실험적 자가면역성 말초신경염에서의 조직병리적 병변 및 CD5+ B-림프구의 발현

조중양,최원준,김성훈,성정준,김호진,박경석,최기영,김현정,이광우 대한임상신경생리학회 1999 Annals of Clinical Neurophysiology Vol.1 No.2

ackground : The pathogenesis of acute inflammatory demyelinating polyradiculoneuropathy (AIDP), Guillain-Barr?syndrome (GBS) in not clear, but it has been known that the immune mechanisms play an important role. Authors performed this study to establish an animal model of experimental allergic neuritis(EAN) by immunizing the myelin components of peripheral nerves and to understand the electrophysiological and histopathological features as well as the CD5+ B-lymphocyte changes in peripheral bloods in the EAN models. Methods : Lewis rats weighing 150-200 gm were injected subcutaneously in soles two with total myelin, P0, P1, or P2 proteins purified from the bovine cauda eguina. The EAN induction was assessed by evaluating clinical manifestations. The electrophysiological and histopathological features were studied as routine methods. The CD5+ B-lymphocyte were double stained using monoclonal FITC conjugated anti-rat CD45RA and R-PE conjugated anti-rat CD5+antibodies and calculated using a fluorescence activated cell sorter (FACS). Results : The EAN animal models were established. In two out of five, in one out of two, in none out of three, and in none out of one Lewis rats injected with purified total myelin, P0, P1, P2 proteins respectively. They showed slow spontaneous motor activity and weak resistance against pulling back by tails. The typical electrophysiological and histologic findings in total protein and P0 induced EAN animal models were the decreased conduction velocity, the decreased compound muscle action potential (CMAP) amplitude and the dispersion phenomenon. The perivascular infiltrates of lymphocytes with focal demyelinating process were found in light microscopy. The CD5+ B-lymphocyte expression in three EANs were 2.38%, 3.50% 2.50%, which were not significantly increased, compared with those in normal controls. Conclusion : The EAN animal models were successfully established by injecting the total myelin and P0 myelin and they showed electrophysiological and histological features typical of demyelinating process. However they did not show an increased expression of CD5+ B-lymphocyte in peripheral bloods which could be indirect evidence of humoral autoimmunity.

근위축성 측상경화증 환자에서 등세모근의 신경생리학적 검사

조중양,전종은,이광우 대한임상신경생리학회 2004 Annals of Clinical Neurophysiology Vol.6 No.2

Background: Needle electromyography (EMG) and motor evoked potential (MEP) of the genioglossus (tongue) are difficult to perform in evaluations of the craniobulbar region in amyotrophic lateral sclerosis (ALS). Therefore, we investigated the yields of needle EMG and MEP recorded from the upper trapezius, since it receives innervation from the lower medulla and upper cervical cord. Methods: Needle EMG and MEP of the upper trapezius were obtained in 17 consecutive ALS patients. The needle EMG parameters recorded included abnormal spontaneous activity and motor unit action potential (MUAP) morphology. An upper motor neuron (UMN) lesion was presumed when either response to cortical stimulation was absent, or the central conduction time was delayed (>mean+2SD). Results: Of the five patients with bulbar-onset ALS, four had abnormalities in the upper trapezius and four in the tongue by needle EMG. In contrast, of the 12 patients with limb-onset ALS, 11 had abnormalities in the upper trapezius, and only five in the tongue. When MEP was performed, it was found that three of the five patients with bulbar symptoms and three of the six patients with isolated limb involvement had abnormal MEP findings. Conclusions: Electrophysiological studies of the upper trapezius are more sensitive those of the tongue in patients without bulbar symptoms. Thus, needle EMG and MEP of the upper trapezius are alternative tools for assessing bulbar and rostral neuraxial involvement in the diagnosis of ALS.

정상 장딴지 신경 반응을 보이는 다발 신경병증 환자에서의 등쪽 장딴지 신경 전도 검사의 임상적 유용성

조중양,허재혁,민주홍,김남희,이광우 대한임상신경생리학회 2005 Annals of Clinical Neurophysiology Vol.7 No.2

Background: The most distal sensory fibers of the feet are often affected first in polyneuropathy. However, they are not evaluated in routine nerve conduction studies. Thus we evaluated the dorsal sural sensory nerve in patients with sensorimotor polyneuropathy with normal sural response, in order to assess the usefulness in electrodiagnostic practice. Methods: In this study, 53 healthy subjects and 27 patients with clinical evidence of sensorimotor polyneuropathy were included. In all subjects, peripheral motor and sensory nerve studies were performed on the upper and lower limbs including dorsal sural nerve conduction studies. On electrodiagnostic testing, all patients had normal sural responses. Results: The dorsal sural sensory nerve action potentials (SNAPs) mean amplitude was 13.12± 5.68?V, mean latency was 3.12±0.43 msec, and mean sensory conduction velocity (SCV) was 36.50±3.40 m/s in healthy subjects. In 7 of 27 patients, the dorsal sural nerve SNAPs were absent bilaterally, and in 20 patients, the mean dorsal sural nerve distal latency was longer(3.40±0.48 ms, P=0.006), and mean SCV was slower than in healthy subjects(35.08±4 . 5 9 , P=0.043). However, dorsal sural nerve amplitude was not different between the groups (P=0.072). Conclusions: Our findings suggest that dorsal sural nerve conduction studies should be included in the routine electrodiagnostic evaluation of patients with suspected polyneuropathy and normal sural nerve responses.

