Neurocutaneous Melanosis Presenting as Chronic Partial Epilepsy

예병석,조양제,장상현,이병인,허경,정현호,장진우,김세훈 대한신경과학회 2008 Journal of Clinical Neurology Vol.4 No.3

Background: Neurocutaneous melanosis (NCM) is a rare neurocutaneous syndrome characterized by the presence of multiple congenital melanocytic nevi (CMN) and the proliferation of melanocytes in the central nervous system, usually involving the leptomeninges. Chronic partial epilepsy as a sole manifestation is rare in NCM. Case Report: A 32-year-old man suffering from chronic partial epilepsy presented with multiple CMN on his trunk and scalp. Brain MRI demonstrated a focal lesion in the right amygdala that was consistent with interictal epileptiform discharges in the right temporal region on electroencephalography(EEG). An anterior temporal lobectomy was performed, and the pathology investigation revealed numerous melanophages in the amygdala. The patient was seizure-free after surgery. Conclusions: We report a patient with NCM presenting as chronic partial epilepsy who was successfully treated by anterior temporal lobectomy.

The Localizing and Lateralizing Value of Auras in Lesional Partial Epilepsy Patients

예병석,허경,조양제,장상현,이문규,이병인 연세대학교의과대학 2012 Yonsei medical journal Vol.53 No.3

Purpose: We investigated the localizing and lateralizing values of auras in patients with lesional partial epilepsy on an outpatient basis. Materials and Methods: A total of 276 subjects were retrospectively selected for this study if they had a unilateral single lobar lesion based on magnetic resonance image (MRI) results, and their scalp electroencephalography (EEG) findings were not discordant with the MRI-defined lobar localization and lateralization. According to the lesion locations,subjects were considered as having mesial temporal (MTLE), lateral temporal (LTLE), frontal (FLE), parietal (PLE), or occipital (OLE) lobe epilepsies. Auras were classified into 13 categories. Results: A hundred and seventy-six subjects (63.8%) had experienced at least one aura. FLE subjects had the fewest number of auras. Epigastric and psychic auras were frequent among MTLE subjects, while visual auras were common in those with PLE and OLE. Somatosensory auras and whole body sensations were more frequent in the subjects with PLE than those without. Autonomic auras were more common in MTLE subjects than in LTLE subjects. Dysphasic auras were more frequently found in left-sided epilepsies. Five pairs of aura categories showed concurrent tendencies, which were the epigastric and autonomic auras, autonomic and emotional auras, visual and vestibular auras, auditory and vestibular auras, and whole-body sensation and auditory auras. Autonomic and emotional auras had a concurrent tendency in left-sided epilepsies, but not in right-sided epilepsies. Conclusion: Our results support the previously known localizing value of auras, and suggest that dysphasic auras and the association of emotional and autonomic auras may have a lateralizing value.

위장관 내시경 시행 중 발생한 대뇌공기색전증

송동범,예병석,허지회,조현지 대한신경과학회 2008 대한신경과학회지 Vol.26 No.2

Cerebral air embolism, the entry of air into the cerebral artery, is an iatrogenic clinical problem in most cases, which may result in seizure, severe neurologic deficits and even death. Although cerebral air embolism may result from almost all procedures that are performed in clinical specialties, occurrence following a gastroscopy is very rare. We report a patient who developed cerebral air embolism following a gastroscopy.

한국 육군 일개 사단에서 군 복무 부적응자들의 정신의학적 평가 : 그린캠프 참가자들을 중심으로

김주현,강석훈,예병석,황현국,서재원,채공주,이환배,김찬형,Kim, Ju-Hyun,Kang, Suk-Hoon,Ye, Byoung-Seok,Hwang, Hyun-Kuk,Suh, Jae-Won,Chai, Gong-Ju,Lee, Hwan-Bae,Kim, Chan-Hyung 대한불안의학회 2010 대한불안의학회지 Vol.6 No.2

