Brain Computerized Tomographic Findings in Various Epilepic Children

Coe, Chang Jun Yonsei University, College of Medicine 1988 Yonsei medical journal Vol.29 No.4

Guillain-Barre syndrome in Korean children

Coe, Chang Jun Yonsei University, College of Medicine 1989 Yonsei medical journal Vol.30 No.1

NFlex Dynamic Stabilization System : Two-Year Clinical Outcomes of Multi-Center Study

Coe, Jeffrey D.,Kitchel, Scott H.,Meisel, Hans Jorg,Wingo, Charles H.,Lee, Soo-Eon,Jahng, Tae-Ahn The Korean Neurosurgical Society 2012 Journal of Korean neurosurgical society Vol.51 No.6

Objective : Pedicle-based dynamic stabilization systems, in which semi-rigid rods or cords are used to restrict or control spinal segmental motion, aim to reduce or eliminate the drawbacks associated with rigid fusion. In this study, we analyzed the two-year clinical outcomes of patients treated with the NFlex (Synthes Spine, Inc.), a pedicle-based dynamic stabilization system. Methods : Five sites participated in a retrospective study of 72 consecutive patients who underwent NFlex stabilization. Of these 72 patients, 65 were available for 2-year follow-up. Patients were included based on the presence of degenerative disc disease (29 patients), degenerative spondylolisthesis (16 patients), lumbar stenosis (9 patients), adjacent segment degeneration (6 patients), and degenerative lumbar scoliosis (5 patients). The clinical outcome measures at each assessment were Visual Analogue Scale (VAS) to measure back pain, and Oswestry Disability Index (ODI) to measure functional status. Radiographic assessments included evidence of instrumentation failure or screw loosening. Results : Sixty-five patients (26 men and 39 women) with a mean age of 54.5 years were included. Mean follow-up was 25.6 months. The mean VAS score improved from 8.1 preoperatively to 3.8 postoperatively, representing a 53% improvement, and the ODI score from 44.5 to 21.8, representing a 51% improvement. Improvements in pain and disability scores were statistically significant. Three implant-related complications were observed. Conclusion : Posterior pedicle-based dynamic stabilization using the NFlex system seems effective in improving pain and functional scores, with sustained clinical improvement after two years. With appropriate patient selection, it may be considered an effective alternative to rigid fusion.

BEHAVIORAL STUDIES OF EPILEPTIC CHILDREN

Chang Jun Coe,Moon Sung,Park 대한소아신경학회 1993 대한소아신경학회지 Vol.1 No.1

The behavioral problem is known to be more common in epileptic children than normal children. It is mainly based on the concept of misunderstanding of epilepsy. The purpose of this study is to determine the exact prevalence of behavioral problems in epileptics comparing to normal children. Achenbach's child behavior check list test was sued for this study, which was redesigned by Korean psychologist. 183 epileptic children were enrolled into the study and 1326 normal children of same age group were studied as control. In group of children, 6 to 11 years of ages, 10% of normal children had behavioral problems, while in epileptics, 18% of male and 20% of female children manifested or had tendency to have behavioral problem. Between normal group and epileptic group, there was no statistical significance. But the social competence of epileptic children is lower than that of normal children 78% of male and 45% in female epileptic children manifested low social competence in active, social, and total social competences. We concluded that behavioral problem in uncomplicated epilepsy is not signifcantly higher than normal children but their social competence were significantly lower than normal children.

COMPARATIVE BEHAVIORAL STUDIES OF DIFFERENT TYPES OF EPILEPSY IN CHILDREN

Chang Jun Coe,Se Wook Oh,Jun Seob Jang 대한소아신경학회 1993 대한소아신경학회지 Vol.1 No.1

According the result of our previous study, it was evidenced that behavioral problem might be a little more frequently occurrence in epileptic children compare to normal healthy children. In comparative study of different types of seizure, the behavioral problems was more frequently associated with temporal lobe epilpesy than other types, and the were aggressive, anxious, withdrawl and depressive in their character. Behavioral disorder was common in epileptic child with learning disorder compare to the ones without learning problems But it was difficult to say that epileptics with leraning problem did always associate with behavioral disorders. In comparative behavioral study between cryptogenic and symptomatic epileptic groups, there was no difference, because we were too strict to select the subject in our study. It was known that behavior of epileptics were influenced by many factors such as intelligence, cognitive function, onset the first seizure, type of seizure, anticonvulsant medication, as well as pre-existing intellectual defect and existence of previous neurologic disorder. To obtain exact results, larger number of patients should be analized by the multiple factors, should be followed in future.

