Consideration for Coronavirus Disease 2019 Drug Treatment in Patients with Epilepsy on Antiepileptic Drugs

Several medications are approved to treat coronavirus disease 2019 (COVID-19) in Korea including nirmatrelvir/ritonavir, remdesivir, and regdanvimab. There is potential drug-drug interaction between antiepileptic drugs (AEDs) and the medications used to treat COVID-19. Several AEDs such as phenytoin, carbamazepine, phenobarbital, and primidone are strong cytochrome P450 inducers and can inhibit the drugs used for COVID-19. Particularly, these drugs are contraindicated with nirmatrelvir/ritonavir (Paxlovid®). There is a weaker drug-drug interaction between the AEDs and remdesivir. No significant interaction has been reported between the AEDs and molnupiravir. Pharmacokinetic interactions of the AEDs are important in effective management of COVID-19 in patients with epilepsy.

Central Neurocytoma Presenting as Symptomatic Cataplexy

Central neurocytomas are well-differentiated tumors and are typically found in intraventriculat lesion in adult. We report a rare case of central neurocytoma presenting as symptomatic cataplexy. A 50-year-old man visited our hospital due to repetitive drop down triggered by emotional changes and was diagnosed of central neurocytoma at right lateral ventricles and head of caudate nucleus. Alterations of striatal dopaminergic system in narcolepsy with cataplexy have been reported, but there are no reports associated with single lesion. This case suggests the striatal lesion plays a role in cataplexy.

Clinical Characteristics of Non-Amnestic Mild Cognitive Impairment: A Single-Center Experience

BACKGROUND: To evaluate the clinical characteristics of patients with non-amnestic mild cognitive impairment (naMCI) in a memory disorder clinic at a single center. METHODS: A retrospective study was conducted involving 312 patients with naMCI from May 2011 to July 2018. Brain magnetic resonance imaging and detailed neuropsychological tests were performed in all patients. We used the proposed criteria for naMCI to classify the patients into single- and multiple-domain groups. We compared the baseline clinical characteristics, neuroimaging findings, and the rate of progression to dementia between these two groups. RESULTS: The 312 patients comprised 210 in the single-domain group (67.3%) and 102 in the multiple-domain group (32.7%). The mean age was significantly higher in the multiple-domain group than in the single-domain group. The years of education, mean Mini Mental State Examination score, and mean Clinical Dementia Rating Scale Sum of Boxes score were significantly lower in the multiple-domain group than in the single-domain group. The Z-scores of neuropsychological tests in most cognitive domains were significantly lower in the multiple-domain group than in the single-domain group. Compared to the single-domain group, the multiple-domain group showed more-severe medial temporal atrophy and contained a higher proportion of patients with moderate white-matter hyperintensities. Thirteen (8.4%) patients with naMCI progressed to dementia, most of who were diagnosed with Alzheimer's disease. CONCLUSIONS: We present a single-center experience of clinical characteristics in patients with naMCI. Close observation of the clinical profiles of patients with naMCI may help identify individuals at the greatest risk of dementia.

Hematoma-Related Nonhabitual Seizures during Subdural Electrode Monitoring

No abstract available.

A Case of Restless Legs Syndrome in Patient with Neurogenic Sciatic Nerve Tumor

Restless legs syndrome (RLS) is chronic neurological disorder, in which the primary symptoms is unpleasant and disturbing sensation accompanied by urge to move in multiple body parts especially in legs. RLS may present in distinct phenotypes often described as “primary” vs. “secondary.” Secondary RLS can arise from etiologies such as iron deficiency, pregnancy, peripheral neuropathy, and end-stage renal disease. We report a rare case of RLS associated with neurogenic tumor of the sciatic nerve. A 72-year-old man complained of recurrent and worsening RLS symptoms in his right lower extremity, despite medical treatment. Interestingly, we found a neurogenic tumor at the right greater sciatic notch region on magnetic resonance imaging of the hip.

