척수 손상 환자의 중추성 통증에 대하여 시행한 Microsurgical DREZotomy의 효과

이지인,김성호,안상호,장성호 영남대학교 의과대학 2002 Yeungnam University Journal of Medicine Vol.19 No.1

The central pain in patient with spinal cord injury is a common and disabling sequela. The microsurgical DREZ(Dorsal Root Entry Zone)otomy is a surgical procedure effective in the treatment of intractable pain and spasticity in spinal cord injured patients. It consists of a microsurgical lesions performed in the ventrolateral region of the dorsal root entry zone at the selected levels. This report presents one case with incomplete paraplegia patient, who had chronic central neuropathic pain ineffective to many conservative treatments in bilateral T10 and right T11 segments and both lower extremities, is relieved from the pain after microsurgical DREZotomy. In conclusion, microsurgical DREZotomy is one method of effective treatments for spinal cord injured patients with intractable central neuropathic pain.

불수의 운동형뇌성마비환자의 음성학적 특징

이지인,오상호,이양수,김풍택 大韓再活醫學會 2000 Annals of Rehabilitation Medicine Vol.24 No.4

Effect of Botulinum Toxin Type A on Morphology of Salivary Glands in Patients with Cerebral Palsy

Zee-Ihn Lee,Dong-Hyun Cho,Won-Duck Choi,박동휘,Seung-Deuk Byun 대한재활의학회 2011 Annals of Rehabilitation Medicine Vol.35 No.5

Objective To investigate the eff ect of botulinum toxin type A (BTXA) on drooling and the morphologic change of the salivary gland in patients with cerebral palsy. Method Eight cerebral palsy patients suffering from severe drooling participated in this study. BTXA was injected into both submandibular and parotid glands under intravenous sedation and with ultrasound guidance (1 unit/gland/kg: maximum 100 units) in an outpatient or inpatient procedure. The severity of drooling was measured before injection and 3 weeks after injection using the Teacher Drooling Scale, the Drooling Score-severity,frequency and the Visual Analog Scale. To investigate the morphologic change of the salivary glands, the size of salivary glands were measured before injection and 3 weeks after injection using computed tomography of the neck. The measurement values were analyzed by Wilcoxon signed rank test. Results Statistically significant improvements were shown in all three parameters for assessing the severity of drooling after BTXA injections (p<0.05). Size of the salivary glands were signifi cantly decreased at 3 weeks after BTXA injection (p<0.05). Conclusion Salivary gland injection with BTXA could be a useful treatment method to reduce drooling in patients with cerebral palsy and decreased size of salivary glands may partially explain the mechanism.

척수 손상 환자에 있어서의 Dysesthetic Pain Syndrome

이지인,이양수,김풍택,박현 大韓再活醫學會 1998 Annals of Rehabilitation Medicine Vol.22 No.1

흰쥐의 좌골신경에 1% 페놀용액을 주입한 실험용 신경병변성 동통모델의 개발

이기훈,이지인,김영은,이양수,김풍택,김명남 경북대학교 의학연구소 2000 경북대학교병원의학연구소논문집 Vol.4 No.1

Development of Neuropathic Pain Model with 1% Phenol Injection in Rat Sciatic Nerve Objective: The purpose of this study is to develop a new neuropathic pain model in the rat. Method: Each male adult rat was anesthetized and the sciatic nerve was exposed. Each exposed nerve was injected with 0.03 cc of 1% phenol solution. Normal saline 0.03 cc was injected to the placebo group. Rats were tested for the presence of mechanical allodynia by von Frey hair. Spontaneous pain behavior (paw shaking, paw elevation) was examined for 5 minutes in the cage. Results: Phenol injected group developed allodynia after the second post-injection day for up to 1 month. Allodynia was also observed in the contralateral lags of phenol injected group. The control group did not develop allodynia. Spontaneous pain behavior was not observed in either group. Conclusion: Neuropathic pain model was developed by 1 % phenol solution injection to the rat sciatic nerve. This study suggests an easier method for making the neuropathic pain model.

