Cortico-Cortical Modulation Induced by 1-Hz Repetitive Transcranial Magnetic Stimulation of the Temporal Cortex

BACKGROUND AND PURPOSE: Repetitive transcranial magnetic stimulation (rTMS) has potential as a noninvasive neuromodulation treatment method for various neuropsychiatric disorders, and repeated sessions of rTMS are more likely to enhance the therapeutic efficacy. This study investigated neurophysiologic and spatiodynamic changes induced by repeated 1-Hz rTMS of the temporal cortex using transcranial magnetic stimulation (TMS) indices and fluorodeoxyglucose positron emission tomography (FDG-PET). METHODS: Twenty-seven healthy subjects underwent daily 1-Hz active or sham rTMS of the right temporal cortex for 5 consecutive days. TMS indices of motor cortical excitability were measured in both hemispheres daily before and after each rTMS session, and 2 weeks after the last stimulation. FDG-PET was performed at baseline and after the 5 days of rTMS sessions. RESULTS: All subjects tolerated all of the sessions well, with only three of them (11.1%) reporting mild transient side effects (i.e., headache, tinnitus, or local irritation). One-Hz rTMS decreased motor evoked potential amplitudes and delayed cortical silent periods in the stimulated hemisphere. Statistical parametric mapping of FDG-PET data revealed a focal reduction of glucose metabolism in the stimulated temporal area and an increase in the bilateral precentral, ipsilateral superior and middle frontal, prefrontal and cingulate gyri. CONCLUSIONS: Repeated rTMS sessions for 5 consecutive days were tolerated in all subjects, with only occasional minor side effects. Focal 1-Hz rTMS of the temporal cortex induces cortico-cortical modulation with widespread functional changes in brain neural networks via long-range neural connections.

Erratum: Cortico-Cortical Modulation Induced by 1-Hz rTMS of the Temporal Cortex

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Peri-ictal Heart Rate Changes in Patients With Localization-Related Epilepsy

BACKGROUND: Epileptic seizures can be associated with changes in autonomic functions. This study evaluated heart rate (HR) changes at the transition from the preictal to the ictal state in patients with epileptic seizures, and investigated whether peri-ictal HR changes can help to predict electroencephalography (EEG) seizures prior to their onset. METHODS: We retrospectively studied 94 seizures in 33 patients who underwent video-EEG monitoring with scalp EEG and electrocardiography. The existence and initial timing of HR changes relative to the onset of EEG seizures were determined by analyzing consecutive RR-interval changes in 10-minute recordings. We evaluated the correlation between the peri-ictal HR changes and the type of localization-related epilepsy. RESULTS: Peri-ictal HR changes were documented in 70.2% (66/94) of all seizures, of which 62 were tachycardia (66.0%) and 4 were bradycardia (4.3%). Peri-ictal tachycardia occurred significantly with seizures as an ictal manifestation, more often in seizures with a right hemispheric onset than in those with a left hemispheric onset (77.4% vs. 50%, p=0.016). Peri-ictal HR changes were observed much earlier in seizures of mesial temporal lobe epilepsy (TLE) than in those of extratemporal lobe epilepsy (-54.4 s vs. -6.7 s, p<0.001). CONCLUSIONS: Peri-ictal HR changes were observed in 70.2% of seizures, 94% of which were tachycardia. These changes could be helpful in predicting seizure onset, especially in mesial TLE.

Predictive Factors of Neurologic Outcome in Patients With Hypoxic-Ischemic Encephalopathy After Cardiopulmonary Resuscitation