한국 소아중증근무력증 환아의 HLA type의 특성에 대한 연구

고창준(Chang Jun Coe),이준수(Joon Soo Lee),차병호(Byung Ho Cha) 대한소아신경학회 1995 대한소아신경학회지 Vol.2 No.2

배 경 : 중증근무력증은 아세틸콜린 수용체에 대한 항체의 생성에 의해 신경근 세포막의 후접합부에서의 아세틸콜린 수용체의 차단, 파괴로 수의근의 피로와 쇠약을 보이는 자가면역질환으로 최근 중증근무력증에서의 유전적 요인에 대한 활발한 연구가 진행되어 Human Leukocyte Antigen(HLA)과 밀접한 상관관계가 있다고 알려졌으나 아직 국내에서 소아 중증근무력증과 HLA type에 대한 연구가 없는 실정으로 연구자들은 본 연구를 통하여 한국 소아중증근무력증의 HLA type의 상관관계 및 특징을 일반인의 빈도와 비교 고찰하고 유전적 요인을 분석 연구하여 향후 소아 중증근무력증의 유전적, 신경면역학적 연구의 기초자료로 삼고자 본 연구를 시행하였다. 대상 및 방법 : 1980년 3월 1994년 12월까지 연세의대 소아신경과에서 중증근무력증으로 진단된 증세발현 시기가 15세 이전인 환아 30명과 대조군으로 친인척 관계가 없는 정상인 50례를 대상으로 하였으며 전례에서 Biotest-Lymphotype ABC-72-Oriental well tray(Biotest AG 63303 Dreieich/Germany)로 HLA -A,B C typing 하였고 Terasaki Second DR(60) Tissue Typing Tray, Lot #6A로 HLA- DR, DQ typing을 시행하여 환자군과 대조군을 발병빈도, 임상정도 및 발병연령에 따라 비교 분석하였다. 통계 분석은 SAS법의 Chi-Square test 및 Fisher exact 2-tail test를 사용하여 통계적 유의성을 판정하였다. 결 과 : 1) 30례의 환자 중 남녀비는 1:1.1로 남녀간에 큰 차이가 없었으며 이들의 평균 증세 발현시기는 4.6±3.6세였으며 각 증세 발현 시기별로 남녀간의 통계학적 차이는 없었다(P>0.05). 2) Osserman의 분류에 따라 분류시 Group Ⅰ이 18례(60%)로 가장 많았고 Ⅱa 8례(27%), Ⅱb 1례(3%), Ⅲ 3례(10%)였으며 Group Ⅳ는 한례도 없었다. 3) HLA Antigen의 발현빈도를 대조군과 환자군을 비교할 때 HLA antigen A30, Bw4, Bw6, Cw4, DR9, DQ9의 발현빈도가 환자군에서 의의있게 높았으며(P<0.05) HLA Cw3, DR4는 발현빈도가 환자군에서 의의 있게 낮았다(P<0.05). 4) 증세 발현시기와 HLA Antigen의 발현빈도와의 상관관계는 6세 이전에 A30, DR9, DQ9 등의 발현빈도가 의의있게 높음을 알 수 있었으며 CW4는 6세 이후에서 의의있게 발현빈도가 높았고 Bw4, Bw6는 2세이하와 6세이후에서 높은 발현빈도를 나타냈었다.(P<0.05). 5) Cw3는 특히 3-5세에, DR4는 6세 이전에서 의의 있게 낮은 발현빈도를 보였다(P<0.05). 6) Ocular type과 Non-ocular type으로 분류시 HLA type과의 상관관계를 보면 Bw4, Bw6,DR9은 Ocular type에서, A30은 Non-oular type에서, DQ9은 type에 관계없이 높은 발현빈도를 보였고 CW3의 경우는 Non-oular type에서 더 낮은 발현빈도를 보였다(P<0.05). Cw4는 Ocular type에서 다소 높은 발현빈도를 보였으며 DR4는 Ocular type에서 낮은 발현빈도를 보였으나 모두 통계적으로 유의하진 않았다(P>0.05). 