Epilepsy and Driving / 대한간질학회지

BACKGROUND: Although the law to restrict the automobile driving of epilepsy patients is existed in Korea, it is not clear. We investigated the opinions of doctors who treat the epilepsy patients on this matter. METHODS: 296 doctors, including neurologists, neurosurgeons, psychiatrists, and pediatricians, participated in this survey. The questionnaire was composed of 15 questions. RESULTS: Their opinions are as follows : the regulation should be legislated (95.3%), the decision on the patient's driving must be done by the doctor (79.1%), the patient's driving is reported obligatorily (34.1%), the seizure free interval for license should be more than 24 months (61.1%), the renewal of the driving license needs to be done every other year, the escaping rebuke for the reporter is also needed (89.5%), and the draft for the law should be composed by the Korean Epilepsy Society (77%). CONCLUSIONS: Many doctors who treat the epilepsy patients agree that the new law to restrict the epilepsy patient's automobile driving is needed. The new law including general and individual restrictions, considering several conditions and made by Korean Epilepsy Society must be accepted by the patients and other members of the society.

Spinocerebellar Ataxia Type 6 in Two Korean Families

BACKGROUND: Spinocerebellar ataxia 6 (SCA6) is an autosomal dominant spinocerebellar degeneration and caused by the expansion of the polymorphic CAG repeat in the human alpha 1A voltage-dependent calcium channel subunit gene. In this study, we report the clinical and molecular genetic characteristics of SCA6 in 2 Korean families. We further describe that SCA6 and Episodic ataxia type 2 are simultaneously developed in same family showing no intergenerational changes of CAG repeat numbers. METHODS: Seventeen members of one family and nine of the other received detailed neurological examination and history taking at least one occasion. After the screening test, molecular diagnostic test by using Zhuchenko's method were performed in 13 patients in one family and 3 in the other, respectively. RESULTS: Normal range of CAG repeat in 92 normal individuals was 8 to 17. In this study, the numbers of CAG repeat in one family was 26 and in another was 23. There were no intergenerational differences in the numbers of CAG repeat. Despite the same number of CAG repeat, the clinical anticipation were found. Only one showed episodic ataxia clinically. CONCLUSIONS: Comparing with other types of SCA, the SCA6 had several remarkable characteristics: 1) very small CAG expansions (21-27 repeats) lead to clinical symptoms and the repeat numbers are relatively stable, 2) clinical anticipation is observed despite the relatively stable repeat on intergenerational transmission. The finidngs that an EA2 and a SCA6 exist in a same family may be suggest that two disease are the same disorder with a high phenotypic variablity.

A Case with Cerebral Radiation Necrosis Mimicking Recurrent Brain Tumor

Regardless of an appropriate radiation therapy administered to a patient with a brain tumor, clinical and radiological evidence of progression may still develop because of a recurrence of the tumor and/or radiation necrosis, or even rarely, a radiation induced neoplasm. The evaluation of tumor recurrence and radiation-induced necrosis presents a diagnostic challenge. A thirty eight year old woman was treated for a focal motor seizure on the right side of her face.with a fractionated external beam radiotherapy under the impression of cystic astrocytoma in the left frontoparietal region. After 6 months, she developed a headache, nausea and vomiting, dysphagia, and secondary generalized seizure. A follow-up brain MRI showed a high signal mass lesion in a T2 weighted image and a fluorodeoxyglucose PET revealed hypometabolism in the left frontoparietal lobe, suggesting radionecrosis. It was confirmed as radionecrosis with an expanding edema by open biopsy. We report a cerebral radiation necrosis mimicking recurrent brain tumor.

A Case of Vertebral Hemangioma Diagnosed with the Assistance of Tc-99m RBC SPECT

Vertebral hemangioma is a slow-growg, benign tumor which is often discovered incidentally during evaluation of neck or back pain.1,2 It is easily demonstrated by spine MRI, but in some cases did not show typical radiological appearance. In that case, Tc-99m RBC SPECT may be another confirmatory diagnostic tool. We report a case of vertebral hemangioma diagnosed with the assistance of Tc-99m RBC SPECT.