흰쥐의 좌골신경에 1% 페놀용액을 주입한 실험용신경병변성 동통모델의 개발

이기훈,이지인,김영은,이양수,김풍택,김명남 大韓再活醫學會 2000 Annals of Rehabilitation Medicine Vol.24 No.2

Effects of Central GABA and Glutamate on Blood Pressure and Single Unit Spikes in the RVLM of Rats

Park, Jae-Sik,Lee, Zee-Ihn,Jang, Jae-Hee,Ahn, Dong-Kuk The Korean Society of Pharmacology 2002 The Korean Journal of Physiology & Pharmacology Vol.6 No.3

The blood pressure (BP) is regulated by the nervous system and humoral factors, such as renin- angiotensin system, vasopressin and others. In the present study, we examined the central effects of glutamate and GABA on the cardiovascular regulation by injection of these substances into the lateral ventricle and also investigated the relationship between these central effects and the action of angiotensin II (Ang). Male Sprague Dawley rats, $350{\sim}400$ g, were anesthetized with urethane and instrumented with an arterial catheter for direct measurement of BP and heart rate (HR), and an guide cannula in the lateral ventricle for drug injection. A glass microelectode was inserted into the rostral ventrolateral medulla (RVLM) for recording single unit spikes. Barosensitive neurons were identified by changes of single unit spikes in RVLM following intravenous injection of nitroprusside and phenylephrine. The effects of GABA and glutamate injected into the lateral ventricle were studied in single neuronal activity of the RVLM in addition to changes in BP and heart rate, and compared the results before and after treatment with intravenous losartan, nonpeptide Ang II-type 1 receptor antagonist (1 mg/100 g BW). Intracerebroventricular administration of GABA decreased systolic blood pressure (SBP) and HR, but increased the firing rates in the RVLM. However, intracerebroventricular glutamate injection produced effects opposite to GABA. After pretreatment of intravenous losartan, the central effects of GABA on BP and firing rate in the RVLM were significantly attenuated and that of glutamate showed a tendency of attenuation. These results suggested that central GABA and glutamate regulated BP and firing rates in RVLM were inversely related to BP change. The central effects of GABA or glutamate on the autonomic nervous function were modulated by humoral factor, Ang II, by maintaining BP.

Th e Additive Eff ects of Hyaluronidase in Subacromial Bursa Injections Administered to Patients with Peri-Articular Shoulder Disorder

Seung Deuk Byun,박동휘,Yong Ho Hong,Zee Ihn Lee 대한재활의학회 2012 Annals of Rehabilitation Medicine Vol.36 No.1

Objective To evaluate the additive eff ects of hyaluronidase combined with steroids in patients with peri-articular shoulder disorder. Method Thirty patients with peri-articular shoulder disorder were given subacromial bursa injections once a week for three consecutive weeks. Fifteen patients (Group A) underwent subacromial bursa injections with hyaluronidase 1,500 IU, triamcinolone 40 mg and 0.5% lidocaine (total 6 ml). Another fi fteen patients (Group B)underwent the same injections with triamcinolone 40 mg and 0.5% lidocaine (total 6 ml). We examined the active range of motion (AROM) in the shoulder, used a visual analogue scale (VAS) for measurement, and administered a shoulder disability questionnaire (SDQ) at the commencement of the study and then every week until one week after the third injection. Results There were no significant difference between group A and B before the injections took place (p>0.05). Statistically signifi cant improvement was seen in the VAS, SDQ, and AROM of fl exion, abduction, internal rotation at one week after the first and second injections compared with the parameters measured at previous visits in both groups (p<0.05), except the SDQ between one week after the fi rst and second injections in group B (p>0.05). Improvement in all parameters measured at one week after the third injection compared with the measurement values at one week after the second injection were not statistically signifi cant in both groups (p>0.05). However,group A (the hyaluronidase group) showed signifi cantly greater improvements than group B in terms of their SDQ and AROM of internal rotation scores one week after the three injections had taken place (p<0.05). Conclusion Peri-articular shoulder disorder patients who underwent subacromial bursa injections using hyaluronidase and steroids showed greater functional improvements than those who were given only steroid injections.