Objectives : In this study, we aimed to elucidate the demographic and psychological characteristics of maladaptive soldiers in the Republic of Korean Army. Methods : Study participants included 110 male conscripts who had participated in the Green camp, which was a form of group psychosocial treatment program for maladaptive soldiers. All participants were interviewed and diagnosed by a psychiatrist, and classified into two groups according to whether they left or rejoined the army. We analyzed the differences between these two groups in terms of demographic features, psychiatric diagnosis and the Minnesota Multiphasic Personality Inventory (MMPI) subscores. Results : Compared with soldiers who rejoined their units, those who left military service exhibited significantly lower educational level (p=0.041) and a higher rate in psychiatric treatment prior to enlistment (p=0.011). Among the 106 subjects, 63 (59.4%) and 23 (21.7%) were diagnosed with personality disorder and adjustment disorder, respectively. Further, those who left military service were diagnosed more frequently with mood disorder (p=0.001) and schizophrenia (p=0.014) than those who rejoined their units. Additionally, the MMPI scores of soldiers who left military service were significantly higher on the psychasthenia (p=0.028) and schizophrenia (p=0.039) scales than those of soldiers who rejoined their units. Conclusion : Most of the maladaptive soldiers were diagnosed with mental disorders. The results of this study suggest that systematic, consistent psychiatric evaluation and intervention for maladaptive male conscripts is crucial in the Republic of Korean army.

강원지역 소방관에서 외상후 스트레스 증상 및 동반증상에 미치는 리질리언스의 영향

이홍의,강석훈,예병석,최종혁,Lee, Hong-Eui,Kang, Suk-Hoon,Ye, Byoung Seok,Choi, Jong-Hyuck 대한불안의학회 2012 대한불안의학회지 Vol.8 No.2

Objective : This study investigated the relationship between the resilience and posttraumatic stress symptoms, as well as comorbid symptoms in firefighters. Methods : We collected 764 firefighters, who worked at six fire department stations in Gangwon-do. We investigated the impact of event scale-revised (IES-R), the life events checklists (LEC), Connor-Davidson resilience scale (CD-RISC), Beck depression inventory (BDI), state trait anxiety inventory (STAI) and alcohol use disorder identification test (AUDIT). Full PTSD groups, partial PTSD groups and non-PTSD groups, which were classified by IES-R scores, were compared in the LEC, CD-RISC, BDI, STAI and AUDIT, ; multiple linear regression analyses were done for independent predictors of variables. Results : Of the 764 firefighters, there were significant differences in LEC (p<0.001), CD-RISC (p<0.001), BDI (p<0.001), and AUDIT (p=0.001) among the full PTSD groups, partial PTSD groups and non-PTSD groups. However, STAI did not show significant difference among three groups. In multiple regression analysis, CD-RISC (${\beta}=-0.168$, p<0.001), LEC (${\beta}=0.211$, p<0.001) and AUDIT (${\beta}=0.115$, p=0.001) were significant predictors for IES-R. Conclusion : The results of the present study suggested that resilience might be a protective factor in PTSD and comorbid symptoms of PTSD.

진행성 실어증 환자의 보호자 보고에 의한 의사소통 관련 주호소의 주제 및 빈도 분석

김가영(Ka young Kim),예병석(Byoung Seok Ye),이주희(JuHee Lee),김향희(HyangHee Kim) 한국언어청각임상학회 2021 Communication Sciences and Disorders Vol.26 No.2

