A Case of Late Postpartum Eclampsia 14 Days after Delivery / 대한간질학회지

Eclampsia is a syndrome characterized by pregnancy-induced hypertension, edema, proteinuria, and generalized tonic-clonic convulsions, occurring between 20 and 40 weeks of gestation or within 48 hours of postpartum. A convulsion that shows up more than 48 hours after delivery is late postpartum eclampsia. A 40-year-old woman was admitted due to a headache and generalized tonic-clonic seizures in 14 days of postpartum. Two months prior to the admission, she had been admitted to the hospital because of mild proteinuria. Her blood pressure on arrival was 160/100 mmHg. There were no focal neurologic signs. She was given lorazepam and valproate sodium intravenously and her convulsion was stopped. A brain MRI showed multiple bilateral high signal intensities in the both deep white matter and the parieto-occipital cortex. Cerebral angiography showed a diffuse vasospasm. We report a patient with late postpartum eclampsia occurring 14 days after parturition whose seizures was accompanied by preceding headache and proteinuria as a pre-eclamptic sign.

Electrophysiological Abnormalities in a Patient with Acute Methyl Bromide Poisoning

No abstract available.

A Case of Adult-onset Rasmussen's Encephalitis Responsive to High-dose Steroid and Antiepileptic Medication

Rasmussen's encephalitis is a rare autoimmune disorder characterized by intractable epilepsy and progressive unilateral hemispheric dysfunction as well as mental deterioration. Although the disorder typically begins in childhood, a few cases have been reported with symptom onset in adulthood showing variable clinical characteristics. We report a 63-year-old woman with adult-onset partial seizure with intermittent secondary generalization, progressive right hemiparesis, and aphasia, who showed positive response to high-dose steroid and antiepileptic drugs.

A Case of Neuropsychiatric Lupus Presenting as Guillain-Barre Syndrome and Cerebral Infarction / 대한류마티스학회지

Systemic lupus erythematosus (SLE) is a disease of unknown etiology in which tissues and cells damaged by pathogenic autoantibodies and immune complexes. Nervous system involvement in patients with SLE encompasses a wide spectrum of neurologic and psychiatric features and the frequency of neuropsychiatric manifestations has been estimated at around 25% to 70%. American College of Rheumatology Ad Hoc Committee on neuropsychiatric lupus nomenclature developed case definitions for 19 different neuropsychiatric manifestations observed in SLE in 1999. Among them, Guillain-Barre syndrome and cerebral infarction are very rare neuropsychiatric manifestation. We experienced a 28-year-old woman with neuropsychiatric lupus which presented as Guillain-Barre syndrome and cerebral infarction. She was recovered after treatment with intravenous immunoglobulin, high dose methylprednisolone, cyclophosphamide and anticoagulants.

Effect of Combination of Ictal Scalp EEG and Seizure Semiology on Seizure Lateralization in Temporal Lobe Epilepsy / 대한간질학회지

PURPOSE: To compare the reliability of lateralization between seizure semiology and ictal scalp EEG findings in mesial temporal lobe epilepsy (MTLE) patients, and to examine the advantage of the combined use of these two methods. METHODS: We independently reviewed the ictal scalp EEG recordings and clinical seizure semiology of 243 seizures recorded in 58 consecutive MTLE patients. All patients were seizure-free for at least 1 year postoperatively. Each seizure was lateralized on the basis of ictal semiology and ictal scalp EEG patterns according to strictly defined criteria, respectively. Individual patients were also lateralized based on these data. RESULTS: Seizure semiology analysis lateralized 64.6 % of seizures and 82.8 % of patients. Ictal scalp EEG analysis lateralized 74.5% of seizures and 74.1% of patients. Combination of the information from the two methods allowed for lateralization in a greater portion of both seizures (79.8%) and patients (89.7%). CONCLUSION: This study suggests that combination of ictal scalp EEG findings and seizure semiology improves the lateralization of individual seizures and patients. Therefore, it is worth lateralizing with standardized combined ictal EEG and semiology analysis for noninvasive presurgical evaluation in TLE patients.

Two Cases of Methyl Bromide Intoxication with Seizures and Altered Mental State / 대한간질학회지

Methyl bromide is presently used as a fumigant for insects in soil, grains or fruit in storage or transport. It is a neurotoxic agent and has been responsible a number of deaths or acute poisonings among occupationally exposed persons. We report 2 patients, who had worked fumigation warehouse, presented with seizures and altered mental state. The serum concentrations of bromide were elevated 32.9 and 42.5 mg/l, respectively. Brain MRI showed bilateral symmetric high signal intensities in the splenium of corpus callosum, the globus pallidus, the quadrigeminal plate, the periaqueductal gray matter, the red nucleus, the substantia nigra, the medial lemniscus, the pontine tegmentum, the dentate nucleus, and the medulla. There was no brain lesion in the other patient. Appropriate and supervised handling of the chemical and regular education to workers are important to avoid the risk of methyl bromide poisoning.

