Suicidality and Its Risk Factor in Migraine Patients

Background@#Migraine patients have a higher frequency of suicidality than people without migraine. The aim of this study was to identify suicidality and its risk factors in migraine patients. @*Methods@#We enrolled 358 migraine patients from 11 hospitals. We collected data regarding their clinical characteristics and the patients completes the questionnaires. We also interviewed patients with the Mini International Neuropsychiatric Interview (MINI)plus version 5.0.0 to identify their suicidality. The International Classification of Headache Disorders, third edition, beta version was used in headache diagnosis. @*Results@#The frequency of suicidality in migraine patients was 118 (33.0%). Migraine patients with suicidality were more likely to have a major depressive disorder or generalized anxiety disorder than those without suicidality. Among variables, risk factors for suicidality in migraine patients were female (odds ratio [OR], 4.110; 95% confidence interval [CI], 1.55310.878; p=0.004), attack duration (OR, 2.559; 95% CI, 1.2105.413; p=0.011), Patient Health Questionnaire9 (OR, 1.111; 95% CI, 1.0381.189; p=0.002), and Generalized Anxiety Disorder7 (OR, 1.194; 95% CI, 1.1011.294; p<0.001). @*Conclusions@#Suicidality in migraine patients is common. Therefore, clinicians who take care of migraine patients should be concerned about suicidality and its risk factors such as female gender, attack duration, depression or anxiety.

Anti-N-Methyl-D-Aspartate Receptor Encephalitis with Ovarian Teratoma Improved by Prompt Surgery

Anti-N-methyl-D aspartate receptor (NMDAR) encephalitis is often accompanied with ovarian teratomas. It has a variety of clinical manifestations including psychiatric symptoms, seizure, and motor dysfunctions. The diagnosis can be definite when clinical symptoms are present and anti-NMDAR antibodies in cerebrospinal fluid are detected. However, in patients with suspected anti-NMDAR encephalitis with teratomas, early surgery may help the clinical outcome even if the antibodies are initially negative. The authors report a patient whose clinical symptoms improved significantly after early removal of teratoma.

Unilateral Oculomotor Nerve Palsy Associated with Leptomeningeal Carcinomatosis and Intracranial Hypertension

Meningeal carcinomatosis is caused by cancer cells invading the meninges and can cause cranial nerve palsies or intracranial hypertension. Intracranial hypertension can present various symptoms such as headache, visual loss, diplopia and may rarely include unilateral cranial nerve palsy. We report a 57-year-old female with leptomeningeal carcinomatosis and intracranial hypertension who presented as unilateral oculomotor nerve palsy.

Headache with Ptosis Attributed to Fungal Sinusitis

No abstract available.

An Immunoglobulin G4 Related Hypertrophic Pachymeningitis Presented with Recurrent Ophthalmoplegia

No abstract available.

Marchiafava-Bignami Disease in Crohn's Disease

No abstract available.

Cryptococcal Meningitis Initially Presenting with Hemiparesis

No abstract available.

Suicidality and Its Risk Factors in Korean People with Epilepsy: A MEPSY Study

BACKGROUND AND PURPOSE: People with epilepsy (PWE) are more likely to experience suicidality, with suicidal ideation and attempts, than people without epilepsy (PWoE). The aims of the present study were to determine 1) the characteristics of suicidality in Korean PWE, 2) whether PWE with suicidality receive psychiatric intervention, and 3) the risk factors for suicidality. METHODS: Patients who consecutively visited epilepsy clinics at secondary- and tertiary-care hospitals were recruited (n=684), along with age- and sex-matched PWoE (n=229). The presence of current major depressive disorder (MDD), generalized anxiety disorder (GAD), and/or suicidality was established using the Mini International Neuropsychiatric Interview-Plus Version 5.0.0. The Korean version of the Liverpool Adverse Events Profile (K-LAEP) was applied to detect adverse effects of antiepileptic drugs (AEDs). RESULTS: Suicidality was present in 208 (30.4%) of the 684 PWE. The rate of suicidality was 4.6 times higher among PWE than PWoE, and 108 (15.7%) PWE had suicidal ideation and had attempted suicide. Among those who had attempted suicide, 40.7% had made at least two attempts. The most common method of suicide attempt was drug overdose (34.9%). Unfortunately, of the 208 PWE with suicidality, 136 (65.4%) did not receive psychiatric intervention. The risk factors for suicidality were MDD [odds ratio (OR)=6.448, 95% confidence interval (CI)=3.739-11.120, p<0.001], GAD (OR=3.561, 95% CI=1.966-6.452, p<0.001), item scores of 3 or 4 on the K-LAEP (OR=2.688, 95% CI=1.647-4.387, p<0.001), and a history of febrile convulsion (OR= 2.188, 95% CI=1.318-3.632, p=0.002). CONCLUSIONS: Suicidality is more prevalent in PWE than in PWoE. Clinicians should monitor psychiatric disorders and the adverse effects of AEDs in PWE in an attempt to reduce the incidence of suicidal ideation or suicide attempts in this patient population.

