Seizure Induced or Aggravated by Carbamazepine

We experienced 2-cases of epileptic seizures aggravated by CBZ, of one which was 15-year old frontal lobe epileptic and the other was 8-year old occipital lobe epileptic. Their seizures were disappeared by withdrawal of CBZ. In conclusion, if a child or adult is noted to have more seizures or to have a new type of seizure when CBZ is added. One should consider the possibility that the seizures are drug-induced rather than part of the natural course of a progressive epilepsy and promptly withdraw CBZ.

Comparision of Heoatitis B Virus Markers in the Serum and the Cerebrospinal Fluid / 영남의대학술지

We investigated HBV markers in serum and cerebrospinal fluid of 50 subjects with neurologic disorders or other disorders, who visited Dept. of neurology, college of medicine, Yeungnam University, from April-1 to August-31 1994 and were performed cerebrospinal fluid analysis to investigate the detection rate of HBV markers in cerebrospinal fluid and the possibility of neurologic disorders associated with HBV infection. The results were as follows. The positivity of HBsAg and. HBV prevalence rate in serum were 6(12.04) and 37(74.0%). Thf, number of patient with HBsAg, only anti-HBV and no markers were 6(12.0%), 31(62.0%) and 13(26.0%), respectively. The positivity of HBsAg and HBV prevalence rate in cerebrospinal fluid were 3(6%) and 18(36.0%). The number of patient with HBsAg, only anti-HBV and no markers were 6(100.0%), 12(38.7%) and 0(0.0%) respectively. The number of patient with virus associated diseases(VAD) and non virus associated diseases(NVAD) were 26(52%) and 24(48%). The HBV prevalence rate in serum of VAD and NVAD groups were 88.5% and 58.3% (p<0.05). The HBV prevalence rate in CSF of VAD and NVAD groups were 53.8% and 16.7%(p<0.05). The HBV prevalence rate in serum and CSF of VAD and NVAD groups were 60.9% and 28.6%

Epileptic Nystagmus Associated with Occipital Lobe Epilepsy

Epileptic seizures of nystagmoid character with the fast -beat to the opposite side of the epileptogenic focus have been described as oculoclonic seizures and epileptic nystagmus. Epileptic nystagmus, especially horizontal, most commonly results from seizure activity involving the occipital cortex, although participation of adjoining portions of the parietal and temporal cortex is possible. The frequency of ictal nystagmus was less than 10% of patients with occipital lobe epilepsy. Although forty-six cases were already reported at the litherature, there was no report in korea. We reported a 20-year old patient who had history of recurrent paroxysmal attacks of epileptic nystagniu, associated with oscillopsia and followed by episodic bilateral blindness and eyelid flutter. Standard and extra occipital electrodes visualized more exact left occipital foci at the videomonitored EEG examination when the patient showed epileptic nystagmus. The ictal Brain SPECT, with the use of 99mTc-HMPAO also localized the seizures to left occipital lobe.

Efficacy of Non-standard Surface Electrodes for Detecting Epileptiform DLwharges in Patients with Temporal Lobe Epilepsies

This study was aimed for comparison of efficacy in detecting epileptiform discharges, which was originating from mesiobasal temporal lobe, among the four non-standard non-mvasive skm surface electrodes such as ear lobe(Al/A2), zygomatic(Zl/Z2), surface sphenoidal(SS1/SS2) and true anterior temporal electrode(Tl/T2). The study was performed with simultaneous placement of the nonstandard electrodes including standard electrodes(F7/F8). The resul ts were as follows. Among the non-standard electrodes, zygomatic and true anterior temporal electrodes detected more epileptiform discharges compared to the other two electrodes, although there was no statistical significancy. Compared to the standard electrodes, zygomatic and true anterior temporal electrode showed statistically high significant detecting rate (p<0. 01). Also average detection rate of epileptiform discharges of the whole non-standard electrodes which was compared to the rate of the standard electrodes showed statistically significance (p<0.05). In conclusions, non-standard surface electrodes, especially zygomatic and true anterior temporal electrode, are considered as valuable to detect the epileptiform discharges from temporal lobe if they were used at the routine initial EEG examination.

