence of Korean medicine for febrile seizure by review of randomized controlled trials on the effect of TCM (traditional Chinese medicine) for febrile seizure. Methods We searched randomized controlled trials about TCM treatment of febrile seizure from the China National Knowledge Infrastructure (CNKI) (January 2008 to June 2016). The selected literatures were assessed by Jadad scale. Results 40 papers were selected from 160 studies. Analyses of selected studies indicated that the TCM treatment group has significantly higher cure rate for febrile seizure than first aid or western medicine group. The most commonly used herbs were Gardeniae Fructus (梔子), Uncariae Ramulus cum Uncis (鉤藤), Cornus Gazeliae (羚羊角), Margarita (珍珠), Scutellariae Radix (黃芩), Glycyrrhizae Radix (甘草). The most commonly used acupoints were GV26 (人中), LI4 (合谷), KI1 (湧泉), GV20 (百會). There were no serious adverse events reported from the TCM treatment group during the treatment period. Conclusions TCM has been shown as not only effective but also safe treatment on febrile seizure. This finding can be widely utilized in clinical practice and can form the basis for development of clinical practice guidelines in future.

• Clinical and Experimental Pediatrics
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• v.50 no.8
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• pp.726-731
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• 2007

This review describes the wide spectrum of paroxysmal events during sleep in infancy and childhood. The differential diagnosis between sleep-related non-epileptic paroxysmal events and epileptic seizures is difficult in special occasions. The nocturnal frontal lobe seizure and of the more common nonepileptic paroxysmal events during sleep are described. The main differentiating features characterizing parasomnias are: onset in early childhood, rare episodes of long duration, relatively lower frequency per night, absence of stereotypy, gradual disappearance of older age. Video-polysomnography is the gold standard to diagnosing and differentiating parasomnias from nocturnal frontal lobe seizures.

• Journal of Trauma and Injury
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• v.36 no.4
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• pp.354-361
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• 2023

Purpose: Ketamine has historically been contraindicated in traumatic brain injury (TBI) due to concern for raising intracranial pressure. However, it is increasingly being used in TBI due to the favorable respiratory and hemodynamic properties. To date, no studies have evaluated whether ketamine administered in subjects with TBI is associated with patient survival or disability. Methods: We performed a retrospective analysis of data from the multicenter Prehospital Tranexamic Acid Use for Traumatic Brain Injury trial, comparing ketamine-exposed and ketamine-unexposed TBI subjects to determine whether an association exists between ketamine administration and mortality, as well as secondary outcome measures. Results: We analyzed 841 eligible subjects from the original study, of which 131 (15.5%) received ketamine. Ketamine-exposed subjects were younger (37.3±16.9 years vs. 42.0±18.6 years, P=0.037), had a worse initial Glasgow Coma Scale score (7±3 vs. 8±4, P=0.003), and were more likely to be intubated than ketamine-unexposed subjects (88.5% vs. 44.2%, P<0.001). Overall, there was no difference in mortality (12.2% vs. 15.5%, P=0.391) or disability measures between groups. Ketamine-exposed subjects had significantly fewer instances of elevated intracranial pressure (ICP) compared to ketamine-unexposed subjects (56.3% vs. 82.3%, P=0.048). In the very rare outcomes of cardiac events and seizure activity, seizure activity was statistically more likely in ketamine-exposed subjects (3.1% vs. 1.0%, P=0.010). In the intracranial hemorrhage subgroup, cardiac events were more likely in ketamine-exposed subjects (2.3% vs. 0.2%, P=0.025). Ketamine exposure was associated with a smaller increase in TBI protein biomarker concentrations. Conclusions: Ketamine administration was not associated with worse survival or disability despite being administered to more severely injured subjects. Ketamine exposure was associated with reduced elevations of ICP, more instances of seizure activity, and lower concentrations of TBI protein biomarkers.

• Clinical and Experimental Pediatrics
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• v.59 no.1
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• pp.35-39
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• 2016

Purpose: This study compared the efficacy and tolerability of intravenous (i.v.) phenobarbital (PHB) and i.v. levetiracetam (LEV) in children with status epilepticus (SE) or acute repetitive seizure (ARS). Methods: The medical records of children (age range, 1 month to 15 years) treated with i.v. PHB or LEV for SE or ARS at our single tertiary center were retrospectively reviewed. Seizure termination was defined as seizure cessation within 30 minutes of infusion completion and no recurrence within 24 hours. Information on the demographic variables, electroencephalography and magnetic resonance imaging findings, previous antiepileptic medications, and adverse events after drug infusion was obtained. Results: The records of 88 patients with SE or ARS (median age, 18 months; 50 treated with PHB and 38 with LEV) were reviewed. The median initial dose of i.v. PHB was 20 mg/kg (range, 10-20 mg/kg) and that of i.v. LEV was 30 mg/kg (range, 20-30 mg/kg). Seizure termination occurred in 57.9% of patients treated with i.v. LEV (22 of 38) and 74.0% treated with i.v. PHB (37 of 50) (P=0.111). The factor associated with seizure termination was the type of event (SE vs. ARS) in each group. Adverse effects were reported in 13.2% of patients treated with i.v. LEV (5 of 38; n=4, aggressive behavior and n=1, vomiting), and 28.0% of patients treated with i.v. PHB (14 of 50). Conclusion: Intravenous LEV was efficacious and safe in children with ARS or SE. Further evaluation is needed to determine the most effective and best-tolerated loading dose of i.v. LEV.

• Tuberculosis and Respiratory Diseases
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• v.77 no.3
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• pp.145-148
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• 2014

Valproic acid is one of the most common antiepileptic drugs used for the treatment of several seizure disorders. A 20-year-old man presented with a sudden decline of consciousness. He had a neurosurgery operation for intracranial and intraventricular hemorrhage. Following surgery, antiepileptic medication was administered to the patient in order to control his seizure events. On valproic acid treatment, he began to complain of fever and dyspnea. His symptoms persisted despite receiving empirical antibiotic treatment. All diagnostic tests for infectious causes were negative. A high-resolution computed tomography scan of the chest revealed predominantly dependent consolidation and ground-glass opacities in both lower lobes. The primary differential was drug associated with interstitial lung disease. Therefore, we discontinued valproic acid treatment and began methylprednisolone treatment. His symptoms and radiologic findings had significantly improved after receiving steroid therapy. We propose that clinicians should be made aware of the potential for valproic acid to induce lung injury.