Gender differences in seizure recurrence and antiepileptic drug polytherapy predicting health-related quality of life of persons 1 year after diagnosis of epilepsy.

PURPOSE: The aim of this study was to determine whether gender influences the prediction of health-related quality of life (HRQoL) in persons with newly diagnosed epilepsy (NDE). METHODS: This was a 1-year longitudinal study. Persons with NDE were assessed with the Quality of Life in Epilepsy Inventory-31 (QOLIE-31), the Hospital Anxiety Depression Scale (HADS), the Stigma Scale, and the Rosenberg Self-esteem Scale. An analysis of covariance (ANCOVA) with interaction terms was used. RESULTS: Among 134 adults with NDE, there were no gender differences in the scores of the QOLIE-31 and its subscales. A multivariate linear regression analysis showed that the HADS-anxiety scores at diagnosis (p = 0.005) and seizure recurrence after diagnosis (p = 0.050) negatively predicted QOLIE-31 scores in persons with NDE. There were significant effects of the gender interaction with seizure recurrence (F = 8.745, p = 0.004, partial eta2 = 0.066) and antiepileptic drug (AED) polytherapy (F = 6.320, p = 0.013, partial eta2 = 0.049) in the adjusted model. Specifically, seizure recurrence negatively predicted the QOLIE-31 scores only in men. By contrast, AED polytherapy negatively predicted the QOLIE-31 scores only in women. CONCLUSIONS: There are gender differences in certain epilepsy-related factors predicting HRQoL at 1 year in persons with NDE.

Abnormal Nocturnal Behavior due to Hypoglycemia in a Patient with Type 2 Diabetes.

Abnormal nocturnal behavior can have many causes, including primary sleep disorder, nocturnal seizures, and underlying medical or neurological disorders. A 79-year-old woman with type 2 diabetes was admitted for evaluation of abnormal nocturnal behavior. Every night at around 04:30 she was observed displaying abnormal behavior including leg shaking, fumbling with bedclothes, crawling around the room with her eyes closed, and non-responsiveness to verbal communication. Polysomnography with 20-channel electroencephalography (EEG) was performed. EEG showed that the posterior dominant rhythm was slower than that observed in the initial EEG, with diffuse theta and delta activities intermixed, and no epileptiform activity. The serum glucose level was 35 mg/dL at that time, and both the EEG findings and clinical symptoms were resolved after an intravenous injection of 50 mL of 50% glucose. These results indicate that nocturnal hypoglycemia should be considered as one of the possible etiologies in patients presenting with abnormal nocturnal behavior.

Higher glycated hemoglobin level is associated with increased risk for ischemic stroke in non-diabetic korean male adults.

BACKGROUND: The role of glycated hemoglobin (HbA1c) in the prediction of ischemic stroke in non-diabetic subjects is not clear. We performed a study to analyze the role of HbA1c in the risk prediction of ischemic stroke in non-diabetic Korean males adult. METHODS: A total of 307 non-diabetic male patients with ischemic stroke were enrolled, and 253 age-matched control subjects without a history of diabetes, hypertension, or cardiovascular disease were selected from a Health Check-up database. Anthropometric measurement data, fasting glucose level, lipid profile, and HbA1c level were available for all subjects. Associations of the variables and the presence or absence of ischemic stroke were analyzed. RESULTS: The ischemic stroke patient group had significantly higher HbA1c levels (5.8±0.5% vs. 5.5±0.5%, P<0.01) and mean systolic and diastolic blood pressure compared with the control group. Among the variables, smoking, low high density lipoprotein cholesterol, systolic blood pressure, and HbA1c were the significant determinants for ischemic stroke. The highest quartile of HbA1c showed a 9.6-fold increased odds ratio for ischemic stroke compared with the lowest quartile of HbA1c (odds ratio, 9.596; 95% confidence interval, 3.859 to 23.863, P<0.01). The proportion of ischemic stroke patients showed a significant trend for increment as the deciles of HbA1c increased (P for trend <0.01). CONCLUSION: Higher HbA1c indicated a significantly increased risk for ischemic stroke after adjusting for other confounding variables in non-diabetic Korean adult males. HbA1c might have significance in predicting the risk for ischemic stroke even in the non-diabetic range.

Factors contributing to driving by people with uncontrolled seizures.

People with epilepsy (PWE) are restricted from driving because of the concern over seizure-related car accidents. We investigated the characteristics of driving in these people and aimed to identify factors associated with driving in those with uncontrolled seizures. Of 290 epilepsy patients, 58% had a driver's license, 40% had driven during the last year. Of 179 persons with uncontrolled seizures, 65 (36%) had driven a car in the previous year. About 9% of PWE with driver's license experienced seizure-related accidents in the previous 5 years, but it was significantly more reported by those with uncontrolled seizures. Being male, married, and employed, and taking fewer antiepileptic drugs were the factors independently associated with increased likelihood of driving in patients with uncontrolled seizures.

Inhibitory effect of proanthocyanidin on ultraviolet B irradiation-induced melanogenesis.

