The Factors Related to Intractability in Patients with Partial Epilepsy / 영남의대학술지

To evaluate the intractability of partial epileptic patients by variables, the author studied 113 patients (uncontrolled: 45, controlled: 68) who were admitted to the Department of Neurology, College of Medicine, Yeungnam University from January, 1991 to August, 1993. The results were as follows. The items related to complex partial seizures, multiple seizure types and a histories of status epilepticus or clusters of seizures were significantly associated with drug-refractoriness (p<0.01). A high frequency of seizures before evaluation was associated with a poor outcome(p<0.01). The presences of known etiology of seizures, neurologic abnormalities and psychiatric disturbance were associated with limited treatment responses(p<0.01, p<0.05, p<0.01). An abnormal EEG findings such as background slowing, focal slowing, epileptiform discharges or secondarily bilateral synchrony were statistically significant (p<0.01). Age at onset, sex, distribution of epileptic foci, duration of seizure before evaluation, family history and abnormal neuroradiologic findings were not statistically significant. By these results, it was suggested that having at least four factors of the above variables were associated with limited treatment response.

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.

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.

Endocrine Study on Menstrual Irregularities in Wilson's Disease

We have investigated endocrine functions of 2 patients with Wilson's disease who showed oligomenorrhea or amenorrhea, The serum basal levels of hypothalamic, pituitary, thyroid, adrenal cortical and ovarian hormones were determined. Then stimulation tests were performed with GnRH(50 microgram/m2), TRH(7 microgram/Kg) and insulin(0.l U/Kg) in one intravenous bolus, Levels of LH, FSH, prolactin, GH, TSH, total testosterone, l7 beta-estradiol, free T3, T4, DHEA-S and cortisol were measured by standard radioimmunoassays. The endocrine profiles which represent functions of hypothalamus, pituitary, thyroid and adrenal cortex was all proved to be normal. Serum estradiol and total testosterone levels were 59.0 microgram/ml ( normal ; 60-130 microgram/ml) and 2.9 ng / dl (normal ; 0.l5-1.1 ng/dl) in one case, and 20.5 microgram / ml and 0.69 ng / dl in the other respectiviely. Low estradial and high total testosterone levels seen in these cases suggested ovarian dysfuncton. Interference of ovarian follicular aromatase activity due to passible copper intoxication could explain these findings as the cause of the menstrual irregularity of patients with Wilson's disease.