결 론 : HLA type A30, Bw4, Bw6, Cw4, DR9, DQ9 등은 한국 소아중증근무력증 환자에서 정상인 집단보다 더 높은 발현빈도를 보였고 Cw3, DR4는 의의있게 낮은 발현빈도를 보였으며 특히 Bw4, Bw6, DR9은 6세 이전 안형에서 높은 발현빈도를 보였으나 좀 더 의미있는 통계적 유의성을 갖기 위해서는 보다 광범위한 연구가 필요할 것으로 사료된다. In myasthenia gravis, the nicotinic acetylcholine receptor at the neuromuscular junction is the target of an autoimmune reaction. One of the important features in this disorder is a strong association with HLA antigens. The association of HLA A1, B8 and DR3 with generalized myasthenia gravis in Caucasoids is well established but no particular gene has been implicated and there is still no adequate explanation in functional terms. In this study. we determined HLA antigen frequencies and corresponding relative risks in 30 Koreans with juvenile myasthenia gravis and normal controls. Using a microcytotoxicity assay and commercially prepared typing trays, we found that HLA A30, Bw4, Bw6 and Cw3, DR9, DQ9 frequencies were significantly increased in patients compared with the control group and there was a decrease in Cw3 and DR4 significantly. Further analysis between different subgroup of patients showed A30, DR9 and DQ9 were more significantly increased in the cases with onset below the age of 6. But Cw4 frequency was increased in patient with over the age of 6. HLA Bw4, Bw6 and DR9 frequencies had a significantly increased prevalence in patient with ocular myasthenia gravis. But A30. with generalized myasthenia gravis. There was an excess of Bw4, Bw6 and DR9 in both ocular type patients and cases with onset below the age of 6. The Korean patients with juvenile myasthenia gravis are characterised by earlier age at onset. more ocular forms and less clinically severe illness than in whites and these characteristics indicate a special subgroup that correlates with the strong Bw4, Bw6, DR9 association.