급성 허혈성 및 출혈성 뇌졸중 환자에서 예후 인자로서의 체온의 역할

조중양,배희준,윤병우,노재규 대한신경과학회 2000 대한신경과학회지 Vol.18 No.5

실험적 자가면역성 말초신경염에서의 조직병리적 병변 및 CD₅⁺ B-림프구의 발현

조중양,최원준,김성훈,성정준,김호진,박경석,최기영,김현정,이광우,Cho, Joong-Yang,Choi, Won-Jun,Kim, Sung-Hun,Sung, Jung-Joon,Kim, Ho-Jin,Park, Kyung-Seok,Choi, Ki-Young,Kim, Hyun-Jung,Lee, Kwang-Woo 대한임상신경생리학회 1999 Annals of Clinical Neurophysiology Vol.1 No.2

Background : The pathogenesis of acute inflammatory demyelinating polyradiculoneuropathy (AIDP), Guillain Barre syndrome (GBS) is not clear, but it has been known that the immune mechanisms play an important role. Authors performed this study to establish an animal model of experimental allergic neuritis (EAN) by immunizing the myelin components of peripheral nerves and to understand the electrophysiological and histopathological features as well as the ${CD_5}^+$ B-lymphocyte changes in peripheral bloods in the EAN models. Methods : Lewis rats weighing 150-200 gm were injected subcutaneously in soles two times with total myelin, P0, P1, or P2 proteins purified from the bovine cauda eguina. The EAN induction was assessed by evaluating clinical manifestations. The electrophysiological and histopathological features were studied as routine methods. The ${CD_5}^+$ Blymphocytes were double stained using monoclonal FITC conjugated anti-rat CD45RA and R-PE conjugated anti-rat ${CD_5}^+$ antibodies and calculated using a fluorescence activated cell sorter (FACS). Results : The EAN animal models were established. In two out of five, in one out of two, in none out of three, and in none out of one Lewis rats injected with purified total myelin, P0, P1, P2 proteins respectively, They showed slow spontaneous motor activity and weak resistance against pulling back by tails. The typical electrophysiological and histologic findings in total protein and P0 induced EAN animal models were the decreased conduction velocity, the decreased compound muscle action potential (CMAP) amplitude and the dispersion phenomenon. The perivascular infiltrates of lymphocytes with focal demyelinating process were found in light microscopy. The ${CD_5}^+$ B-lymphocyte expression in three EANs were 2.38%, 3.50% 2.50%, which were not significantly increased, compared with those in normal controls. Conclusion : The EAN animal models were successfully established by injecting the total myelin and P0 myelin and they showed electrophysiological and histological features typical of demyelinating process. However they did not show an increased expression of ${CD_5}^+$ B-lymphocyte in peripheral bloods which could be indirect evidence of humoral autoimmunity.

Acute Subdural Hematoma Following Spinal Cerebrospinal Fluid Drainage in a Patient with Freezing of Gait

김한준,조중양,이동하,홍근식,조용진 대한신경과학회 2009 Journal of Clinical Neurology Vol.5 No.2

BackgroundaaHeadache is a common complication of lumbar puncture (LP). Although in most cases post-LP headaches are not severe and have a benign course, they can also be a manifestation of a potentially life-threatening complication such as subdural hematoma (SDH). Case ReportaaWe describe a patient in whom a massive SDH developed after LP and cerebrospinal fluid (CSF) drainage, which were performed during the diagnostic evaluation of freezing of gait. ConclusionsaaSDH should not be excluded from the differential diagnosis of headache following LP, especially when there is a loss of CSF.

근력약화 시 감각신경활동전위진폭의 감소를 보인 갑상샘독성주기마비 1예

박소영,조중양,박종관,이동하,조용진,김한준,홍근식 대한임상신경생리학회 2007 Annals of Clinical Neurophysiology Vol.9 No.1

주기마비(periodic paralysis)는 반복되는 일시적인 근력 저하를 특징으로 하는 질환으로 일차성 주기마비와, 이차성 주기마비로 나눌 수 있다. 이차성 주기마비 중 갑상샘독성주기마비의 발병빈도는 입원한 갑상샘 중독 환자의 1.9%에서 발생하며 서양에 비해 동양에서 흔한 것으로 알려져 있다.1 갑상샘항진증에 합병된 저칼륨혈증주기마비는 일시적인 근력저하를 보이는 임상증상, 생화학적검사에서 저칼륨혈증과 갑상샘호르몬 변화, 신경전도검사에서 복합근활동전위진폭의 감소 등으로 진단한다. 저자들은 갑상샘독성주기마비 환자에서 근력약화 시에 신경전도검사상 복합근활동전위진폭의 감소와 함께 감각신경활동전위진폭의 감소를 경험하였기에 보고한다.