Motor Driving of the Epileptic Patients

Driving restrction for people with seizure disorder is intended to ensure the public's safety, but such resrictions may unduly harm the welfare of many people with seizures. There is a trend toward greater liberalization of driving standards for people with seizure disorder. The present survey indicates the current driving status of 194 male patients which were managed at the Yeungnam University Hospital from Jan. 1994 to JarL 1995. The result was as follows: 33% of the epileptic patients held traffic licences, 21% actually driving, 5% holding the licences and driving the truck and bus commercially; 72% of the patients took licences after onset of the disease, 29% disclosed by traffic authorities due to their military services; Over the half of the patients had complex partial seizure, 68% was seizure-free over one year, 91 % had no history of trabbic accident. Our traffic road regulations prohibited driving cars by epileptic patients, but practically the authorities permitted epileptic patients to drive cars case by case according to the medical certifications which were issued by the physician. In conclusion, we insist that new traffic road regulation, medical standards for permission and regulation, medico-legal- administrative committee, and thorough detection and regular follow-up of the patients were essential for safety of patients and other peoples.

Driving of Motor Vehicles of the Epileptic Patients / 영남의대학술지

No abstract available.

Significance of Dexamethasone Suppression Test in Patients with Stroke / 영남의대학술지

The purpose of this study was to evaluate the effect of stroke on hypothalamic-pituitary axis using dexamethasone suppression test. The effects were evaluated according to age, sex, type, size, and lesion site of stroke. There tests were performed in 62 patients with stroke(cerebral infarction, 42 cases : intracerebral hemorrage, 20 cases) and 21 disabled controlled patients without intracranial diseases at Yeungnam University Hospital from June 1992 to June 1993. The results summarized as follows. 1. Cerebral infarction showed significantly higher frequency of DST non-suppression in stroke patients than control (p<0.05). 2. Patients with left hemisphere stroke showed more frequent abnormal neuroendocrine test results (p<0.01). 3. Patients with large infarction revealed strongly non-suppressed DST results(p<0.01). 4. Significantly higher basal cortisol level in patients with cerebral infarction was noted(p<0.01). 5. There are no statistical significance between DST results and sex, age, motor impairment, type of cerebral infarction.

Occupational Status of the Epileptics

We studied occupational status of 175 epileptics have been treated at Yeungnarn university hospital from 1991 to 1992. Their age were in the range of being capable of working. The main purposes were to study the effect of seizure type and degree of control to having job;the effect of additional disabilities to the means of living of epileptics. The results were like these: 1. The employment rate of our patients was 56%. 2. There were no statistical significancy at the effect of seizure type and degree of control to having job(P0.05). But additional disabilities and education showed significant effect to the position of job (p<0.05). 4. Among the 138 responders 14 patients had experienced seizure attacks at work and 6 of these 14 patients had some kinds of problem on performing their work by the attacks. 11 of 138 patients disclosed their disease to the employer at the beginning of employment. Conclusion our epileptic patients also have many problems on having job. Which were predominantly related to education. Disabilities and self-denial rather than other related factors.

Cytogenetic Characteristics and Related Genes in Human Meningiomas

Cytogenetic techniques were used to detect specific chromosomal losses and / or stuctural changes in 6 meningioma cell population of 11meningioma patients. Polymorphic DNA markers were uti.lized to investigate the loss of constitutional heterozygosity on chromosomes 8. 17 and 22 in 9 meningioma cell population of 1l meningioma patients. As a result, 5 cases(M-2.4,5.9, and 10) represented 45. XX. -22 or 45, XY.-22 as stem line. In addition to chromosome 22, other chromosomes were lost randomly. In one case(M-3) normal karyotypic pattern was oberved. The 9q+ structural change was also noted in case M-2. This structural change was thought to be the chromosomal involvement secondary to the loss of chromosome 22 in meningioma. Retentions of constitutional heterozygosity on chromosomes 8 and 17 were found in all cases. Loss of constitutional hererozygosity on chromosome 22 were found at Hind m RFLP of v-sis in cases M-1 and M-7. EcoRI RFLP of v-sis in case M-1. Bgl II RFLP of v-sis case M-1. Xba I RFLP of v-sis in cases M-6. M-9 and M-11. And EcoRI RFLP of bcr in all cases. Rearrangement of chromosome 22 in case M-1 was detected on the Xba I RFLP of v-sis as extra band(3.14kb). The reduction to hemizygosity on chromosome 22 was one important step in tumorigenesis of meningioma. Monosomy 22 might operate at the primary level of tumor initiation. Random losses of other chromosomes or structural changes as 9q+ were postula!ed to be related to tumor development.