Repetitive exposure of the skin to ultraviolet (UV) radiation induces various adverse effects, including skin thickening, wrinkle formation, inflammation, and pigmentation. Various natural and synthetic compounds were studied to determine whether they might prevent UV induction of these adverse effects. In particular, naturally occurring antioxidants were used for regulating skin damage induced by UV radiation since several antioxidants were found to inhibit photoaging through prevention of collagen synthesis via inhibition of matrix metalloproteinases (MMP) and/or decrease of melanin synthesis. The L values in pigmented skin were lower at 4 wk (52.97 +/- 2.09) than at the start of this study (0 wk, 62.89 +/- 0.56) in the control. In the proanthocyanidin mixture group, the L value was increased (56.83 +/- 1.71) similar to the control (52.97 +/- 2.09). Proanthocyanidin also suppressed the expression levels of tyrosinase by 20-40%, and blocked the expression of MITF, TRP-1, and TRP-2, which are factors implicated in the control of melanogenesis. Taken together, these data indicate that proanthocyanidin may be useful to attenuate UVB-induced melanogenesis.

Partially purified paeoniflorin exerts protective effects on UV-induced DNA damage and reduces facial wrinkles in human skin.

Partially purified paeoniflorin (PF), a new cosmetic ingredient from roots of Paeoniae lactiflora, has been developed. Its paeoniflorin content is about 64%, far higher than that of conventional, cosmetic-grade peony root extracts (approximately 10%). In this report, we studied the effects of PF on UV-induced DNA damage in both cultured human keratinocytes and hairless mouse skin. We also investigated the anti-wrinkle effects of PF-containing cosmetic preparations on human skin. From the in vitro and in vivo comet assay, it was revealed that PF protected cells from DNA damage induced by ultraviolet B (UVB) irradiation in both cultured normal human keratinocytes (19.4% decrease at 0.001%) and hairless mouse skin keratinocytes (41% decrease at 0.01%). An eight-week clinical trial using 0.5% PF-containing formulation with 20 volunteers resulted in a statistically significant reduction in facial wrinkles (p < 0.05). These results suggest that the partially purified paeoniflorin has potent anti-aging and anti-wrinkle activities and should be a useful ingredient for these purposes.

Analysis of the lesion distributions and mechanism of acute middle cerebral artery infarctions involving the striatocapsular region.

BACKGROUND AND PURPOSE: There is no clear description about the patterns of each mechanism of striatocapsular infarctions. The aims of our study were to elucidate differences in the distributions of lesions of acute middle cerebral artery (MCA) infarctions involving the striatocapsular region and to compare those following embolic striatocapsular infarctions with those originating from MCA disease. METHODS: We prospectively enrolled patients with acute infarcts located in the lenticulostriate artery territory that were not lacunar infarcts. Brain coronal diffusion-weighted imaging (DWI) was obtained and magnetic resonance angiography (MRA) was carried out to evaluate the distribution of infarct lesions and MCA stenosis in all patients. The types of infarct distribution were divided into three categories: (1) dominant in the distal territory (DD), (2) distributed equally between the distal and proximal territories (DE), and (3) dominant in the proximal territory. We performed tests for embolic sources (transthoracic echocardiography, transesophageal echocardiography, Holter monitoring, and contrast-enhanced MRA including the aortic arch) in most patients. Stroke mechanisms were classified into stroke from proximal embolism, MCA disease, and stroke of undetermined etiology. RESULTS: A total of 47 patients (28 men and 19 women; mean age, 62 years) were recruited. A proximal embolic source was significantly more prevalent in patients with a DE lesion than in those with a DD lesion. The most common proximal embolic source was of cardiac origin. In contrast, symptomatic MCA stenoses were more common in patients with a DD lesion than in those with a DE lesion. CONCLUSIONS: These results suggest that the dominant area of striatocapsular infarction on coronal DWI is an important clue for stroke etiology. Coronal DWI could therefore be helpful to determining the mechanisms in patients with striatocapsular infarctions that are currently described as having an "undetermined etiology" according to the Trial of Org 10172 in Acute Stroke Treatment classification.

Neuro-Behçet's disease mimicking a cerebral tumor: a case report.

We report a rare case of neuro-Behcet's disease (NBD) presenting as an inflammatory pseudotumor in the brain. A 52-year-old woman was evaluated for subacute dizziness and headache. Brain magnetic resonance (MR) imaging showed a right cerebellar mass, which disappeared 2 weeks later. After a year, recurrent mucocutaneous manifestations of Beh et's disease were observed. Immunosuppressant and steroid maintenance treatment were started. She experienced two more neurologic attacks and brain MR imaging revealed an enhancing mass in the right temporal lobe. The second attack showed a good response to steroid pulse therapy, but the third attack did not respond to steroid and her neurologic signs suggested an impending transtentorial hernia. The right temporal lobectomy was performed for the purpose of life-saving. The pathologic finding of the mass was a chronic inflammatory vasculitis, compatible with NBD.