A Case of Adult Neuronal Ceroid-Lipofuscinosis, Proven by Brain Biopsy

A 20-year-old woman was admitted because of intractable seizures, myoclonus, gait ataxia, and severe intellectual deterioration with age of onset at 16 years. She had no family history of neurological disease. A thorough laboratory investigation was unremarkable. Brain MRI showed generalized cerebral and cerebellar atrophy. Interictal EEG showed intermittent generalized polyspike and waves, maximum on the bilateral parieto-occipital areas, and MNSEP showed giant cortical SEP. Brain biopsy revealed intraneuronal accumulation of granular osmiophilic deposits (GROD), which is characteristic of electromicroscopic findings of neuronal ceroid lipofuscinosis (NCL). We report biopsy-proven adult NCL, which is one of the rare neurodegenerative diseases. (J Korean Neurol Assoc 19(1):45~48, 2001

Symptomatic Hyponatremia Induced by Oxcarbazepine: 2 Cases / 대한간질학회지

Although oxcarbazepine (OXC)-induced hyponatremia is usually asymptomatic, it can lead to serious complications. We reports two cases of symptomatic hyponatremia induced by OXC. First case was 39-year-old female with partial epilepsy who developed the exceeding tiredness, headache, and seizures under OXC with a serum sodium level of 121 mEq/L. After the discontinuation of OXC, serum sodium was normalized and the clinical symptoms disappeared. Second case was 48-year-old female with partial epilepsy who complained of the fluctuating tiredness and fatigability, and then eventually developed seizures after OXC was increased in dosage. At that time, serum sodium was 121 mEq/L. She remained asymptomatic with normal level of serum sodium even if OXC was maintained with topiramate. Our cases may suggest that symptomatic hyponatremia is not rare unlike the results from previous studies. Therefore, clinician should be alert to mild symptoms such as headache, lethargy, and tiredness in patients treated with OXC.

Neuropsychological Characteristics of Mesial Temporal Lobe Epilepsy:Lesion Laterality-Sex Interaction

BACKGROUND: We investigated the neuropsychological features of laterality-sex interactions in mesial temporal lobe epilepsy (MTLE), using a broad and comprehensive neuropsychological test battery. METHODS: Eighty-nine consecutive patients (female 46) with MTLE (left 46) were included in the study. They underwent anterior temporal lobectomy and became seizure-free for at least one year postoperatively. All patients had a language dominancy in the left hemisphere. The following neuropsychological tests including : Korean Wechsler Intelligence Scale (KWIS), Wechsler Memory Scale-Revised (WMS-R), Wisconsin Card Sorting Test (WCST), and Color Trails Test (CTT), were performed preoperatively. Each variable of the neuropsychological tests were analyzed with regard to laterality-sex interactions. RESULTS: General memory, verbal memory, and delayed recall of WMS-R and a executive function measured by WCST were significantly decreased in patients with left MTLE compared to those with right MTLE. However, this laterality effect especially on verbal memory and some variables of WCST including the number of category completed was observed only in female patients. Interference index of CTT had a tendency to be increased in the male patients with right MTLE. The intelligence scale of KWIS was not correlated with lesion laterality or sex. CONCLUSIONS: Laterality-sex interactions were evident for verbal memory and an executive function in female patients with MTLE. Further studies need to be done on these neuropsychological features. (J Korean Neurol Assoc 19(2):132~138, 2001)

Hyponatremia Associated with Oxcarbazepine: Cross-Sectional Study

BACKGROUND: Renewed attention was focused on hyponatremia when oxcarbazepine (OXC) was introduced. Although OXC-induced hyponatremia is usually asymptomatic, it can lead to serious complications. We estimated the frequency of hyponatremia in patients treated with OXC and investigated its risk factor in the Korean population. METHODS: A cross-sectional study was carried out in 59 patients receiving OXC and 71 patients receiving carba-mazepine (CBZ). Hyponatremia was defined as serum sodium levels less than 135 mEq/L. Data from our patients were examined to ascertain the characteristics of OXC-induced hyponatremia. RESULTS: In the Korean population, the frequency of OXC-induced hyponatremia was 15% (9 out of 59) including 2 symptomatic patients compared to 7% (5 out of 71) without symptomatic cases in CBZ treated patients. The mean serum sodium level in OXC-treated patients was significantly lower than that in CBZ-treated patients. Sex was significantly related to serum sodium levels in both OXC-and CBZ-treated patients. OXC-induced hyponatremia was more frequently observed in females. Age, dosage, and polytherapy were probably not predisposing risk factors in both OXC- and CBZ-induced hyponatremia. CONCLUSIONS: In the Korean population, the prevalence of both OXC- and CBZ-induced hyponatremia seems to be lower than those in other countries. However, the symptomatic cases of OXC-induced hyponatremia are not rare compared to those in foreign countries. We therefore, strongly encourage the monitoring of sodium levels during OXC therapy especially in female patients. (J Korean Neurol Assoc 19(2):139~142, 2001)

