• Clinical and Experimental Pediatrics
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• v.56 no.7
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• pp.275-281
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• 2013

Temporal lobe epilepsy (TLE) is the most common type of medically intractable epilepsy in adults and children, and mesial temporal sclerosis is the most common underlying cause of TLE. Unlike in the case of adults, TLE in infants and young children often has etiologies other than mesial temporal sclerosis, such as tumors, cortical dysplasia, trauma, and vascular malformations. Differences in seizure semiology have also been reported. Motor manifestations are prominent in infants and young children, but they become less obvious with increasing age. Further, automatisms tend to become increasingly complex with age. However, in childhood and especially in adolescence, the clinical manifestations are similar to those of the adult population. Selective amygdalohippocampectomy can lead to excellent postoperative seizure outcome in adults, but favorable results have been seen in children as well. Anterior temporal lobectomy may prove to be a more successful surgery than amygdalohippocampectomy in children with intractable TLE. The presence of a focal brain lesion on magnetic resonance imaging is one of the most reliable independent predictors of a good postoperative seizure outcome. Seizure-free status is the most important predictor of improved psychosocial outcome with advanced quality of life and a lower proportion of disability among adults and children. Since the brain is more plastic during infancy and early childhood, recovery is promoted. In contrast, long epilepsy duration is an important risk factor for surgically refractory seizures. Therefore, patients with medically intractable TLE should undergo surgery as early as possible.

• Journal of Biomedical Engineering Research
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• v.31 no.1
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• pp.50-55
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• 2010

Gait initiation is a transitional process from the balanced upright standing to the beginning of steady-state walking. Dysbalanced gait initiation often causes stroke patients to fall. The net center of pressure, measured by two triaxial force plates from twenty healthy subjects and two stroke patients, was investigated to assess asymmetry of gait initiation in hemiparetic subjects. The time interval and distance of the net center of pressure(CoP) moved from the initiation point to the toe off(S1) and from the toe off to the initial contact(S2) were calculated during gait initiation of normal and stroke patients. When the patient with right hemiplegia(A) initiated his gait with right foot, the time interval and the distance of the net CoP in S1 and S2 were smaller than that of normal subjects' values. However, he initiated the gait with left foot(unaffected side) the time interval and the distance of net CoP in S1 were larger than normative values. Differently, the patient with left hemiplegia(B) has shown that larger time interval and distance in S1 and smaller time interval and distance in S2 in both sides. His asymmetry(with which side the gait initiated) was not significant. It is too early to conclude that these results could be general characteristics of the stroke patients because the variations were large and moreover, the level of motor recovery of the patients was different. However, it is expected that these trials could help to set up the strategy of the therapy for the rehabilitation or prevention of fall in stroke patients.

• Journal of Korean Neurosurgical Society
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• v.57 no.1
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• pp.42-49
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• 2015

Objective : The cervicothoracic junction (CTJ) is a biomechanically and anatomically complex region that has traditionally posed problems for surgical access. In this retrospective study, we describe our clinical experiences of the treatment of metastatic spinal tumors at the CTJ and the results. Methods : From June 2006 to December 2011, 23 patients who underwent surgery for spinal tumors involving the CTJ were enrolled in our study. All of the patients were operated on through the posterior approach, and extent of resection was classified as radical, debulking, and simple neural decompression. Adjuvant radiation therapy (RT) was also considered. Visual analog scale score for pain assessment and Medical Research Council (MRC) grade for motor weakness were used, while pre- and post-operative performance status was evaluated using the Eastern Cooperative Oncology Group (ECOG). Results : Almost all of the patients were operated using palliative surgical methods (91.3%, 21/23). Ten complications following surgery occurred and revision was performed in four patients. Of the 23 patients of this study, 22 showed significant pain relief according to their visual analogue scale scores. Concerning the aspect of neurological and functional recovery, mean MRC grade and ECOG score was significantly improved after surgery (p<0.05). In terms of survival, radiation therapy had a significant role. Median overall survival was 124 days after surgery, and the adjuvant-RT group (median 214 days) had longer survival times than prior-RT (63 days) group. Conclusion : Although surgical procedure in CTJ may be difficult, we expect good clinical results by adopting a palliative posterior surgical method with appropriate preoperative preparation and postoperative treatment.

• Journal of Acupuncture Research
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• v.19 no.5
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• pp.35-45
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• 2002

Objective : The aim of this study was to investigate the effect of tong's acupuncture on recovery of motor disorders in stroke patients. Methods : Twenty two patients with poststroke-hemiplegia were randomized into two groups. Ten patients(test group) treated by 2 methods-tong's acupuncture and body acupuncture. The other twelve patients(control group) treated only by body acupuncture. The activity of daily living was measured with a National Institutes of Health stroke scale(NlHSS) and Modified Barthel Index(MBI). The therapy was performed one a day for 2 weeks. Results: In terms of score of NIHSS. the test group showed statistically meaningful decrease after 2 week treatment. but the control group showed statistically meaningful decrease after I week(p<0.05). And in terms of score of MBI. the test group showed statistically meaningful increase after 2 week treatment. but the control group showed statistically meaningful increase after I week(p<0.05). There was no statistically meaningful difference after 1 and 2 week treatment between the groups. Conclusions: These results support that test group has almost same effectness compared with control group in improvement of the activity of daily living of poststroke-hemiplegic patients.