집중적 전기 자극치료가 만성 뇌졸중 환자의 보행에 미치는 효과

박해운,이지인,이양수,Park, Hea-Woon,Lee, Zee-Ihn,Lee, Yang-Soo 대한임상신경생리학회 2005 Annals of Clinical Neurophysiology Vol.7 No.1

Background: The purpose of this study is to investigate the effect of the intensive functional electrical stimulation(FES) on the improvement of the gait pattern of the chronic hemiplegic patients. Method: Six hemiplegic patients, who could walk independently but have equinovarus deformity during the gait cycle, participated in this study. The affected peroneus longus and tibialis anterior muscles of all subjects were stimulated for 2 weeks period (20 minutes duration, 6 times/day). We measured the activities (mean voltage) of those muscles during the walking, using dynamic EMG. Results: After treatment, there were significant improvements in the strength of peroneus longus and tibialis anterior muscles and the gait speed, but there was no interval change of the spasticity of plantar flexor. The mean voltages of two muscles are significantly increased in all the patients (p<0.05). Conclusion: The results showed that the intensive FES on affected peroneus longus and tibialis anterior muscles in chronic hemiplegic patients could be useful for the improvement of functional gait.

뇌졸중환자에서 뇌지도화를 통해 증명된 동측 운동신경 경로

장성호,한봉수,장용민,변우목,이지인,이호 한국뇌학회 2001 한국뇌학회지 Vol.1 No.2

목적: 뇌졸중환자에서 fMRI와 TMS를 이용하여 수부의 운동신경기능에 대한 뇌지도화를 시행하여 운동신경기능 회복 기전에 대하여 연구하고자 하였다. 방법: 40세 여자 환자로 우측 심부 백질 경색으로 인한 좌측 편마비환자이었다. 기능적 자기공명영상은 1.5T MR scanner로 Blood Oxygen Level-Dependent(BOLD) 기법을 적용하였다. 운동 과제는 손가락을 1∼2 Hz의 주기로 쥐었다 펴기를 반복하였다. TMS는 원형코일의 앞쪽 부위를 1.0 cm 간격으로 자극하여 양측 단무지외전근에서 운동유발전위를 얻었다. 결과: FMRI를 시행한 결과 건측인 우측 수부운동 시 좌측 일차 감각운동피질(SM1)이 활성화되었다. 환측인 좌측 수부운동 시에는 양측 SM1이 활성화되었다. TMS를 이용한 뇌지도화에서는 건측인 좌측 대뇌 피질로부터 환측인 좌측 상지로 가는 동측 운동유발전위가 유발되었다. 동측 운동유발전위는 좌측 대뇌 피질을 자극하여 우측 단무지외전근에서 유발된 운동유발전위에 비하여 잠시가 지연되어 있고 전위가 감소되어 있었다. 결론: FMRI와 TMS를 이용한 뇌지도화를 통하여 건측 대뇌피질로부터 환측 상지로의 동측 운동신경 경로에 의하여 운동신경기능 회복이 되었으며 이 동측 운동신경 경로는 비피질척수로에서 기인된 것으로 추정할 수 있었다. Objective: This study investigated the mechanism of motor recovery using both functional Magnetic Resonance Imaging(fMRI) and Transcranial Magnetic Stimulation(TMS) in a left hemiplegic patient with infarction on the right deep white matter. Method: FMRI was performed using blood oxygen level-dependent(BOLD) technique at 1.5 T with a standard head coil. The motor activation task consisted of finger flexion-extension exercises in 1-2 Hz cycles. TMS was carried out using a round coil. The anterior portion of the coil was moved over different scalp positions 1.0 cm apart. Motor evoked potential(MEP) from both abductor pollicis brevis(APB) muscle was obtained simultaneously Results: FMRI showed that the left primary sensorimotor cortex(SM1) was activated with the right hand movements. On the other hand, the bilateral SM1 were activated with the left hand movements. Brain mapping using TMS revealed that ipsilateral MEPs were obtained at the left APB muscle. Ipsilateral MEPs of left APB muscle showed delayed latency and lower amplitude compared to that of right APB muscle when stimulated at the left motor cortex. Conclusions: We concluded that ipsilateral motor pathway from undamaged motor cortex seemed to contribute to the motor recovery in this patient. The ipsilateral motor pathway was considered to be originated from non-corticospinal tract by its configuration.