Neuropsychological Characteristics of Mesial Temporal Lobe Epilepsy:Lesion Laterality-Sex Interaction

BACKGROUND: We investigated the neuropsychological features of laterality-sex interactions in mesial temporal lobe epilepsy (MTLE), using a broad and comprehensive neuropsychological test battery. METHODS: Eighty-nine consecutive patients (female 46) with MTLE (left 46) were included in the study. They underwent anterior temporal lobectomy and became seizure-free for at least one year postoperatively. All patients had a language dominancy in the left hemisphere. The following neuropsychological tests including : Korean Wechsler Intelligence Scale (KWIS), Wechsler Memory Scale-Revised (WMS-R), Wisconsin Card Sorting Test (WCST), and Color Trails Test (CTT), were performed preoperatively. Each variable of the neuropsychological tests were analyzed with regard to laterality-sex interactions. RESULTS: General memory, verbal memory, and delayed recall of WMS-R and a executive function measured by WCST were significantly decreased in patients with left MTLE compared to those with right MTLE. However, this laterality effect especially on verbal memory and some variables of WCST including the number of category completed was observed only in female patients. Interference index of CTT had a tendency to be increased in the male patients with right MTLE. The intelligence scale of KWIS was not correlated with lesion laterality or sex. CONCLUSIONS: Laterality-sex interactions were evident for verbal memory and an executive function in female patients with MTLE. Further studies need to be done on these neuropsychological features. (J Korean Neurol Assoc 19(2):132~138, 2001)

Hyponatremia Associated with Oxcarbazepine: Cross-Sectional Study

BACKGROUND: Renewed attention was focused on hyponatremia when oxcarbazepine (OXC) was introduced. Although OXC-induced hyponatremia is usually asymptomatic, it can lead to serious complications. We estimated the frequency of hyponatremia in patients treated with OXC and investigated its risk factor in the Korean population. METHODS: A cross-sectional study was carried out in 59 patients receiving OXC and 71 patients receiving carba-mazepine (CBZ). Hyponatremia was defined as serum sodium levels less than 135 mEq/L. Data from our patients were examined to ascertain the characteristics of OXC-induced hyponatremia. RESULTS: In the Korean population, the frequency of OXC-induced hyponatremia was 15% (9 out of 59) including 2 symptomatic patients compared to 7% (5 out of 71) without symptomatic cases in CBZ treated patients. The mean serum sodium level in OXC-treated patients was significantly lower than that in CBZ-treated patients. Sex was significantly related to serum sodium levels in both OXC-and CBZ-treated patients. OXC-induced hyponatremia was more frequently observed in females. Age, dosage, and polytherapy were probably not predisposing risk factors in both OXC- and CBZ-induced hyponatremia. CONCLUSIONS: In the Korean population, the prevalence of both OXC- and CBZ-induced hyponatremia seems to be lower than those in other countries. However, the symptomatic cases of OXC-induced hyponatremia are not rare compared to those in foreign countries. We therefore, strongly encourage the monitoring of sodium levels during OXC therapy especially in female patients. (J Korean Neurol Assoc 19(2):139~142, 2001)

Neuropsychological Characteristics of Mesial Temporal Lobe Epilepsy: Lesion Laterality-Sex Interaction

BACKGROUND: Memory changes and its predictors after anterior temporal lobectomy (ATL) were investigated. A standardized regression-based (SRB) outcome methodology was used, accounting for the effects of practice and preoperative memory functions. METHODS: Consecutive 45 ATL patients (male 22) with mesial temporal sclerosis (dominant 21) who became seizure-free for at least 1 year postoperatively were included in the study. Wechsler Memory Scale-Revised(WMS-R) was performed pre- and postoperatively. Memory changes were estimated using SRB norms and then were correlated with age of onset, seizure duration, chronological age, seizure risk factors, and preoperative memory function. RESULTS: 1) The majority of cases (76~84%) showed no significant memory changes. Significant declines in verbal memory were noted for 8 (18%) out of 45 ATL patients whereas significant declines in visual memory were found in only 2 (4%). There were no differences in memory changes according to lesion laterality. 2) Later age at onset, shorter duration of epilepsy, absence of history of infection or febrile convulsion were significantly related to verbal memory decrease after ATL. 3) Using SRB methodology, adequacy of preoperative memory performance was correlated with decrease in visual memory but not in verbal memory, even if absolute change scores between pre-and postoperative values were associated with preoperative performances in both verbal and visual memory. CONCLUSIONS: Although group variability of memory outcome after ATL using WMS-R was not found to be significant, considerable individual variability of memory outcome after ATL was found along with significant predictors of postoperative verbal memory decrease. (J Korean Neurol Assoc 19(3):219~225, 2001)

