Foot Scan System을 이용한 파킨슨병 환자의 역동적 족압 분석

이찬녕,엄광문,박건우,고성범,김병조,오경미,김호정,이대희 대한신경과학회 2007 대한신경과학회지 Vol.25 No.2

Background: Foot Scan System (RS scan international cooperation) measuring the plantar pressure distribution is simple and inexpensive tool for gait analysis. The analysis of plantar pressure distribution of the feet during gait maybe helps the assessment of motor symptoms or gait stability of Idiopathic Parkinson’s disease (IPD). Methods: We compared the parameters of foot scan system between 34 normal controls and 23 IPD patients before and after levodopa administration. Data of plantar force distribution and time of stance phase were collected using pressure-sensitive insoles as parts of the Foot Scan System. Results:There were significant difference between normal controls and IPD patients in fore foot peak pressure/rear foot peak pressure ratio, time percentage of heel strike phase, mid stance phase, propulsion phase in stance phase. But in these parameters there were no significant difference between IPD patients before dopamine with after dopamine medication. Conclusions: Using the Foot Scan System (RS scan international cooperation) measuring the plantar pressure distribution, we showed that F/R ratio and time percentage of propulsion phase are reduced significantly in patients with IPD, which enables us to understand the features of gait in IPD patients more easily.

Interferon-β를 사용하던 다발성경화증 환자에서 발생한 만성 염증성 탈수초성 다발성 신경병증

이찬녕,김병조,박건우,고성범,김호정,이대희 대한신경과학회 2006 대한신경과학회지 Vol.24 No.5

Preliminary studies have evaluated the effects of interferonβ formulations in the treatment of chronic inflammatory demyelinating polyneuropathy (CIDP) because of pathogenic similarities between CIDP and multiple sclerosis (MS). However, the efficacy of Interferon, which has been widely used for relapsing-remitting MS, is controversial in CIDP. We report here a 31year old woman with relapsing-remitting type MS treated with IFNβ-1b over 2 years who developed overt CIDP. She responded favorably to steroids. This case suggests that IFNβ-1b treatment may not prevent development of CIDP.

결핵성수막염의 뇌혈관 합병증

송무현,이찬녕,오경미,한진규,고성범,박만규,박건우,이대희 대한신경과학회 2004 대한신경과학회지 Vol.22 No.5

Background: Cerebral infarction as a complication of tuberculous meningitis (TBM) is not uncommon, but has been rarely reported. The purposes of this study were to evaluate the clinical characteristics of cerebral infarction secondary to TBM and investigate the predictive values for cerebral infarction in patients with TBM. Methods: We prospectively collected patients with TBM for 24 months. Patients were divided into two groups, either patients with stroke or without stroke. We compared the demographic features, clinical, laboratory, and neuroradiologic findings between the two groups. We classified the stroke subtype with neuroimaging findings. Results: The 26 patients were diagnosed as TBM, and 6 patients had complications with cerebral infarction. The neutrophil percentage in the cerebrospinal fluid (CSF) leukocyte were significantly higher in patients with stroke than in patients without stroke (p=0.0098). On initial CT scan, meningeal enhancement was found in 9 patients, and 4 of them complicated with stroke. However, there were no significant differences in the other clinical and laboratory features such as demographic features, interval between meningitis onset time and treatment initiation time, peripheral white blood cell count, and CSF findings. In six patients with stroke, lacunar infarctions and non-lacunar territorial infarctions were found in 3 patients, respectively. In territorial non-lacunar infarction patients, one patient died due to herniation. Conclusions: We suggest that the possibility of cerebral infarction under the treatment of TBM should be considered, when the patient shows focal neurologic signs, meningeal enhancement on the CT scan and sustained polymorphic CSF pleocytosis.

좌측 만성 무증상 꼬리핵 경색 및 급성 조가비핵 뇌출혈 이후 발생한 일시적 기억력 장애 1예

최창운,이찬녕,박건우 대한치매학회 2012 Dementia and Neurocognitive Disorders Vol.11 No.4

Transient memory impairment can be occurred by many causes. One of them is acute focal brain lesion in strategic site. Caudate nucleus and medial basal ganglia (globus pallidus) are lesion of strategic site. They play its role in cognitive processing. But lateral basal ganglia (putamen) is known as a structure involving movement, not cognitive function. We report a interesting case of transient memory dysfunction with acute focal putamen ICH with old caudate nucleus infarction.