배경 및 목적: 진행성 실어증은 서서히 나타나는 증상으로서, 환자의 의사소통 능력 변화를 가장 빨리 인식할 수 있는 사람은 환자의 보호자이다. 환자에게 적절한 중재를 제공하기 위해서 보호자 주호소를 분석할 필요가 있다. 방법: 제1단계에서 진행성 실어증 환자 44명(남:여=19:25, 평균 연령=70.5±10.14)의 전자의무기록(EMRs)을 활용하여 언어 관련 주호소를 정리하고, NVivo 1.0을 사용하여 주제 분석하였으며, 이를 바탕으로 45개 문항의 언어 설문지가 개발되었다. 제2단계에서 개발된 언어 설문지를 활용하여 보호자 9명(남:여=2:7. 평균 연령=56.5±12.82)에게 반구조화된 인터뷰를 실시하였으며, 인터뷰 내용을 주제 및 빈도 분석하였다. 결과: 주제 분석 결과, 총 6개의 상위 주제와 총 18개의 하위 주제가 도출되었다. 상위 주제는 ‘구어 표현’, ‘구어 이해’, ‘문어 표현’, ‘문어 이해’, ‘계산’, ‘말’이 포함되었다. 각 상위 주제에서 가장 빈번하게 도출된 하위 주제는 ‘단어’, ‘문장’, ‘언어적 측면’, ‘독해’, ‘돈 계산’, ‘조음’이었다. 더불어, 보호자들이 가장 심하다고 느끼는 환자의 언어 문제는 ‘구어 표현’, ‘구어 이해’, ‘문어 이해’, ‘말’이었다. 논의 및 결론: 주호소는 진행성 실어증 환자의 현재 의사소통 능력을 반영하는 주요한 정보이다. 따라서 본 연구의 결과는 임상가들과 환자/보호자들이 진행성 실어증에서 보이는 의사소통장애의 본질을 제대로 이해하고, 치료 계획을 수립하는 데 도움을 줄 수 있을 것이다. Objectives: Progressive aphasia is a symptom that gradually appears and the caregivers are the ones who first notice the changes of patients’ communication abilities. Therefore, it is necessary to identify and analyze the chief complaints (CCs) reported by caregivers in order to better manage communication problems. Methods: First, communication-related CCs of 44 patients (men:women=19:25, mean age=70.5±10.14) with progressive aphasia were extracted from the electronic medical records (EMRs), and thematic analysis was performed using the NVivo 1.0 program. Consequently, a 45-item interview questionnaire was developed based on the contents of the CCs. Second, a semi-structured interview using the questionnaire was conducted with 9 caregivers (men:women=2:7, mean age=56.5± 12.82) of patients to verify the questionnaire, and additional thematic and frequency analyses of contents of the interview were performed. Results: Six main themes and 18 subthemes were extracted from the caregivers’ interview. The 6 main themes included ‘verbal expression’, ‘verbal comprehension’, ‘written expression’, ‘written comprehension’, ‘calculation’, and ‘speech’. As for the subthemes, ‘word’, ‘sentence’, ‘linguistic aspect’, ‘reading comprehension’, ‘money management’ and ‘articulation’ were the most frequently reported problems. In addition, the most severely perceived main themes of CCs were ‘verbal expression’, ‘verbal comprehension’, ‘written comprehension’ and ‘speech’. Conclusion: CCs contain crucial information regarding the current status of communication abilities of patients with progressive aphasia. The results of this study may provide information for clinicians and patients/caregivers to understand the nature of communication problems among patients and to direct future planning of the intervention program.

The Impact of Masticatory Function on Cognitive Impairment in Older Patients: A Population-Based Matched Case-Control Study

고경아,박진영,이중석,예병석,정의원,최성호,차재국 연세대학교의과대학 2022 Yonsei medical journal Vol.63 No.8

Purpose: The aim of this study was to investigate the association between the changes in masticatory function and cognitive im pairment by analyzing longitudinal data of older Korean patients. Materials and Methods: Patients aged over 60 years with dental records between 2005 to 2010 (baseline; T1) and 2014 to 2020(follow-up; T2) were selected in a single medical center. Based on the dementia diagnosis after T2, the cohort was classified intotwo groups, the dementia group (n=122) and the control group (n=366). Changes in masticatory function were calculated using thetotal functional tooth unit (T-FTU) in both groups. The incidence of tooth extraction (%) and the subsequent rehabilitation duringthe observation period were also evaluated. Results: In the dementia group, T-FTU significantly decreased from T1 to T2 (9.81±2.78 to 9.11±3.16, respectively, p=0.008), whileno significant change was observed in the control group. During the mean observation period of 9 years, significantly more teethwere extracted and neglected to be prosthetically restored in the dementia group than in the control group. Regression analysis re vealed that the number of missing teeth neglected [odds ratio (OR)=1.195, 95% confidence interval (CI)=1.025–1.393, p=0.023] andprevious alcohol consumption (OR=4.445, 95% CI=1.831–1.795, p=0.001) were the most significant risk factors of dementia. Conclusion: There might be a causative relationship between the neglected missing dentition and the onset of dementia.