Differentiation of Temporal Lobe Epilepsy by Scalp Ictal EEG and Its Correlation with Surgical Outcome / 대한간질학회지

PURPOSE: Ebersole and Pacia recently introduced a classification of scalp ictal EEG in temporal lobe epilepsy (TLE). So we investigated whether scalp ictal EEG without sphenoidal electrode can differentiate mesial TLE from neocortical TLE and can be predictive of surgical outcome after temporal lobectomy. METHODS: A consecutive 77 patients (male 43, female 34) with TLE were included who had temporal lobectomy after the comprehensive presurgical evaluation. The patients with mesial TLE were 59 and those with neocortical TLE 18. The total 358 seizures were analyzed using bipolar and monopolar montage without sphenoidal electrodes. Scalp ictal EEGs were categorized into 3 types based on Ebersole and Pacia's classification and then were evaluated with regard to the differentiation of TLE and its correlation with surgical outcome. RESULTS: 1) Out of the total 77 patients, type 1 pattern was observed in 23 (30%), type 2 in 51 (65%), and type 3 in 3 (5%). The number of patients with mesial TLE were 17 (74%) out of 23 with type 1, 41 (80%) out of 51 with type 2, 1 out of 3 with type 3. Type 1 pattern was relatively specific (74%) but not sensitive (30%) for mesial TLE. Also the lesion location of neocortical TLE with type 1 onset was not limited to medial temporal area. 2) Scalp ictal EEG patterns were significantly correlated with surgical outcome only in the subgroup of mesial TLE (p=0.006) but not in neocortical TLE. Type 1 onset pattern in mesial TLE was associated with favorable outcome comparing to type 2 onset. CONCLUSIONS: Scalp ictal EEG onset pattern cannot accurately differentiate mesial TLE from neocortical TLE. However, its onset pattern can be predictive of surgical outcome.

Postoperative Electroencephalogram and Seizure Outcome after Temporal Lobectomy in Mesial Temporal Lobe Epilepsy

BACKGROUND: The significance of the postoperative electroencephalogram (EEG) is not yet fully understood. We investigated whether the postoperative EEG is predictive of persistent seizures over time. METHODS: The postoperative 115 EEGs were retrospectively reviewed in 65 patients with mesial temporal lobe epilepsy who underwent temporal lobectomy. The EEGs were divided into 3 groups including the total EEGs, EEGs taken around 1 year after surgery, and EEGs taken around 2 years after surgery. The postoperative EEGs were studied with respect to persistent seizures at one point in time as well as over time. RESULTS: 1) Overall, spikes predicted persistent or recurrent seizures in 1 year after EEG was recorded (p<0.01) but not in 2 years (p=0.075). The subset of EEGs around 2 years after surgery was predictive of good outcome over time whereas EEGs around 1 year after surgery were not. 2) Overall, the presence of spikes were correlated with seizures at the time when the EEGs were recorded (p=0.000). The subset of EEGs around 2 years after surgery were associated with recurrence of seizures (p<0.05) whereas EEGs around 1 year after surgery were not. CONCLUSIONS: EEGs can be predictive of persistent or recurrent seizures at one point in time as well as over time. Their prognostic value, however, depends on the time interval after surgery to be recorded. EEGs around 2 years after surgery are superior in reflecting surgical outcome than EEGs around 1 year after surgery.

Kleine-Levin Syndrome: Two Cases

Kleine-Levin syndrome (KLS) is characterized by recurring episodes of hypersomnia, megaphagia, and abnormal behavior. We report two cases of KLS. Two boys, aged 18 (case 1) and 17 (case 2), had recurrent episodes of hyper-somnolence with compulsive eating or drinking and hypersexuality for several years. HLA-DR typing was HLA-DR3 and 13 in case 1 and HLA-DR4 and 10 in case 2. Case 1 showed hypersomnia with early onset of REM sleep on MSLT and frequent frontal intermittent rhythmic delta activity on EEG. Both cases showed no abnormalities on brain MRI. HLA-DR typing facilitates differentiation between KLS and narcolepsy by the absence of HLA-DR2.