Prevalence of Self-Perceived Snoring and Apnea and Their Association with Daytime Sleepiness in Korean High School Students

BACKGROUND AND PURPOSE: There has been no nationwide population-based study of the prevalence of self-perceived snoring/apnea in Korean adolescents. The purpose of this study was to estimate prevalence of self-perceived snoring/apnea in Korean high-school students and to evaluate their association with daytime sleepiness. METHODS: An online survey was used to investigate 12,672 students at 75 high schools across the 15 nationwide districts of South Korea. The variables were obtained using a self-reported questionnaire. The students answered questions about self-perceived snoring/apnea during the past 30 days. Daytime sleepiness was measured using a validated Korean version of the Epworth Sleepiness Scale, which was modified for adolescents. Covariates were the sex, school grade, frequency of self-perceived snoring/apnea, body mass index, sleep duration during a school day, and subjective perception of sleep duration. RESULTS: The prevalence of self-perceived snoring/apnea was 22.8% (26.4% for males vs. 18.8% for females, p<0.001) and 9.2% (10.5% for males vs. 7.7% for females, p<0.001). Obesity was significantly associated with self-perceived snoring [odds ratio (OR)=2.18, 95% confidence interval (CI)=1.94–2.46] and apnea (OR=1.57, 95% CI=1.33–1.86). Multivariate analysis showed that any frequency of self-perceived snoring/apnea was significantly associated with excessive daytime sleepiness (EDS). The OR of EDS increased significantly with the frequency of snoring and apnea. Female, sleep duration of <5 hours during a school day, and subjective perceptions of insufficient and considerable sleep durations were also significantly associated with EDS. CONCLUSIONS: The prevalence of self-perceived snoring/apnea was significantly higher in students who were male and obese. Students with self-perceived snoring/apnea exhibited more significant EDS and an increased risk of EDS as the frequency of snoring and apnea increased.

Frequency of Depression and Suicidality in Patients with Neurological Disorders: Epilepsy, Parkinson's Disease, and Ischemic Stroke

BACKGROUND: Depression and suicide are common in neurological disorders. However, their reported frequencies have varied widely due to heterogeneities in methodology and assessment timing. We evaluated the frequencies of current depression and suicidality in patients with epilepsy, Parkinson's disease (PD), and ischemic stroke (IS). METHODS: We enrolled patients who visited a tertiary care hospital in Seoul between January and December 2013. All of the patients completed the Beck Depression Inventory (BDI) and the Hospital Anxiety and Depression Scale-Depression subscale (HADS-D). Any patient with depressive symptoms (defined as a total HADS-D or BDI score of ≥9 or ≥17, respectively) was reassessed with a structured psychiatric interview based on the Mini International Neuropsychiatric Interview Plus 5.0.0 (MINI). RESULTS: In total, 305 patients were recruited, comprising epilepsy (n=92, 30.2%), PD (n=99, 32.4%), and IS (n=114, 37.4%). Depressive symptoms were exhibited by 52 epilepsy patients (56.5%), 56 PD patients (56.6%), and 54 IS patients (47.4%), and these were further evaluated with the aid of the MINI. Seven epilepsy patients were diagnosed as major depressive disorder (MDD), five as dysthymic disorder (DD), and nine as depressive disorder not otherwise specified (DDNOS). Twelve PD patients were diagnosed as MDD, 7 as DD, and 10 as DDNOS. Ten stroke patients were diagnosed as MDD, 7 as DD, and 11 as DDNOS. Most patients with depressive symptoms (91.4%) exhibited suicidality. CONCLUSIONS: Patients with epilepsy, PD, and IS frequently exhibit depression and suicidality. Neurologists should always be concerned about comorbid psychiatric problems when they see patients with neurological disorders.

Solid Cerebellar Hemangioblastoma with Peritumoral Edema: 5-Years Follow up

Hemangioblastomas are angioblastic tumors of the central nervous system. Cerebellar hemangioblastomas are traditionally classified into two morphologic types-cystic and solid. Cystic hemangioblastomas are associated with peritumoral edema, but solid hemangioblastomas are not. We report a case of solid cerebellar hemangioblastoma with massive peritumoral edema. An 83-year-old female visited our hospital due to a sudden headache. Five years ago, she had been admitted to our hospital with similar headache and diagnosed with cerebellar hemangioblastoma. Follow-up brain MRI 5 years later showed an increased size of a homogeneous enhancing mass with aggravated peritumoral edema in the left lower cerebellar hemisphere. Cerebral angiography showed a highly vascularized mass in the cerebellum, which was compatible with a solid-type hemangioblastoma.