The risk factors of recurrent ischemic stroke / 영남의대학술지

To eveluate the risk factors which are related to recurrence of ischemic stroke, we selected subjects who were admitted to YNUH due to recurrent stroke and compared their risk factors with non-recurred group- who suffered from single ischemic stroke. In the subjects, 55 of them are men and 22 were women and in the non-recurred groups, 84 of them were men and 40 were women, Subject's age ranged from 29 to 86 years(Mean 62. 5years), and non-recurred group's age ranged from 27 to 90 years(Mean 60.7years), Peak incidence of ischemic stroke is in the 7th decade in both groups. Age and sex are not statistically significant for recurrence of ischemic stroke. The patient's history of diabetes mellitus, myocardial infarction, atrial fibrillation, transient attack and type or site of ischemic stroke had no significant effect statistically on the recurrent ischemic stroke. However, when the patient had previous history of hypertension or systolic blood pressure more than 160mmHg and diastolic more than 95mmHg, there was substantial difference (P<0.05) between the two group in the recurrence of ischemic stroke. According to the above results, hypertension is most likely significang risk factor of the recurrence of ischemic stroke within 2yeats after initial one. Therefore, adequate treatment of the hypertension is impertant for the prevention of ischemic stroke. Further study is required for searching other risk factors.

A Preliminary Study on the Functional Recovery after Acute Stroke (Assessed by Barthel ADL index)

We evaluated the performance of activities of daily living by using Barthel ADL index and the factors affecting the quality of life were also analyzed in 82 survivors who suffered from single cerebral infarction in MCA territory and followed for more tham 3 months. The results were as follows: 1. Among the patients, 56(68.3%) patients regained functional indepeadency.but they were not necessarily normal or socially independent. 2. They improved markedly in first 4 weeks after onset of the stroke. 3. Functional recovery in the left hemiplegic patients was better than the right, but there was no difference in functional recovery related to sex and etiologic factors. 4. There was no correlation between age and ADL score 5. The major determinants for long term quality of life were the initial neurologic signs and the size of infarcted area demonstrated by Computed Tomography.

The role of G protein in the activation of phospholipase C from bovine brain / 영남의대학술지

The objective of the present study was to identify the characteristics of phospholipase C (PLC) isozymes purified from bovine brain and to investigate their interrelationship with G protein. The purified PLC isozymes β, γ and δ were obtained and the characteristics of PLC activity on various concentrations of free Ca²⁺ were observed. The activity of PLC was increased with increasing Ca²⁺ concentration and the activity PLC δ was increased higher in the presence of phosphatidyl choline (PC) than in the absence of PC. For vesicle formation as the structure of cell membrane, cholic acid and deoxycholic acid as detergent on phosphatidylinositol bisphosphate (PIP₂) substrate containing PC were used, and then the activity of PLC isozymes were increased with increasing concentration of cholate, from 0.2% to 1% and were increased slightly in deoxycholate. In the PIP₂ containing phospholipid and glycolipid as brain extract, the activity of PLC isozymes were checked in 0.2-1% cholic acid. The activities of PLC isozymes were continuously increased up to 1% cholic acid. The quantitation of PLC isozymes from several bovine organs by radioimmunoassay was made. Brain was the most sufficient organ in terms of amount of PLC β and δ. A large amount of PLC δ was existed in adrenal gland. The binding capacity of GTPrS and G protein was observed and other observations of the binding effect of GTPrS-G protein and PLC monoclonal Ab-Protein A from tissue homogenate with PLC were made. From the observation the binding capacity was revealed the range of 0.11-1.49%. The effects of each type of G protein on the percent activity of purified PLC isozymes were observed. From the observation, activities of isozymes were increased in Goa & Gmix, and the activities of PLC β and δ were increased in Gβγ and Gia. Activities of PLC β and γ were decreased in Gta but PLC δ increased.

