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박성파,정두교 대한신경과학회 2005 대한신경과학회지 Vol.23 No.1
Background: Topiramate (TPM), a broad-spectrum antiepileptic drug, has recently been demonstrated to be effective as a monotherapeutic device for migraine prevention. We investigated the impact of TPM on cognition during migraine prevention. Methods: Twenty-eight migraineurs were evaluated. They were instructed to take 25 mg of TPM per day, with 25 mg weekly increments to a maximum of 100 mg per day according to the therapeutic responsiveness. We assessed cognitive dysfunctions by spontaneous patient reports and several neuropsychological tests comparing the baseline and at 3 months during on-treatment. We also compared these tests to age, sex, education, clinical features of migraine, TPM dose, and global effectiveness. Results: After 3 months of therapy, 21 patients undertook a follow-up neuropsychological test. Even though headache frequency, severity, and disability were significantly decreased in a follow-up period, there was a significant impairment in backward digit span (P=.006) and verbal fluency (P=.023). Thirteen patients (62%) showed an impaired backward digit span, and 11 patients (52%) exhibited an impaired verbal fluency. Five patients (24%) complained of symptoms associated with these impairments. Cognitive impairments were well correlated to the frequency of migraine attack, higher daily TPM dose, and global effectiveness. In six patients who showed the impairment of both items, TPM was withdrawn and their cognition was retested after 2 weeks. There was a significant improvement in these cognitive functions. Conclusions: TPM appears to exert a dose-related, strong negative influence on working memory and verbal fluency during migraine prevention. It can be related to drug tolerability.
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박성파,권오영 대한신경과학회 2009 Journal of Clinical Neurology Vol.5 No.4
Background and Purpose Levetiracetam (LEV) is an antiepileptic drug (AED) that has favorable effects on cognition. Although neuropsychological studies have demonstrated these favorable outcomes on cognition, there are few electrophysiologic data describing the functional changes exerted by LEV. The purpose of this study was to determine the effects of LEV adjunctive therapy on the current-source density (CSD) in the high beta frequency band (22-30 Hz) of EEG background activity in refractory partial epilepsy (RPE). Methods We conducted a 24-week, open-label, prospective study in 24 patients with RPE. Scalp electroencephalography and neuropsychological tests (NPTs) were conducted twice, once before the LEV trial and then again after 24 weeks of medication. Results The CSD in the 22-30 Hz band of EEG background activity increased in the bilateral anterior cingulate gyri, left parahippocampal gyrus, and a small area of the right anterior parahippocampal gyrus after the LEV trial. Neither seizure freedom nor the dosage increment of LEV elicited meaningful CSD changes. Verbal memory and executive function were improved after the 24-week LEV trial. Conclusions To our knowledge, this is the first study to examine the changes in CSD induced by LEV adjunctive therapy in RPE patients. The CSD changes and NPT results suggest that LEV enhances the activities of the neuronal networks in the prefrontal cortex and left hippocampus.
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Cognitive Effects of Antiepileptic Drugs
박성파,권순학 대한신경과학회 2008 Journal of Clinical Neurology Vol.4 No.3
Antiepileptic drugs (AEDs) can adversely affect cognitive function by suppressing neuronal excitability or enhancing inhibitory neurotransmission. The main cognitive effects of AEDs are impaired attention, vigilance, and psychomotor speed, but secondary effects can manifest on other cognitive functions. Although the long-term use of AEDs can obviously elicit cognitive dysfunction in epilepsy patients, their cognitive effects over short periods of up to a year are inconclusive due to methodological problems. In general, the effects on cognition are worse for older AEDs (e.g., phenobarbital) than for placebo, nondrug condition, and newer AEDs. However, topiramate is the newer AED that has the greatest risk cognitive impairment irrespective of the comparator group. Since the cognitive impact of AEDs can be serious, clinicians should be alert to adverse events by evaluating cognitive function using screening tests. Adverse cognitive events of AEDs can be avoided by slow titration to the lowest effective dosage and by avoiding polytherapy.