Obsessive-Compulsive Symptoms and Their Impacts on Psychosocial Functioning in People with Epilepsy

BACKGROUND AND PURPOSE: Obsessive-compulsive symptoms (OCS) in people with epilepsy (PWE) have not been studied systematically. We evaluated the severity, predictors, and psychosocial impact of OCS in PWE. METHODS: We recruited PWE who visited our epilepsy clinic and age-, gender-, and education-matched healthy controls. Both PWE and healthy controls completed the Maudsley Obsessional-Compulsive Inventory (MOCI), which measures OCS. PWE also completed the Beck Depression Inventory (BDI) and the Quality of Life in Epilepsy Inventory-31 (QOLIE-31). We examined the severity of OCS in PWE relative to healthy controls. Predictors of OCS and the QOLIE-31 score were measured by regression analyses. A path analysis model was constructed to verify interrelations between the variables. RESULTS: The MOCI total score was significantly higher in PWE than in healthy controls (p=0.002). OCS were found in 20% of eligible patients. The strongest predictor of the MOCI total score was the BDI score (beta=0.417, p<0.001), followed by EEG abnormality (beta=0.194, p<0.001) and etiology (beta=0.107, p=0.031). Epileptic syndrome, the side of the epileptic focus, and action mechanisms of antiepileptic drugs did not affect the MOCI total score. The strongest predictor of the QOLIE-31 overall score was the BDI score (beta=-0.569, p<0.001), followed by seizure control (beta=-0.163, p<0.001) and the MOCI total score (beta=-0.148, p=0.001). The MOCI total score directly affected the QOLIE-31 overall score and also exerted indirect effects on the QOLIE-31 overall score through seizure control and the BDI score. CONCLUSIONS: OCS are more likely to develop in PWE than in healthy people. The development of OCS appears to elicit psychosocial problems directly or indirectly by provoking depression or uncontrolled seizures.

Depression and Anxiety in People with Epilepsy

Many recent epidemiological studies have found the prevalence of depression and anxiety to be higher in people with epilepsy (PWE) than in people without epilepsy. Furthermore, people with depression or anxiety have been more likely to suffer from epilepsy than those without depression or anxiety. Almost one-third of PWE suffer from depression and anxiety, which is similar to the prevalence of drug-refractory epilepsy. Various brain areas, including the frontal, temporal, and limbic regions, are associated with the biological pathogenesis of depression in PWE. It has been suggested that structural abnormalities, monoamine pathways, cerebral glucose metabolism, the hypothalamic-pituitary-adrenal axis, and interleukin-1b are associated with the pathogenesis of depression in PWE. The amygdala and the hippocampus are important anatomical structures related to anxiety, and gamma-aminobutyric acid and serotonin are associated with its pathogenesis. Depression and anxiety may lead to suicidal ideation or attempts and feelings of stigmatization. These experiences are also likely to increase the adverse effects associated with antiepileptic drugs and have been related to poor responses to pharmacological and surgical treatments. Ultimately, the quality of life is likely to be worse in PWE with depression and anxiety than in PWE without these disorders, which makes the early detection and appropriate management of depression and anxiety in PWE indispensable. Simple screening instruments may be helpful for in this regard, particularly in busy epilepsy clinics. Although both medical and psychobehavioral therapies may ameliorate these conditions, randomized controlled trials are needed to confirm that.