2014년 일상예찬 캠페인 “일상생활지침서” 사용 효과 연구

최호진,문연실,이찬녕,양영순,송은향,김희진,나해리,심용수,박경원,정지향,양동원,김상윤,박기형 대한치매학회 2014 Dementia and Neurocognitive Disorders Vol.13 No.4

Background: Activities daily living (ADL) disability has a direct influence on the patients’ quality of life and on the amount of care needed. It is major factor of care in dementia patients. So Korean Dementia Association suggested guideline about activities of daily living in dementia patients in 2013. The purpose of this article is to investigate the effect of this. Methods: A total of 110 subjects were enrolled. Assessments included age, sex, education level of patients and caregiver, the duration of disease, pattern of family, economic status. We divided “active practice” group and “passive practice” group by recognition of guideline contents after study. We compared two groups before and after by Korean Mini-Mental State Examination (K-MMSE), Short form of Geriatric Depression Scale- Korean version (S-GDS), Korean version of Zarit’s Burden Interview (ZBI-K), Alzheimer’s Disease Cooperative Study-Activities of Daily Living scale (ADCS-ADL). Finally, we investigate the level of satisfaction about our guideline. Results: Age of patients, the duration of disease was lower and education level of caregiver and economic status was higher in “active practice group”. The pattern of family also differed from two groups. It was observed distinct difference between the variations of two groups in S-GDS, ZBI-K, and ADCS-ADL. The level of satisfaction about our guideline was very high. Conclusions: Considering these results, our guideline about activities of daily living is effective to manage dementia patient. Active application of it is needed in clinic or center for dementia.

A Multicenter, Randomized, Double-blind, Placebo-controlled Clinical Trial for Efficacy of Acetyl-L-carnitine in Patients with Dementia Associated with Cerebrovascular Disease

양영순,최호진,이찬녕,김용범,YongTaeKwak 대한치매학회 2018 Dementia and Neurocognitive Disorders Vol.17 No.1

Background and Purpose: Acetyl-L-carnitine (ALC) is a widely used drug for various neurodegenerative diseases including dementia. The aim of the present study was to elucidate the efficacy of ALC in dementia patients with cerebrovascular disease (vascular cognitive impairment; VCI). Methods: Fifty-six patients were randomized to treatment with 500 mg ter in die ALC, or placebo in this 28-week, double-blind, placebo-controlled trial. The primary outcome measure was the Korean version of Montreal Cognitive Assessment (MoCA-K). Results: Following treatment with ALC, the cognitive function measured by the MoCA-K was significantly improved in the ALC-treated groups. However, other secondary outcomes were not statistically significant between ALC- and placebo-treated groups. In MoCA-K analysis, attention and language sub-items significantly favored the ALC-treated group. Conclusions: Compared with placebo, treatment with ALC 1,500 mg/day produced significant changes in MoCA-K in dementia patients with VCI. ALC was well tolerated in this population. Despite the study limitations, the findings suggested the potential benefits associated with the use of ALC in dementia patients with VCI.

Differential Diagnosis of Patients with Inconclusive Parkinsonian Features Using [18F]FP-CIT PET/CT

박은경,황유미,이찬녕,김수진,오선영,김영철,최재걸,박건우 대한핵의학회 2014 핵의학 분자영상 Vol.48 No.2

Purpose It is often difficult to differentiate parkinsonism,especially when patients show uncertain parkinsonian features. We investigated the usefulness of dopamine transporter(DAT) imaging for the differential diagnosis of inconclusiveparkinsonism using [18F]FP-CIT PET. Methods Twenty-four patients with inconclusive parkinsonianfeatures at initial clinical evaluation and nine healthycontrols were studied. Patients consisted of three subgroups:nine patients whose diagnoses were unclear concerningwhether they had idiopathic Parkinson’s disease or druginducedparkinsonism (‘PD/DIP’), nine patients who fulfilledneither the diagnostic criteria of PD nor of essential tremor(‘PD/ET’), and six patients who were alleged to have eitherPD or atypical parkinsonian syndrome (‘PD/APS’). BrainPET images were obtained 120 min after injection of185 MBq [18F]FP-CIT. Imaging results were quantified andcompared with follow-up clinical diagnoses. Results Overall, 11 of 24 patients demonstrated abnormallydecreased DAT availability on the PET scans, whereas 13were normal. PET results could diagnose PD/DIP and PD/ET patients as having PD in six patients, DIP in seven, and ETin five; however, the diagnoses of all six PD/APS patientsremained inconclusive. Among 15 patients who obtained afinal follow-up diagnosis, the image-based diagnosis wascongruent with the follow-up diagnosis in 11 patients. Fourunsolved cases had normal DAT availability, but clinicallyprogressed to PD during the follow-up period. Conclusion [18F]FP-CIT PET imaging is useful in the differentialdiagnosis of patients with inconclusive parkinsonianfeatures, except in patients who show atypical features orwho eventually progress to PD.