보툴리눔독소의 근육내주사 이후 발생한 의인성 보툴리눔독소증

유준상,선우일남,신하영,고혜선,예병석,김승민 대한신경과학회 2010 대한신경과학회지 Vol.28 No.1

Botulinum toxin type A (BTA) is widely used for both medical treatment and cosmetic purposes. A 46-year-old woman presented with progressive generalized weakness and dysphagia. The patient had injected BTA into her both of her calves by herself for cosmetic purposes. Repetitive nerve stimulation of the right facial nerve demonstrated reduced compound muscle action potential amplitudes of the orbicularis oculi and nasalis muscles, and a reduced response to low-frequency, repetitive stimulation. The possibility of iatrogenic botulism should be considered when using BTA.

Association between Olfactory Deficit and Motor and Cognitive Function in Parkinson’s Disease

Han Soo Yoo,정석종,이양현,예병석,손영호,이필휴 대한파킨슨병및이상운동질환학회 2020 Journal Of Movement Disorders Vol.13 No.2

ObjectiveaaTo investigate whether baseline olfactory dysfunction in Parkinson’s disease (PD) patients is associated with baselineand longitudinal motor and cognitive function. MethodsaaWe recruited 228 drug-naïve PD patients who were followed for a mean of 6 years. Patients underwent the Cross-CulturalSmell Identification Test (CCSIT), a neuropsychological test, and N-(3-[18F]fluoropropyl)-2β-carbomethoxy-3β-(4-iodophenyl)nortropane positron emission tomography within 6 months of the baseline evaluation. Olfactory dysfunction was categorized asnormosmia (CCSIT score ≥ 9), hyposmia (CCSIT score 5–8), and anosmia (CCSIT score ≤ 4). During the follow-up period, weinvestigated changes in the levodopa-equivalent dose (LED) and the occurrence of wearing-off, levodopa-induced dyskinesia,and dementia. ResultsaaAmong the PD patients, 80.7% were hyposmic at the time of diagnosis, and 26.1% were anosmic. Baseline olfactory dysfunctionwas not associated with either initial parkinsonian motor symptoms or with the longitudinal LED increment and motorcomplications. Meanwhile, the anosmic group had lower baseline scores on the Korea version of the Boston Naming Test andStroop color reading test than the normosmic and hyposmic groups. The anosmic group exhibited a higher rate of conversion todementia than the normosmic [adjusted hazard ratio (HR) 3.99, 95% confidence interval (CI) 1.08–14.72] and hyposmic (adjustedHR 2.48, 95% CI 1.15–5.32) PD groups, regardless of baseline motor deficits and cognitive status. ConclusionaaBaseline olfactory dysfunction was not associated with motor deficits and complications, but it was associated withcognitive dysfunction and prognosis, suggesting that severe olfactory impairment may reflect early cortical involvement, probablyin the frontotemporal region, and rapid spreading of Lewy body pathology.

Cohort Profile: Firefighter Research on the Enhancement of Safety and Health (FRESH), a Prospective Cohort Study on Korean Firefighters

김윤태,김우진,최지은,배문주,장희선,이찬주,이혜정,임동진,예병석,김미지,정여주,오성수,정영철,강은석,박성하,이승구,박기수,고상백,김창수 연세대학교의과대학 2020 Yonsei medical journal Vol.61 No.1

Firefighters have a high risk of developing cardiovascular and mental disorders due to their physical and chemical environments. However, in Korea, few studies have been conducted on environmental risk of firefighters. The Firefighter Research on the Enhancementof Safety and Health (FRESH) study aimed to discover the risk factors for cardiovascular disease and mental disordersamong firefighters. Former and current firefighters were recruited from three university hospitals. A total of 1022 participantscompleted baseline health examinations from 2016 to 2017. All participants were scheduled for follow-ups every 2 years. Baselinehealth survey, laboratory testing of blood and urine samples, blood heavy metal concentration, urine polycyclic aromatic hydrocarbons(PAHs) metabolites, stress-related hormone test, natural killer cell activity, as well as physical and mental health examinationsthat focused on cardiovascular and mental disorders, were conducted. In addition, 3 Tesla (3T) brain magnetic resonanceimaging (MRI) and neuropsychological tests were also performed to investigate structural and functional changes in the brains of352 firefighters aged >40 years or new hires with less than 1 year of service.