Erratum: Depression and Anxiety in People with Epilepsy

The Korean version of Neurological Disorders Depression Inventory for Epilepsy in Table 3 was inadvertently omitted from the original publication of this article.

Idiopathic Normal-Pressure Hydrocephalus Patient With an Ataxic Gait as the Predominant Presenting Manifestation

A 43-year-old man presented with progressive ataxic gait of 5 months duration. His gait speed was almost normal, and he did not exhibit shuffling, freezing, or festination. A formal neuropsychological evaluation revealed a deficit in visuospatial function and memory with mild frontal dysfunctions. Brain MRI revealed communicating hydrocephalus with an Evans' ratio of 0.32. After CSF removal by lumbar puncture the patient showed a marked improvement in gait as well as frontal lobe functions, and was finally diagnosed as having idiopathic normal-pressure hydrocephalus.

Safe Implementation of Mechanical Thrombectomy in Acute Stroke Patients with Major Arterial Occlusion and Concomitant Subdural Hematoma / 신경중재치료의학

Mechanical thrombectomy (MT) alone in cases of large-vessel acute ischemic stroke (AIS) with a concomitant subdural hematoma (SDH) seems feasible and safe, but there's still a lack of evidence in the clinical literature. We report three cases of AIS with SDH, of which MT was performed with successful recanalization and no major changes in SDH: two elderly men with acute traumatic SDH and one man with incidental chronic SDH. (1) A 67-year-old man with acute traumatic SDH in the right side developed right middle cerebral artery (MCA) stroke, (2) a 72-year-old man with chronic SDH in the left side developed right MCA stroke, and (3) a 76-year-old-man with acute traumatic SDH in the right side developed top-of-basilar artery syndrome. As for AIS patients with a SDH, MT may be the only feasible and safe treatment option.

Psychiatric comorbidity in patients with epilepsy

People with epilepsy have a higher risk of developing psychiatric problems than the general population. The degree of affective symptoms such as depression and anxiety was affected by seizure control and epileptic syndromes. The higher degree of depression symptoms was more likely to elicit the suicidal ideation, psychosocial problems, adverse events of antiepileptic drugs, and poor quality of life. Antiepileptic drugs also provoke various psychiatric problems in people with epilepsy due to their specifi c action mechanisms on epilepsy. Carbamazepine, valproate, and lamotrigine can be used as a mood stabilizer, whereas phenobarbital, vigabatrin, topiramate, and levetiracetam may cautiously apply to PWE with psychiatric comorbidity.

Ipsilateral Hemiparesis in Rostral Medullary Infarction

No abstract available.

Validity and Reliability of the Korean Version of the Liverpool Adverse Events Profile (K-LAEP) in People with Epilepsy / 대한간질학회지

PURPOSE: The aim of the study was to evaluate the validity and reliability of the Korean version of the Liverpool Adverse Events Profile (K-LAEP). METHODS: An observational, cross-sectional study was performed in people with epilepsy (PWE) treated with a stable dose of antiepileptic drugs (AEDs). The scale was translated from the English version into a Korean version and was then back-translated to examine its accuracy. Patients completed the K-LAEP, Quality of Life in Epilepsy-31 (QOLIE-31), Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI).

Validity and Reliability of the Korean Version of the Liverpool Adverse Events Profile (K-LAEP) in People with Epilepsy