A Case of Epilepsia Arithmetices

Activation of epileptic seizure or electroencephalographic epileptiform discharges by mental calculation is rare, not reported in Korea. We report a 10-year-old right handed school girl without previous seizure history who showed clinically absence seizures and generalized synchronous 3 to 3.5Hz spike-and-wave dlscharges only when she attempted to perform difficult mental arithmetic. No further seizure was provoked after Valproic acid intake.

A Case of Idiopathic Hypoparathyroidism with Albright's Hereditary Osteodystrophy

A 27 years old female patient who had some features of idiopathic hypoparathryoid manifestation such as hypocalcemica, hyperphosphatemia. Chronic tetany, no evidence of osteomalacia, rickets and renal insufficiency, also was found to have certain characteristic skeletal and developmental abnormalities :rounded face, short neck, thick-set stocky body habitus, brachymetatarsia and mental retardation, which are attributable to Albright's Hereditary Osteodystrophy. On the basis of a circulating immunoreative Parathormone level, this case could be considered as idiopathic hypoparathyrodism rather than psuedohypoparathyroidism, despite of Albright's Hereditary Osteodystrophy because the patient's circulating parathormone level is normal range in C-terminal radioimmunoassay system. Presumably, the suggested explanation about the patients normal range of immunoreative parathormone is that the hypoparathyroid state is not a deficiency of circulating parathormone but an ineffectiveness of acitve parathormone because of a defect in conversion of secreted proparatbyroid hormone into an active form as proposed by Nusynowitz et al.(l973) The similar concentrations in immunoreactive parathormone levels of patient's family in same radioimmunoassay systems support this hypothesis. We concluded this case as idiopathic hypoparathyroidism with Albright's Hereditary Osteodystrophy.

A Case of Primary Malignant Leptomeningeal Melanomatosis

Primary malignant melaomatosis of leptomeninges is uncommon, not reported in the Korea to this time. Primary melanomatosis of leptomeninges are not associated with any specific clinical or radiological symptoms. The diagnosis was made by ultrastructural demonstration of malignant melanoma cells from CSF. The patient is 23 years male, who has had meningeal irritating symptoms such as intermittent headache. Nausea, vomiting and disturbed consciousness. Brain CT and MRI showed no mass lesion but cytology of cerebrospinal fluid revealed malignant melanoma cells. There was no evidence of extracerebral melanoma.

A Case of Wilson's Disease Associated with Somatomotor Status Epileticus

Wilson's disease is a genetically transmitted autosomal recessive disorder of copper metabolism which affects the liver. Brain and other organs. The seizure in Wilson's disease is not infrequent but. It's report is very rare in Korea. The frequency of seizure is about 10 times more than that of general population The statistical proportions of types of seizure associated with Wilson's disease do not differ significantly from that seen in the general population. And the most common seizure type is focal motor form. The issue of the mechanisms producing seizure in Wilson's disease has attracted controversy, but the cause of seizure seems to be related with copper itself. Although the seizure is well controlled by anticonvulsants, the prognosis of seizure depends on the treatment of Wilson`s disease. We report a case of Wilson's disease associated with somatomotor status epilepticus.

Study on the changes of nerve conduction with wrist fixation in carpal tunnel syndrome / 영남의대학술지

The author studied 20 healthy adults (20 hands) as a control and 30 patients (40 hands) with carpal tunnel syndrome to evaluate the clinical usefulness of measuring nerve conduction velocity after wrist flexion in diagnosis of carpal tunnel syndrome. The median nerve conduction velocity over wrist to finger segment was measured before and after wrist flexion for 1, 2 and 5 minutes, using belly-tendon method for motor nerve distal latency (MNDL) and antidromic method for sensory nerve conduction velocity (SNCV). The results were as follows: 1. In control group, MNDL increased in 1 hand and SNCV decreased in 2 hands after wrist flexion. In patient group, MNDL increased in 2 hands and SNCV decreased in 3 hands after wrist flexion. 2. In both control and patient group, there were no significant changes in mean values of SNCV and MNDL between before and after wrist flexion. 3. Phalen's wrist flexion test was positive in 5 percent of control and 60 percent of patient group. 4. Tinel's sign was present in 10 percent of control and 33 percent of patient group.