전반적 발달장애(Pervasive Developmental Disorder)

고창준(Chang Jun Coe),차병호(Byung Ho Cha),이준수(Joon Soo Lee),장진섭(Jin Seob jang) 대한소아신경학회 1993 대한소아신경학회지 Vol.1 No.2

Pevasive developmental disorder is consisted of Kanner's autism , pervasive developmental disorder, Asperger syndrome and high intellegence autism. Those symptoms were reviewed as well as their prognosis and many hypothetical research works of their pathogenesis. 100 cases of autistic children, who were studying at the special school were investigated with abnormal behavior check list test and about 30% of them are not thought to be belonged to autism. By this study, we concluded that the diagnosis should be made more sincerely , hopefully the diagnosis better to be made by team work such as child neurology, psychology, psychiatry as well as education. And well planned educational system should be established for their well being in their future life.

소아 간질 아동의 행동에 관한 연구

고창준(Chang Jun Coe),박재현(Jae Hyun Park),이준수(Jun Soo Lee),강훈철(Hun Chul Kang) 대한소아신경학회 1999 대한소아신경학회지 Vol.7 No.2

Purpose : Some of epileptic children are known to have behavioral problems. But some experts deny frequent association of behavioral problems in epileptic children, compared to non epileptic children. The purpose of this study is to know the relations between the clinical characteristics and behavioral problems in epileptic children. Methods : Ninety-nine, patients were grouped according to underlying disease causing epilepy, seizure type, occurrence of seizure within recent 1 year and duration of treatment. CBCL(Child Behavior Chencklist), which were modified by Oh et al., was used as a tool for psychosocial assessment. Results : 1) Symptomatic group had higher risk than cryptogenic group on school in social competence scale. In behavioral problem scale. Symptomatic group showed none of social problems or thought problems. 2) Partial seizure group has higher risk than generalized seizure group on social problems in behavioral problem scale. 3) Patients with recent seizure experience had higher risk on social, school in social competence scale, social problems, thought problems, attention problems, total behavioral problems in behavioral scale. 4) There was no correlation between duration of treatment and psychosocial parameters. Conclusion : In epileptic children, behavioral problem was not significantly outstanding compared with non epileptic children. It appears that some of their behavior problems have been originated mainly form problems in social adaptation, which might have not been caused by disease itself, but by social prejudice and social misunderstanding. 목 적 : 소아간질은 아동에게 의학적 문제 이외에 심리적, 사회적으로 영향을 미친다. 특히 성장과 발달을 하고 있는 소아에서는 경련 이외에 사회심리적 행동에 미치는 영향이 더 크다. 이에 저자들은 소아간질 환아에서 임상특성과 행동장애와의 관계를 알아보고자 본 연구를 시작하였다. 방 법 : 1999년 1월부터 1999년 9월까지 연세대학교 의과대학 소아과에 간질을 주소로 내원하여 치료받고 있는 4세 이상 17세 미만의 환아 200명을 설문 조사하였으며, 항경련제를 성실히 복용치 않거나, 설문에 불충분하게 응답한 환아 101명을 제외한 99명을 대상으로 하였다. 99례중 남아는 61례(61.1%), 여아는 38(38.4%)였다. 행동의 평가 KCBCL(한국아동행동평가법)을 사용하였으며, 임상군은 원인질환에 따라 증상군과 잠재군, 발작의 종류에 따라 부분 발작과 전신 발작, 최근 1년 내에 경련을 경험한 군과 없었던 군, 치료 기간에 1년 미만인 군과 1년 이상인 군으로 나누어, KCBCL 내 각 행동평가 척도와 임상 척도와 상관관계룰 조사하였다. 결 과 : 1) 증상군에서 사회 미성숙 척도, 사고의 문제 척도, 학업수행 척도에서 문제가 더 많았다(P<0.05). 2) 부분발작군에서 전신발작군보다 사회 미성숙 척도에서 더 많은 문제를 보였다.(P<0.05). 3) 최근 1년 내에 1번 이상의 발작을 경험하여 발작의 빈도가 높은군에서 사회미성숙 척도, 사고의 문제 척도, 주의집중문제 척도, 총문제행동 척도, 학업수행 척도, 사회성 척도에서 더 많은 문제를 보였다(P<0.05). 4) 치료 기간과 행동평가 척도 사이에는 유의한 차이가 없었다. 결 론 : 소아간질 환아에서 선행질환, 발작형태, 발작의 빈번한 발현 등은 행동상의 문제를 동반하는 요인이 되나 일반수준에 비하여 소수에서 행동장애가 발현되었고, 간질 환아의 치료시 발작의 특성 및 행동상의 문제들에 대한 고려가 같이 이루어져야 할 것이며, 좀 더 많은 환아를 대상으로 한 연구가 요구된다.