• Archives of Plastic Surgery
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• v.35 no.6
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• pp.723-728
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• 2008

Purpose: The disinsertion of the phalangeal tendon distal insertion has difficulties in ordinary tenorrhaphy operation for the anatomical features, and still has controversy between non-surgical and surgical management. The purpose of this study is to select treatment for the injury of the phalangeal tendon distal insertion, as we've had a good results from operation treatment with Pull-in suture technique. Methods: We reviewed the hospital records of 12 patients treated with Pull-in suture technique with disinsertion of the phalangeal extensor or flexor tendon distal insertion from June 2006 to June 2007. Eight patients were involved with the tendon disinsertion without bone fracture, and 4 patients were involved with the fracture of the phalangeal tendon distal insertion site. After removal of the K-wire in week 6, active physical exercises were commenced immediately. The mean follow-up period was 12.4 months. Results: All the patients who had tendon disinsertion with bone fracture had IIB, by Wehbe and Schneider's classification 2, and we evaluated the results comparing the same finger of the other hand according to Crawford's evaluation criteria 5. The nine excellent and three good results were obtained and there were no limitation of motor for the patient who had operation for the rupture of flexor tendon as well. There were no particular complications during the follow-up period. Conclusion: The most important thing for the disinsertion of the phalangeal tendon distal insertion is to maintain an accurate and durable reduction state keeping the tension of tendon. At this point, after removal of the K-wire, the Pull-in suture technique allows accurate realignment of the tendon-bone unit without any specific instrumentation under the more stable state. The Pull-in suture technique seems to be a strong alternative for the treatment of disinsertion of the phalangeal tendon distal insertion, with successful treatment outcome(rapid functional recovery and high patient satisfaction).

• The Journal of Korean Physical Therapy
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• v.25 no.4
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• pp.224-231
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• 2013

Purpose: The purpose of this case study was to investigate three poor fibrinolytic responders with chronic ischemic stroke to acute exercise intensity and time. Methods: Three ischemic stroke patients (male) from the stroke center located at Busan metropolitan area in Republic of Korea volunteered at this study. They performed two single session exercises that were a VO2peak test and a single bout treadmill walking (70-75%HRpeak, 30 min, 50min). Fasting blood samples for determination of tissue Plasminogen Activator (tPA) and Plasminogen Activator Inhibitor-1 (PAI-1) were obtained before, immediately after, 30min after acute exercise. SPSS 12.0 was used for analyzing of data and computing mean and standard deviation, and change rate was conducted between times. Results: In fibrinolytic activity according to the intensity and time of acute exercise, tPA change increased steadily during the recovery stage after the VO2peak in the cases, but PAI-1 activity showed different patterns among the cases. In a single bout treadmill walking (70-75%HRpeak, 30 min, 50min), tPA change increased between 30min and 50min. Conclusion: In conclusion, these results suggest that the exercise prescription for poor fibrinolytic responder with three male chronic ischemic stroke patients without motor disability recommend at 70-75%HRpeak, over 30min.

• Journal of the Korean Academy of Clinical Electrophysiology
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• v.8 no.1
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• pp.15-22
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• 2010

Purpose : This study examines the effects of pre-eccentric exercise and stretch ing to bicepsbrachii to prevent delayed onset muscle soreness and recovery of muscular function depending on the training intensity with 28 normal adults in their twenties. Methods : The subjects were divided into a control group, a group without any previous eccentric exercise, and a stretching group. Pre-eccentric exercise group conducted exercise with the intensity of 25% of maximal voluntary contraction. Pre-eccentric exercise and stretching was applied before to induce delayed onset muscle soreness and after, 24 hour post, 48 hour post, and 72 hour post. Measurements were conducted to examine pain and muscular function changes before, immediately after, and after inducing delayed onset muscle soreness. After inducing delayed onset muscle soreness, measurements were taken at the 24th hour, 48th hour, and 72nd hour. Results : The pre-eccentric exercise group and stretching group showed a significant difference from the control group by isometric contract ion power and mechanical pain threshold as a result of measuring delayed onset muscle soreness. Conclusion : From these results, electrical stimulation using presynaptic inhibition mechanism of transcutaneous electrical stimulation (TES) had positive effects for walking ability on inhibition of muscle tone in lower extremity. The motor level stimulation group experienced a more significant effect than the sensory level stimulation group. Therefore, the transcutaneous electrical stimulation (TES) is considered to be effective on walking ability increasing through inhibition of muscle tone in lower extremity for rehabilitation of post stroke hemiplegic patients.