PURPOSE: The aim of the study was to evaluate the validity and reliability of the Korean version of the Liverpool Adverse Events Profile (K-LAEP).METHODS: An observational, cross-sectional study was performed in people with epilepsy (PWE) treated with a stable dose of antiepileptic drugs (AEDs). The scale was translated from the English version into a Korean version and was then back-translated to examine its accuracy. Patients completed the K-LAEP, Quality of Life in Epilepsy-31 (QOLIE-31), Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI).RESULTS: Three hundreds twelve patients were enrolled. The K-LAEP was completed in a short time, perceived as easy to comprehend, and there was no relevant information missing. Ceiling/floor effects were negligible. Internal consistency (Cronbach's alpha=0.9) and test-retest reliability (ICC=0.8) were satisfactory. The K-LAEP scores consistently correlated with QOLIE-31 (r= -0.528), BDI (r=0.526) and BAI (r=0.557) scores. When the K-LAEP was used to discriminate between patients with and without AED-related toxicity, the scores on the QOLIE, BDI and BAI corresponded. Anxiety symptoms were the strongest predictor to determine K-LAEP scores.CONCLUSIONS: The K-LAEP scale reveals highly acceptable parameters of the validity and reliability, suggesting that it is an appropriate instrument to measure adverse effects among Korean PWE.

Bilateral Vertebral Artery Dissection Involving the Basilar Artery: the Role of High-Resolution MR Imaging

No abstract available.

Comparison of Quality of Life in Patients With Epilepsy Taking Zonisamide or Topiramate: Before and After Treatment

BACKGROUND: Patients with epilepsy experience impairments in their quality of life (QOL). The objective of this study was to determine the influences of clinical factors on QOL and to compare QOL before and after antiepileptic drug (AED) treatment. METHODS: A cohort of 79 patients with epilepsy (43 male and 36 female) was recruited for this prospective study. The Quality of Life in Epilepsy (QOLIE)-31 survey was applied to evaluate QOL. The QOLIE-31 questionnaire was completed by the subjects before and 24 weeks after AED monotherapy (zonisamide or topiramate). The relationships of demographic, social, and clinical factors with QOL were evaluated. RESULTS: There was a negative correlation between seizure frequency and QOL in patients with epilepsy (p<0.05). The scores of patients without adverse effect were significantly higher for the seizure worry item of the QOLIE-31 questionnaire at 24 weeks compared to baseline (p<0.05). No other significant differences were found for any of the other QOLIE-31 items. CONCLUSIONS: Age, sex, seizure frequency, AED treatment, and AED adverse effects were significant clinical factors affecting QOL in patients with epilepsy. It is suggested that the physician should recognize these factors and manage them appropriately to improve the QOL of patients with epilepsy.

Psychiatric Symptoms and Quality of Life in Patients with Drug-Refractory Epilepsy Receiving Adjunctive Levetiracetam Therapy

BACKGROUND AND PURPOSE: Levetiracetam (LEV) is a new antiepileptic drug that has been found to be effective as an adjunctive therapy for uncontrolled partial seizures. However, the results of several studies suggested that LEV has negative psychotropic effects, including irritability, aggressiveness, suicidality, and mood disorders. We investigated the impact of adjunctive LEV on psychiatric symptoms and quality of life (QOL) in patients with drug-refractory epilepsy (DRE) and determined the risk factors provoking psychiatric adverse events. METHODS: A 24-week, prospective, open-label study was conducted. At enrollment, we interviewed patients and reviewed their medical charts to collect demographic and clinical information. They were asked to complete self-report health questionnaires designed to measure various psychiatric symptoms and QOL at enrollment and 24 weeks later. RESULTS: Seventy-one patients were included in the study, 12 patients (16.9%) of whom discontinued LEV therapy due to serious adverse events including suicidality. The risk factor for premature withdrawal was a previous history of psychiatric diseases (odds ratio 4.59; 95% confidence interval, 1.22-17.32). LEV intake resulted in significant improvements in Beck Anxiety Inventory score (p<0.01) and some domains of the Symptom Checklist-90-Revised, such as somatization (p<0.05), obsessive-compulsiveness (p<0.05), depression (p<0.05), and anxiety (p<0.05). These improvements were not related to the occurrence of seizure freedom. The Quality of Life in Epilepsy Inventory-31 overall score and subscale scores, such as seizure worry (p<0.01), overall QOL (p<0.05), emotional well-being (p<0.05), energy-fatigue (p<0.05), and social function (p<0.05), also improved. CONCLUSIONS: Adjunctive LEV in patients with DRE is likely to improve psychiatric symptoms and QOL. Clinicians should be well aware of the psychiatric histories of patients to prevent them from developing serious adverse events related to LEV.