The Changes in the Expression of gamma-Aminobutyric Acid Related Enzymes in the Mouse Hippocampus Following Ketogenic Diet / 대한해부학회지

The ketogenic diet (KD) has been used to treat intractable childhood epilepsy. However, its mechanism of action remains unknown. In the present study, we examined the effects of KD on the expression of multiple constituents of the GABAergic system in the hippocampus through immunohistochemistry and northern blot analysis. From the results, we have shown that KD increased expression of GABA and decreased GABA transporter1 (GABATp) and GABA transaminase (GABA-T) mRNA levels in the hippocampus. These results suggest that the neuroinhibitory effect of KD may be mediated, at least in part, by the increment of GABAergic activity in the hippocampus. KD may increase the GABA levels in the synaptic space by limiting GABA reuptake and in the presynaptic nerve terminal by inhibiting GABA degradation.

Correlation between Mirror Movements and Recovery of Motor Power in Stroke Patients

BACKGROUND: Mirror movement is common in young children, and it could be seen in normal adults. Several mechanisms including motor pathway reorganization involved in motor recovery after stroke. Motor pathway reorganization has been reported to be a mechanism in several studies of patients with mirror movement. However, the correlation of motor recovery and mirror movement has been debated. We studied the degree of mirror movement in stroke patients compared with a controlled group to look into their relationship. METHODS: Our controls were 50 adults without neurologic symptoms and signs. The hemiparetic group was comprised 94 patients who had incurred unilateral brain lesion: 36 patients were acute stroke patients, 58 patients were chronic stroke patients. Mirror movements were assessed by three different tasks: abduction of thumb, sequential finger tapping, and grasping. We analyzed mirror movements in controls and patients, and tried to find a correlation between the degree of mirror movement and the recovery of motor power in chronic stroke patients. RESULTS: In controls, male exhibited more frequent mirror movement than female at specific tasks, and there was no difference between tasks of right or left hand. In stroke patients, there was more mirror movement in the nonparetic hand than in the paretic one during the movement of contralateral hand. In acute stroke, the frequency of mirror movement had no variability according to the degree of motor power. The recovery of motor power at a late stage was not correlated with the degree of mirror movement. Consclusions: Motor pathway reorganization seems to be insignificant for motor recovery because the degree of mirror movement was not correlated with the recovery of motor power in this study.

Effect of decompressive partial temporal lobectomy on extensive panhemispheric infarction of middle cerebral artery with impending herniation process

Acute infarction in the whole territory of the middle cerebral artery (MCA) can lead to massive cerebral edema, raised intracranial pressure and cerebral herniation which may result in come and death ultimately. There are same reports which mentioned that craniectomy or stroketomy was an effective life-saving procedure and favorable outcome would be expected after the procedure. In this study, the effect of decompressive partial temporal lobectomy was evaluated in twelve patients of extensive panhemispheric infarction of middle cerebral artery(MCA). We investigated radiologically proven patients of extensive panhemispheric infarction of MCA with impending herniation process, who were admitted to our hospital from March 1991 to June 1996, prospectively and retrospectively. Decompressive partial temporal lobectomy was performed in twelve patients and eighteen patients were treated by only conventional medical treatment(control group). Prognosis were compared between two groups to analyse the effect of the decompressive lobectomy. Fourteen out of the 18 controls(78%) and five out of 12 patients who were treated by decompressive lobectomy(41%) expired due to herniation process. The mortality between two groups was significantly different(P(0.05). Four patient had relatively good outcome(by Barthel index score) and all of them belonged to the decompressive lobectomy group. These results suggest that the decompressive lobectomy be an effective life saving procedure for malignant cerebral edema after a total MCA infarction.

Post-Lumbar puncture headache: Does bed rest prevent the post-lumbar puncture headache?

BACKGROUND & OBJECTIVES: It is widely believed that the post-lumbar puncture headache(PLPH) is related to CSF leakage through the dural hole made by needle tract. So it is accepted that PLPH is prevented by at least 4 hour bed rest after lumbar puncture (LP). If bed rest was unneccessary, the administrative and nursing advantages would be obvious,, especially in neurologic units, whereLP has been done frequently. Therefore, we evaluate the incidence of PLPH in the ambulant and bed-rest patients prospectively and compared the incidence difference between two group. METHODS: Eighty-eight patients without preceding headache who were done lumbar puncture for diagnostic purpose were selected prospectively. We compared the incidence of PLPH between the ambulant (50 patients) and bed-rest group (38 patient,) at 6 hour and 24 hours. We also evaluated the effect of the CSF profile (count of RBC and WBC, protein level and opening pressure) on PLPH. RESULTS: The PLPH was found in 11 cases(12.5%) among bed-rest and ambulant groups. The frequency of each group was 8% (3/38) in bed-rest group and 16%(8/50) in ambulant group, but there is no significant difference between two groups (p-vaIue = 0.26). The frequency of PLPH is also not correlated to the CSF profiles; count of RBC and WBC, protein level, and opening pressure. CONCLUSIONS: There is no significant difference between the ambulant and bed rest group in the frequency of the PLPH. We conclude that the bed rest after LP is unnecessary for the prevention of the PLPH.