• Clinical and Experimental Pediatrics
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• v.59 no.sup1
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• pp.161-164
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• 2016

Guillain-$Barr{\acute{e}}$ syndrome and acute transverse myelitis manifest as demyelinating diseases of the peripheral and central nervous system. Concurrency of these two disorders is rarely documented in literature. A 4-year-old girl presenting with cough, fever, and an impaired walking ability was admitted to hospital. She had no previous complaints in her medical history. A physical examination revealed lack of muscle strength of the lower extremities and deep tendon reflexes. MRI could not be carried out due to technical problems; therefore, both Guillain-$Barr{\acute{e}}$ syndrome and acute transverse myelitis were considered for the diagnosis. Intravenous immunoglobulin treatment was started as first line therapy. Because this treatment did not relieve the patient's symptoms, spinal MRI was carried out on the fourth day of admission and demyelinating areas were identified. Based on the new findings, the patient was diagnosed with acute transverse myelitis, and high dose intravenous methylprednisolone therapy was started. Electromyography findings were consistent with acute polyneuropathy affecting both motor and sensory fibers. Therefore, the patient was diagnosed with concurrency of Guillain-$Barr{\acute{e}}$ syndrome and acute transverse myelitis. Interestingly, while concurrency of these 2 disorders is rare, this association has been demonstrated in various recent publications. Progress in diagnostic tests (magnetic resonance imaging and electrophysiological examination studies) has enabled clinicians to establish the right diagnosis. The possibility of concurrent Guillain-$Barr{\acute{e}}$ syndrome and acute transverse myelitis should be considered if recovery takes longer than anticipated.

• Journal of Korean Neurosurgical Society
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• v.37 no.1
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• pp.8-15
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• 2005

Objective: We evaluate temporal correlations between postoperative symptomatic and electrophysiological improvements, and assessed the recovery time required for patients with carpal tunnel syndrome(CTS) before returning to routine activities. Methods: 30 CTS patients were treated via the endoscopic monoportal approach, from March 2001 to September 2003. We assessed the symptoms (hyperesthesia in the finger tips, or abnormal sensations and painful numbness or night pain) and electrophysiological changes in the preoperative state, 1 month and 6 months after surgery. We marked the times at which patients became able to return to activities of daily living and work, after undergoing endoscopic carpal tunnel release. Results: At the end of the follow-up period, high levels of achievement and good outcomes were observed, with respect to both the symptoms and electrophysiological studies. We discovered significant differences between the preoperative and postoperative periods, especially in terms of motor nerve onset latency from $4.50{\pm}1.43$ to $3.97{\pm}0.69$ and sensory nerve conduction velocity, the wrist-to-finger from $19.81{\pm}10.03$ to $28.18{\pm}11.01$ and wrist-to-palm from $23.34{\pm}13.40$ to $31.79{\pm}13.38$(P<0.05 for each comparison). The average time interval required before return to activities of daily living was 26.4 days, and time interval required before return to work was 48.08 days. Conclusion: Electrophysiological improvements are largely consistent with symptomatic relief, but there is some disparity between electrophysiological and symptomatic improvement.

• Journal of Korean Neurosurgical Society
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• v.44 no.1
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• pp.1-7
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• 2008

Objective : The purpose of this study was to investigate the factors affecting the surgical outcome and to compare the surgical results between transsylvian and transcortical approaches in patients with putaminal hematomas. Methods : Retrospective review of charts and CT scan images was conducted in 45 patients (20 transsylvian and 25 transcortical approaches) who underwent open surgical evacuation of putaminal hematomas. Mean Glasgow coma scale (GCS) score and hematoma volume were $7.5{\pm}3.2$ and $78.1{\pm}29.3\;cc$, respectively. The factors affecting the functional mortality were investigated using a multivariate logistic regression analysis. In addition, surgical results between transsylvian and transcortical approaches were compared. Results : None of the patients had a good recovery after the surgery. Overall functional survival rate and mortality were 37.7% and 31%, respectively. The only risk factor for functional mortality was GCS motor score after controlling age, history of hypertension, side of hematoma, hematoma amount midline shift, presence of intraventricular hemorrhage and surgical approach (p=0.005). Even though a transcortical approach was shorter in operative time (4.4 versus 5.1 hour) and showed a higher mortality rate (40% versus 20%) and lower functional survival (45% versus 35%) compared to the transsylvian approach, the differences were not statistically significant between the two groups. Conclusion : In patients who have large amounts of hematoma and require open surgical evacuation, the only significant risk factor for functional survival is the preoperative GCS score. Cortical incision methods such as transsylvian and transcortical approaches have no influence on the surgical outcome. To decompress the swollen brain rapidly, transcortical approach seems to be more suitable than transsylvian approach.