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Long-Term Efficacy and Safety of Zonisamide Monotherapy in Epilepsy Patients
박성파,김선영,황양하,이호원,서정규,권순학 대한신경과학회 2007 Journal of Clinical Neurology Vol.3 No.4
Background and Purpose: Zonisamide (ZNS) is a useful antiepileptic drug with a broad therapeutic spectrum. However, there is limited information on the long-term use of ZNS as a monotherapy. This study investigated the long-term effects of ZNS as a monotherapy for the treatment of epilepsy. Methods: We retrospectively analyzed the records of epilepsy patients treated with ZNS monotherapy at our clinic. We identified outcomes for patients treated with ZNS monotherapy for a minimum of 6 months. Efficacy was quantified as the percentage change in seizure frequency, and safety was assessed by the frequency and types of adverse events. Results: Sixty patients who received ZNS for a minimum of 6 months were included. The mean duration of treatment was 19.8 months (range, 6-37 months), and the mean ZNS dosage was 255 mg/day (range, 100-500 mg/day). Twenty-seven patients (45%) were seizure-free, and an additional 20 patients (33%) had above 50% seizure frequency reduction at the last follow-up visit. Partial seizures with or without secondary generalization and generalized seizures were well controlled by ZNS, whereas complex partial seizures were not. Forty-eight patients (80%) reported mild-to-moderate adverse events, including memory loss (35%), attention deficit (27%), and weight loss (20%). Conclusions: Long-term ZNS monotherapy is effective at treating a broad spectrum of seizure disorders, except complex partial seizures. However, a specific adverse event, such as cognitive impairment, is common and long-lasting.
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박성파,정보우,서정규 慶北大學校 醫科大學 1995 慶北醫大誌 Vol.36 No.2
목적 : 뇌졸중 환자에게 경두개적 자기자극(transcranial magnetic stimulation, TCMS)으로 얻은 운동유발전위(motor evoked potential, MEP)가 뇌졸중에 의한 운동기능의 장애를 반영하고 그 기능의 회복을 예측하는데 도움을 줄 것인지 알아보고자 하였다. 대상 및 방법 : 뇌졸중 환자 27례에 TCMS를 시행하여 얻어진 MEP를 대조군 22례와 비교하고 아울러 초기 및 추적검사를 시행하여 그 성적을 서로 비교하였다. 결과 : 환자군의 중추 운동 전도시간(central motor conduction time, CMCT)은 초기와 추적검사에서 모두 병변측이 건측에 비해, 그리고 병변측이 대조군에 비해 유의하게 증가되었으며, 병변측에서는 초기검사의 CMCT가 추적검사의 CMCT 비해 유의하게 증가되었다. 피질 MEP의 무반응은 환자군의 병변측에서 초기검사의 48%, 추적검사의 26%에서 각각 관찰되었으나 대조군 및 환자군의 건측에서는 없었다. 환자군의 초기 및 추적검사 모두에서 MEP의 grade가 증가할수록 근력은 유의하게 감소되었으며 초기에 근력마비가 심하거나 피질 MEP가 무반응인 환자군에서는 추적검사에서도 근력 회복의 예후가 불량하였다. 결론 : 뇌졸중 환자에서 TCMS에 의한 MEP는 뇌졸중에 의한 운동기능의 장애를 정량적으로 평가하고, 뇌졸중 후 운동기능의 회복을 예측하는데 도움을 줄 것이라 사료된다. This study was performed to know whether motor evoked potentials(MEPs) through transcranial magnetic stimulation(TCMS) in stroke patients will reflect the motor dysfunction of stroke, and aid us to predict the functional recovery after stroke. MEPs of 27 stroke patients performing TCMS were compared with those of 22 normal controls, according to the initial and follow-up states of stroke. Central motor conduction time(CMCT) was significantly increased in the lesion side of patient group compared with the sound side of patient group or both sides of control group. At the lesion side of patient group, the CMCT was significantly increased in the initital state compared with follow-up state. No response of cortical MEPs was seen in 48% of patients at the initial lesion side, and 26% at follow-up lesion side, but not in patients at the sound side and in controls at both sides. The increase of MEP grade was significantly correlated to the decrease of muscle strength. Patients with severe motor weakness or no response of cortical MEPs in the initial state also had a poor functional recovery of muscle strength in follow-up state. In conclusion, MEPs using TCMS in stroke patients is useful for quantitative evaluation of the motor dysfunction in stroke, and aid us to predict the functional recovery after stroke.
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