Isolated Weakness of Radial-side Fingers Due to a Small Cortical Infarction

Predominant involvement of a particular group of fingers due to a central nervous system lesion has been described as pseudoperipheral palsy. Two patients visited our hospital with isolated weakness of a particular group of fingers due to small cortical infarctions. A 51-year-old woman suddenly developed weakness in her left index and middle fingers. The brain MRI showed a small infarct in the right frontal cortex. A 67-year-old man was sudden difficulty using his chopsticks and had weakness in his right thumb and index finger. The brain MRI showed a small infarct in the left precentral cortex.

Is High IQ Protective Against Cognitive Dysfunction in Narcoleptic Patients?

BACKGROUND AND PURPOSE: The aims of this study were to elucidate the cognitive functions of narcoleptics and determine whether intelligence protects against cognitive dysfunction and depressive mood in these patients. METHODS: Sixty-six subjects (33 narcoleptics, 33 controls) were administered a battery of neuropsychological tests and an individual standardized intelligence test. The cognitive functions of the narcoleptic patients and the healthy controls were compared, as were those of high-IQ and mid-to-low-IQ narcoleptic patients. RESULTS: Narcoleptics exhibited significantly lower scores in the Corsi Block-Tapping Test forward and backward, and the digit symbol tests, and significantly higher Beck Depression Inventory scores than the controls. However, verbal attention, verbal-visual long-term memory, and executive function task scores did not differ significantly between patients and controls. The mid-to-low-IQ patient group had lower mean digit span backward test, phonemic and semantic fluency Controlled Oral Word Association Test and Korean version of the Boston Naming Test scores, and a higher total score and general depressive symptoms subscales Beck Depression Inventory score than the high-IQ patient group. However, controls exhibited no IQ-related differences in cognitive performance or depressive mood. Patients in the high-IQ group exhibited impaired visual attention and working memory as compared with controls. CONCLUSIONS: The findings of the present study show that narcolepsy patients have deficits in visual attention and visual working memory, and tend to feel more general depressive symptoms but not somatic symptoms than their control, nonnarcoleptic counterparts. In addition, it appears that higher intelligence protects against cognitive dysfunction and depressive mood.

Prediction of Hemorrhagic Transformation and Functional Outcome Using HAT Score in Acute Ischemic Stroke Patients Treated with Intravenous Alteplase

BACKGROUND: Intravenous thrombolysis with alteplase is the most effective therapy for acute ischemic stroke, but hemorrhagic transformation (HT) is a potentially dangerous complication of such thrombolysis. Few studies have investigated the predictors of HT after thrombolysis in Korean stroke patients. METHODS: From 2003 to 2009, acute ischemic stroke patients who received intravenous alteplase were included from the prospective stroke registry of Kyung Hee University Hospital. Patients submitted to CT or MRI scans with gradient echo sequences within 12-36 hours of thrombolysis. The Hemorrhage After Thrombolysis (HAT) score [ranging from 0 (minimum risk) to 5 (maximum risk)] was calculated retrospectively for each patient. The predictive ability of the HAT score for HT and symptomatic intracranial hemorrhage (sICH) was calculated using C statistics. RESULTS: Among 151 consecutive patients, HT was confirmed in 35 on follow-up brain imaging. Atrial fibrillation (OR=2.709, 95%CI=1.118-6.567) and low one-third CT scan (OR=3.419, 95%CI=1.281-9.121) increased the risk of HT after intravenous thrombolysis in multivariate logistic regression analysis. HT, sICH (based on the National Institute of Neurological Disorders and Stroke and the Safe Implementation of Treatment in Stroke-Monitoring Study definitions), unfavorable [modified Rankin Scale (mRS) score of 2-6] and poor (mRS score of 3-6) outcomes at 3 months, and mortality at 3 months were increased with higher HAT scores (C statistic=0.632, 0.637, 0.843, 0.670, 0.689, and 0.659, respectively; p=0.018, 0.036, 0.042, 0.002, 0.015, and <0.001). CONCLUSIONS: The HAT score can be used to predict the risk of sICH following intravenous thrombolysis and the long-term clinical outcome.

Status Epilepticus in Influenza A (H1N1) Viral Encephalitis

There has been a worldwide pandemic infection of influenza A (H1N1) since June 2009. A 23-year-old female presented with fever and sore throat and was diagnosed as having influenza A (H1N1) infection. After 2 days of illness, she had headache, nausea, and neck stiffness. Cerebrospinal-fluid findings were consistent with viral infection, and brain MRI revealed intense signals in both frontotemporal cortices. During her illness she developed repetitive seizures, which were considered to be status epilepticus.