Posterior Type of Alzheimer’s Dementia Presenting with Homonymous Hemianopsia

박윤아,박건우,이찬녕 대한치매학회 2017 Dementia and Neurocognitive Disorders Vol.16 No.4

Background Alzheimer’s disease is a chronic neurodegenerative condition, mostly affecting the medial temporal lobe and associated neocortical structures. In this report, we present a rare clinical manifestation of this disease. Case Report A 61-year-old female with word finding difficulty and memory disturbances was diagnosed with Alzheimer’s disease. Two years later, she complained of right homonymous hemianopia without optic ataxia, ocular apraxia, and simultagnosia. No findings other than parenchymal disease were apparent in magnetic resonance imaging and laboratory tests. Conclusions In this case, in a patient initially diagnosed with Alzheimer’s dementia with progressive disease, we found only homonymous hemianopia, without signs of Balint’s syndrome or Gerstmann’s syndrome. After careful investigation showing that Alzheimer’s dementia with visual symptom was not associated with parenchymal disease, we concluded a case of atypical variant of Alzheimer’s disease.

Regional Metabolic Changes Influencing Three-Dimensional Perception in Parkinson’s Disease

박윤아,박건우,이찬녕 대한신경과학회 2022 Journal of Clinical Neurology Vol.18 No.4

Background and Purpose Stereopsis refers to the perception of depth and awareness of the distance of an object from the observer that results from the brain receiving visual stimuli from both eyes in combination. Patients with idiopathic Parkinson’s disease (PD patients) typically experience problems with vision, eyeball movements, and visual perception due to degeneration of the cells that generate dopamine in the brain. We therefore hypothesized that stereopsis is affected more by visual cortical dysfunction in idiopathic PD than by retina and subcortical structural dysfunction. Methods We analyzed stereopsis in 12 PD patients and 7 healthy controls using a three-dimensional (3D) television (TV). Before allowing patients to watch TV, we examined their visual acuity and strabismus using the Titmus Stereo Fly Test, and evaluated their cognitive function using cognitive tests. The patients watched 3D and two-dimensional (2D) versions of a movie with an approximate duration of 17 minutes, and then completed a questionnaire about stereopsis. All subjects underwent brain F-18 fluorodeoxyglucose (FDG) positronemission tomography after watching the 3D version of the movie. One week later, subjects watched the 2D version of the same movie under the same conditions. Each scan was analyzed using statistical parametric mapping (version 8) software. Results The visual cortex was activated less in the PD patients than in the healthy controls when watching the 2D or 3D movie. However, there was no significant difference between watching 2D and 3D movies in the PD patients or healthy controls. Conclusions The lower activation of the primary visual cortex in PD patients suggests the presence of dysfunction of the visual cortex. In addition, there was less activation of the visual association cortex in PD patients when watching a 3D movie than in controls under the same conditions. This might be one reason why PD patients do not recognize real and dynamic stereopsis. These findings have clinical significance since they suggest that safety needs to be considered when making devices or programs using 3D or virtual reality for use by patients with various cerebral degenerative diseases

Shape Analysis of the Subcortical Nuclei in Amyotrophic Lateral Sclerosis without Cognitive Impairment

태우석,성주혜,백설희,이찬녕,김병조 대한신경과학회 2020 Journal of Clinical Neurology Vol.16 No.4

Background and Purpose Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease that mainly affects the pyramidal motor system. However, recent studies have suggested that degeneration of the extramotor system plays a role in the disability experienced by patients with ALS. We investigated the local shape changes and mean volumes of the subcortical nuclei in sporadic ALS patients with preserved cognition. Methods The participants comprised 32 patients with ALS and 43 age- and sex-matched healthy controls. Three-dimensional T1-weighted structural images were acquired. Surfacebased vertex analysis was performed with fully automated segmentation of both amygdalae, hippocampi, caudate nuclei, nuclei accumbens, putamina, pallida, and thalami, and the brainstem. The scalar distances from the mean surfaces of the individual subcortical nuclei were compared between groups, and correlations of the local shape distances with initial Amyotrophic Lateral Sclerosis Functional Rating Scale Revised (ALS-FRS-R) scores and the delta FRS-R and with the disease duration were analyzed. Results ALS patients showed regional shape contractions on the lateral surfaces of both pallida, the lateroposterior surface of the right putamen, and the anterior basal surface of the right accumbens. Delta FRS-R scores were negatively correlated with local shape distances in the right hippocampus and the putamina. However, the initial ALS-FRS-R score and disease duration were not correlated with local shape distances. Conclusions Subcortical gray-matter structures are involved in the neurodegenerative process of ALS before cognitive impairment becomes evident.