소아 간질 환아의 학습장애 유형에 대한 분석

차병호, 고창준(Bung Ho Cha, Chang Jun Coe) 대한소아신경학회 1996 대한소아신경학회지 Vol.3 No.2

Background : Learning disabilities are the most common problem of the developmental disabilities including low achievement, underachievement and specific learning disability. The causes are usually unknown but presumed to be due to central nervous system dysfunction. Epilepsy is one of the causes of learning disability, so that we have studied the characteristics of learning disabilities in epileptic children. Materials and Methods : We have evaluated 345 epileptic children at the pediatric Department, college of Medicine, Yonsei University, Seoul, Korea to know the incidence of learning disability(LD) and carried out comparative study between two groups; epileptics with normal learning ability and with LD if they have common clinical features. And 18 out 119 patients with LD have been carried out individual tests such as CBCL (Chid Behavior Check List), KEDI-WICS, Basic learning ability test. Results : 1) The 119 of 345 patients (34.5%) are associated with learning disability. 2) LD in not related with the duration of anticonvulsant(s) therapy, but it significantly related with numbers of anticonvulsants used. 3) The rate of social and behavioral problems in epileptics with learning disability is higher than epileptics with normal learning ability. 4) The 10 of 18 patients carried out individual tests are low achievers and the others are underachievers. In LEDI-WISC test, low achievers whose total IQ are below 80 score show much lower moter IQ than language IQ. On the other band underachievers whose total IQ are greater than 80 show no differences between motor and language IQ. In basic learning ability test, low achievers show particulary lower scores in information processing and mathematic areas and underachievers, in writing area. Conclusions : The learning disability would be oftenly associated with epileptic children and they have behavioral and social problems. Therefore in epileptic children, it is important to evaluate the learning abilities and associated problems as well as seizure control. 연구배경: 학습장애는 학습지진, 학습부진, 특수학습장애를 포함하며 소아에서 발생하는 발달장애 중에 가장 흔한 질환으로, 원인은 아직 확실히 밝혀지지 않았으나 소아 간질을 포함한 다양한 원인에 의한 뇌기능 부진일 것으로 추정하고 있다. 따라서 본 저자들은 소아 간질 환아를 대상으로 학습장애의 유형을 분석하여 간질과 연관된 학습장애의 특성을 알아보고자 본 연구를 실시하였다. 연구대상 및 방법: 1995년 8월부터 1995년 10월까지 연세대학교 외과대학 소아과에 간질로 내원한 5세 이상의 환아 345명을 대상으로 간질 환아의 학습장애 빈도 및 임상적 특성을 분석하였고, 학습장애아 중에 18명에 대해서는 개별검사로 아동행동검사, 지능검사(KEDI-WISC), 기초학습기능검사를 시행하여 간질과 동반된 학습장애아의 특성을 분석하였다. 결과: 1) 대상환아 345명 중 학습장애아는 119명으로 간질 환자에서 학습장애가 동반되는 경우는 34.5%였다. 2) 간질 환자에서 항경련제 투여 기간과 학습장애의 발현 빈도와는 상관관계가 없었다. 3) 특정한 경련 형태와 합습장애동반과는 상관관계가 없었다. 4) 많은 수의 항경련제를 복합 투여할 경우 학습장애가 동반되는 비율이 높았다. 5) 학습장애가 동반된 간질 환자의 경우 대인관계 이상이나 행동장애를 동반하는 비율이 높았다. 6) 학습장애가 동반된 간질환아 18명에 대한 개별검사 결과 학습지진아의 경우 동작성 지능이 언어성 지능보다 더욱 저조한 특성을 보였고, 기초학습기능검사상 정보처리, 셈하기 항복이 특히 저조한 반면, 특수학습장애아의 경우 언어성 지능이나 동작성 지능의 차이가 없었으며, 기초학습기능검사상 쓰기 항목이 특히 저조하였다. 결론: 저자들의 연구결과 간질 환자의 약 34%에서 학습장애가 동반되었고 이들에게서 행동장애나 대인관계의 이상이 동반되는 비율이 높았다. 따라서 소아 간질환아의 경우 경련조절뿐 아니라 학습에 대한 평가가 반드시 이루어져야 하며, 동반될 수 있는 심리적, 환경적 문제가 같이 해결되야 할 것으로 사료된다.

연수 침범이 동반된 교중앙탈수초증 1 례

오성욱, 고창준(Sung Wook Oh, Chang Jun Coe) 대한소아신경학회 1996 대한소아신경학회지 Vol.3 No.2

About 10% of cases of central pontine myelinolysis are associated with extrapontine lesions in the medulla, spinal cord, basal ganglia, cerebellum, cerebral cortex, thalamus. We experienced a case of central pontine myelinolysis accompanied with medullary invasion who had been transfered from a local hospital presented with stuporous mental state, respiratory difficulty, abnormal eyeball and eyelid movements. Rare to diagnose central pontine myelinolysis with medullary invasion during one's life time, we report the case with the brief review of the literature. 저자들은 혼미한 의식 상태, 호흡 곤란, 안구의 불수의적 운동을 주소로 외부 병원에서 전원된 환아에서 연수 침범이 동반된 중앙교탈수초중 1례를 경험하였기에 문헌 고찰과 함께 보고 하는 바이다.