BACKGROUND: Cardiopulmonary resuscitation (CPR) can lead to various neurologic outcomes in patients with hypoxicischemic encephalopathy (HIE). This study investigated the usefulness of clinical markers and electroencephalography (EEG) in predicting the neurologic prognosis of HIE after CPR. METHODS: We reviewed the clinical findings of 51 patients with HIE, including the medical history, the duration from the onset of symptoms to the recovery of spontaneous circulation, Glasgow Coma Scale (GCS) and Full Outline of Unresponsiveness (FOUR) scores, and presence of seizure or status epilepticus. Patients were divided into three outcomes groups: death, persistent vegetative state, and recovering alertness and awareness. Digital EEG and visual and quantitative analyses were performed in each patient. For quantitative EEG (qEEG) analysis, we defined and compared the distance in the spatial band-power patterns and phase coherence patterns between healthy normal subjects and each patient. RESULTS: Patients with HIE showed a high mortality rate (54.9%, 28/51), and their neurologic prognosis was significantly related to the initial GCS and FOUR scores. In the qEEG analysis, patients' groups showed a prominent delta frequency band, and the healthy normal group presented a marked alpha predominance. As the severity decreased, the similarity in the spatial band-power pattern and functional connectivity pattern between normal subjects and patients increased. CONCLUSIONS: Low initial GCS and FOUR scores could be predictive of a poor neurologic prognosis in patients with HIE, and qEEG analysis might be a useful predictor of their neurologic outcomes.

The Surgical Treatment of Non-Visualizing Tuberculous Kidney / 대한비뇨기과학회지

A clinical observation was made on 19 cages of nonvisualizing tuberculous kidney, who were admitted to national medical center during the period from January, 1981 to April, 1982. Following results were obtained. 1. Most common age group were from 3rd to 5th decade. 2. Most frequent symptom or complaint was grose hematuria and this was subsided after operation. 3. In laboratory findings, pyuria 178.9% and microscopic hematuria (78.9%) were identified. 4. The most common other site of tuberculosis was lung about 12 cases. 5. In microbiologic study for 24hr urine and caseous material from kidney, following answers were given. 1) 24hr urine AFB smear :+: 8cases Tuberculosis culture :+: 4cases 2) Caseous materiel from kidney AFB smear :+: 10 cases Tuberculosis culture :+: 2cases. 6. R.G.P. was tired in all cases, but could not insert the ureteral catheter due to ureteral stricture in 14 cases. 7. All cases of nonvisualizing kidneys were removed.

A Clinical Observation on Perinephric Abscess (II) / 대한비뇨기과학회지

We reviewed retrospectively 15 cases of perinephric abscess from 1970 to 1982 and compared these results to previously published data from 1970 to 1977 (Report I) 1. The organisms causing abscesses were determined as follows: S. aureus was in 7 cases (46%), E. coil in 4 cases (27%), Klebsiella in 2 cases (13%), Acinetobacter in 2 cases (13%), In addition, three patients had multiple abscess pathogens. 2. Laboratory evaluation revealed as follows: Pyuria was present in 4 cases (27%), Blood culture were positive in 2 cases (13%) and urine culture was positive in one case. The organisms isolated from blood and urine were felt to be the organism causing the abscesses. 3. There is no remarkable change in species of sensitive drugs, when comparing with that of previous Report I . 4. Four cases had underlying renal diseases (3 in chronic pyelonephritis and 1 in renal injury) and two cases had associated conditions (1 in impetigo and 1 in diabetes)

Combined Retrocaval Ureter and Benign Testicular Tumor / 대한비뇨기과학회지

Retrocaval ureter is a rare venous congenital anomaly. We experienced a case of this anomaly, which combined with benign testicular tumor in 21 year old. man. I.V.P, vena cavogram and abdominal C.T were performed. Abdominal C.T was a precise and non-invasive method in the confirming of this anomaly, replacing the vena cavogram, if there remained the moderate degree of Rt. renal function. Now, we introduce the finding of abdominal C.T. in retrocaval ureter.

Combined Retrocaval Ureter and Benign Testicular Tumor / 대한비뇨기과학회지

Retrocaval ureter is a rare venous congenital anomaly. We experienced a case of this anomaly, which combined with benign testicular tumor in 21 year old. man. I.V.P, vena cavogram and abdominal C.T were performed. Abdominal C.T was a precise and non-invasive method in the confirming of this anomaly, replacing the vena cavogram, if there remained the moderate degree of Rt. renal function. Now, we introduce the finding of abdominal C.T. in retrocaval ureter.

Clinical Observation on Non-visualizing Kidney / 대한비뇨기과학회지

We reviewed 67 cases of non-visualizing from September, 1979 to August, 1981. Among these, renal tuberculosis was the most common cause of non-visualizing kidney and renal or ureteral stone was thenext in number.