정주 면역글로불린을 투여 받은 길랑-바레 증후군 환자에서 치료효과와 예후에 영향을 주는 인자들에 관한 연구

이지영,조중양,김성훈,이광우 대한임상신경생리학회 2004 Annals of Clinical Neurophysiology Vol.6 No.2

Background: There were several studies comparing prognostic factors in Guillain-Barre syndrome treated with intravenous immunoglobulin and plasmapheresis. However, there were controversies in what were significant factors and there were few studies so far comparing the therapeutic outcomes in patients treated with immunoglobulin. This study was aimed to determine the prognostic factors which affected the therapeutic outcome of Guillain-Barre syndrome treated with intravenous immunoglobulin. Method: We retrospectively reviewed the medical records of patients with Guillain-Barre syndrome admitted to our hospital between January 1999 and March 2004. All patients were treated with intravenous immunoglobulin. Outcome and prognosis were followed up after four weeks using the overall disability sum score. Results: Thirty-six patients were enrolled in this study. According to the clinical and electrophysiological findings, 17 patients were AIDP, 10 were axonal forms, two were mixed and seven had electrophysiologically no evidence of abnormalities. At a follow-up of four weeks, disabilities at the nadir (p<0.001) and admission (P<0.012), initial manifestations of bulbar symptom (P<0.024) and electrodiagnostic features (P<0.013) were significantly correlated with outcome in patients treated with intravenous immunoglobulin. But only disabilities at the nadir (P<0.033) and electrodiagnostic features (P<0.018) were significant in the multivariate logistic regression analysis. Conclusion: Among the patient treated with intravenous immunoglobulin, the outcomes were significantly different according to the neurological status at the nadir. Therefore early diagnosis, administration of intravenous immunoglobulin and preventing complications during acute stages are essential to minimize neurological deficit and shorten the periods of recovery.

비전형적인 중상으로 발현한 급성 출혈성 백질뇌염

민주홍,이수호,조중양,박성혜,이광우 대한임상신경생리학회 2005 Annals of Clinical Neurophysiology Vol.7 No.1

Acute disseminated encephalomyelitis (ADEM) and acute hemorrhagic leukoencephalitis (Hurst’s disease) are rare autoimmune demyelinating disorders, which show a monophasic illness with preceding infection. We report a 42-yearold woman presented with multiphasic and progressive neurologic deterioration without definite evidences of infection. She developed hypesthetic ataxia, followed by ipsilateral weakness after a weak, and finally encephalopathy after a month. In contrast to the first MRI showing a small longitudinal lesion, the next images revealed massive bilateral frontal lesions with hemorrhagic necrosis and biopsy unveiled inflammatory demyelination.

중증 근무력증과 전신성 홍반성 낭창의 동반 발생

허재혁,민주홍,조중양,김남희,이광우 대한임상신경생리학회 2005 Annals of Clinical Neurophysiology Vol.7 No.2

Background: Myasthenia gravis (MG) and systemic lupus erythematosus (SLE) are well recognized to coexist and have some similarities in immunologic, clinical and serologic findings. Despite several reports of the association with autoantibodies and thymectomy in these disorders, the pathomechanism of coexistence remains to be elucidated. Objective: We aimed to investigate the relationship of MG and SLE through overall features of patients with both disorders;: clinical, laboratory, and electrophysiological findings. Materials and Methods: We reviewed the medical records of 6 consecutive patients with MG and SLE (2 men, 4 women, ages 17-51, mean 30.5 years, Seoul National University Hospital, from 1998 to 2005). Results: Three patients who developed SLE first, had ocular type of MG and 2 were children showing much severe and recurrent SLE features and only 1 patient had thymic hyperplasia. The other 3 developed MG first and they were generalized type and none underwent thymectomy. In addition, the development of MG or SLE was not coincident with remission or improvement of another disorder. Conclusion: The coexistence of SLE and MG may support the hypothesis of two different antibody populations modulated by thymus in the opposite extremesThis report suggests that the systemic and extensive autoimmune response in preceding MG or SLE may effect the development of the other disorder followed, while. the coexistence of two disorders cannot be explained by the hypothesis of two different antibody populations modulated by thymus in the opposite extremes The role of thymectomy and the theorectical subsequent effect on the development of SLE have been debated with controversy. However, SLE occurred without thymectomy in MG and these disorders did not develop in the quiescent period of another disorder. Therefore, the other pathomechanism for the coexistence of MG and SLE should be elucidated.