A clinical study of acute carbon monoxide intoxication / 영남의대학술지

To obtain the basic data of prognosis of acute carbon monoxide (CO) intoxication, one hundred and sixteen cases of CO intoxication defined by carboxyhemoglobin (COHb) and admitted via emergency room of Yeungnam University Hospital from Oct. '85 to April' 89 have been clinically analyzed and evaluated, including delayed postanoxic encephalopathy (DPE) and the following results were obtained. 1. The ratio of male to female was 1:1.5 and mental state was drowsy mostly (26.2% of 116 cases) 2. The more disturbed the mental state, the more decreased was the arterial pH and PaCO₂, which may be the result of metabolic acidosis. 3. The early laboratory findings in patients of CO intoxication were as follows: leukocytosis-65.5%, increase of hematocrit-23.3%, hyperglycemia-19.8%, increase of GPT-19.8% increase of creatinine-0.9% and glucosuria-12.1%. 4. The early findings of EKG were abnormal in 35.3%: change of rhythm-25.0%, abnormal ST segment 15.5% (change of rhythm and abnormal ST segment-5.2%) but the conduction disorder was not present. 5. The abnormal EEG above mild degree was 93.1%, of which moderate was most frequent (80.2%). 6. The incidence of DPE was 7.8% among all admitted CO patients. DPE cases had long duration of exposure time (8 hours), severe leukocytosis (20,000) and an abnormal EEG (MA).

103 Cases of Young Adults with Stroke: The Causes and Prognosis

Stroke in young adults are relatively uncommon. To investigate the causes, clinical findings and prognosis of cerebral infarction (CI), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH) in young patients, we reviewed the medical records of 103 young patients(age: 15-45 years) who had been admitted to Yeungnam University'Hospital from Jan. 1986 to Dec. 1990. The proportion ol young adults was 6.1% in all cerebrovascular disease patients in our hospital during the same period. The mean age was 36.38 +/- 7.27 years. About two third of the patients were older than 35 years old. The ratio of male to female patients was 1.39 to 1. The percentage of patients with ICH was 45.6%, CI, 37.9%, and SAH, 16.5%. The causes of cerebral infarction were atherosclerosis (38.4%), cardiogenic cause (28.2%), nonatherosclero tic vasculopathy (10.3%), and hematologic abnormality (7.7%) in order of frequency, and the most involoved site was the carotid territories (79.4%). The major causes of intracerebral hemorrhage were hypertension (59.6%) and arteriovenous malformation (8.5%). The locations of the hematoma on brain CT scan were the basal ganglia (42 : 5%), lobe (34%), thalamus (8.5%), pons (6.4%) and ventricle (4.3%) in that order of frequency. Subarachnoid hemorrhage was mainly due to ruptured aneurysm (76.4%). Undetermined causes noted in 15 cases (14.6%). The overall mortality of this group of patients was 23.3%. Most of the patients (83.3%) with fatal outcome died within the first 2 weeks. The degree of neurologic sequelae among survivors was mild (45.6%) to moderate (22.3%).

The Clinical Study of the Brain CT Patterns in the Seventeen Global Aphasic patients

The lesion of the global aphasia often involves both Broca's and Wernicke's speech area, and is shown as broad lesion in the Brain CT However, practically there were several reports about the Brain CT findings of the global aphasia, which suggested atypical patterns that did not involve both language centers, simultaneously. Therefore we subdivided the patterns of Brain CT finding of the 17 global aphasic patients into 4 subtypes according to whether or not the cortical language area was involved. We obtained the following results; 1. Type A : Involvement of the both language areas : 9 cases (53%) 2. Type B : Involvement of only Broca's area with sparing of Wernicke's area : 3 cases(17%) 3. Type C : Involvement of only Wernicke's area with sparing of Broca's area : 1 case (6%) 4. Type D : Involvement only of subcortical area with sparing of cortical language areas : 4 cases (24%).