급성 말초성 안면신경마비 환자의 안면신경 손상 정도에 영향을 미치는 요인에 대한 후향적 연구: 근전도검사를 이용하여

김필군,성원석,구본혁,유희경,석경환,이주현,김민정,박연철,서병관,백용현,박동석,Kim, Pil Kun,Sung, Won Suk,Goo, Bon Hyuk,Ryu, Hee Kyung,Suk, Kyung Hwan,Lee, Ju Hyeon,Kim, Min Jeong,Park, Yeon Cheol,Seo, Byung Kwan,Baek, Yong Hyeon,Park, 대한침구의학회 2013 대한침구의학회지 Vol.30 No.5

Objectives : This research was conducted to investigate the factors that affect the level of facial nerve damage. Methods : From October 2009 to September 2013, the total number of 581 patients of Bell's palsy and Ramsay-Hunt syndrome visited Facial Palsy Center in Kyung Hee University Hospital at Gangdong for Traditional Korean and Western combined medical treatment. Of these, 453 patients of peripheral facial nerve palsy were selected for the research. After reviewing the medical records that have details of age, gender, diagnosis(Bell's palsy and Ramsay-Hunt syndrome), onset, underlying diseases(DM, HTN), and HbAlc value, the analysis on the influence factors on the level of facial nerve damage was drew out. Results : The axonal loss rate of oris branch and nasal branch were significantly higher than the axonal loss rate of frontal branch and oculi branch. In addition, the frequency of becoming a major damaged branch was also high in the oris branch nasal branch. The factors by month, weather, smoking, and alcohol did not influence EMG axonal loss rate. Male rather than female and patient with Rasmay-Hut syndrome rather than Bell's palsy had a higher axonal loss rate in all branches. Of those, front of branch of male was remarkably higher than female. Patient with DM as P/H had high axonal loss rate in all branches. Patient with HTN as P/H had high axonal loss rate in all branches except for oris branches. Patients with DM and HTN group had significantly higher value from the average of axonal loss rate than patients who are only with HTN and without DM/HTN. DM alone group had significantly higher value than patients who are without DM/HTN. However, HTN alone was not significantly high. By analysing HbAlc of the patients who were hospitalised regardless DM, axonal loss rate was high in the order of DM group, preDM group, normal group. Nevertheless, only DM group showed higher axonal rate statistically than normal group. Considering DM and HbA1c value, the patients can be divided into 4 different groups of hkDM, lkDM, hfDM and nDM. By analysing those groups, the average damaged value of the groups with diagnosis followed by treatment(lkDM, hkDM) were higher than the average rate of hfDM and statistically higher than the rate of the nDM. Conclusions : The influential factors of increasing the level of EMG damage are male(only for the frontal branch), age above sixties, HTN, DM, and HbAlc value above 6.5. Besides, the negligible factors are month, season, diagnosis, alcohol, and smoking. Further research including clinical prognosis should be conducted.

안면신경마비 예후인자로서 근전도검사(EMG)와 조기 시행한 신경전도검사(ENoG)의 유용성에 대한 연구: 한양방 협진치료 기반으로

성원석,김필군,구본혁,유희경,석경환,이주현,김민정,박연철,서병관,박동석,백용현 대한침구의학회 2013 대한침구의학회지 Vol.30 No.4

Objectives : This study was performed to confirm the usefulness of EMG and early-performed ENoG as predicting factor for facial palsy by clinical outcome. Methods : We gathered patients who visited the Facial Palsy Center in Kyung Hee University Hospital at Gangdong between January 2010 and September 2012. We used inclusion/exclusion criteria and reviewed 231 patients’ medical records including gender, age, HB grade and EMG & ENoG axonal loss. We compared the relation between EMG axonal loss and improvement degree at 4 & 6 weeks after treatment, and between ENoG axonal loss at 3-5 & 6-8 days after onset and EMG axnoal loss using regression analysis. Results : Each analysis had statistical significance, but EMG & improvement degree at 6 weeks after treatment showed statistically higher correlation than that at 4 weeks after treatment, and ENoG at 6∼8 days after onset & EMG showed statistically higher correlation than that at 3∼5 day after onset. Conclusions : We could get the evidence of the validity of EMG and early-performed ENoG as predicting factor for facial palsy based on collaborative treatment between Korean and western medicine.

퇴행성 슬관절염 환자의 한열 성향에 따른 한약 제제의 유효성과 안전성 비교

송지연,김민정,성원석,김필군,구본혁,곽현영,김지혜,김동혁,박연철,서병관,백용현,최도영,이재동,박동석 대한침구의학회 2012 대한침구의학회지 Vol.29 No.5

Objectives : To demonstrate the importance of syndrome differentiation in clinical research of herb medication, through the comparative study on efficacy and safety of herb medication according to cold-heat tendency of OA knee patients. Methods : During December 2010 to July 2011, 138 knee OA patients were randomly assigned to WIN-34B 600mg(300mg, b.i.d.), 1,200mg(600mg, b.i.d.) and placebo b.i.d. for 8 weeks. Patient were re-classified into cold-heat tendency group according to cold-heat questionnaires. To investigate efficacy and safety, we assessed the 100mm pain VAS at baseline and 8 weeks later, and we monitored adverse event of patients during treatment period. Results : 1. Efficacy study : In WIN-34B 1,200mg group, VAS mean changes of heat tendency group showed slightly increase than those of cold tendency, but no significant difference within two groups. In heat tendency group, WIN-34B 1,200mg group showed a significant decrease of VAS compared to placebo group. but there were no significant difference in cold tendency group. 2. Safety study; In WIN-34B 600mg group, incidence of adverse events of cold tendency group was higher than those of heat tendency, but not in WIN-34B 1,200mg group. Conclusions : This study suggests that WIN-34B tend to have more efficacy in heat tendency-knee OA patients and WIN-34B is safe drug relatively, regardless of cold-heat tendency. In further clinical research on efficacy and safety of WIN-34B, stratification using syndrome differentiation is required.

외상성 안면마비 환자에 대한 임상적 고찰

김민정,송지연,성원석,김필군,유희경,박연철,서병관,우현수,백용현,박동석,Kim, Min Jung,Song, Ji Yeon,Sung, Won Seok,Kim, Pil Kun,Ryu, Hee Kyoung,Park, Yeon Cheol,Seo, Byung Kwan,Woo, Hyun Su,Baek, Yong Hyeon,Park, Dong Suk 대한침구의학회 2012 대한침구의학회지 Vol.29 No.6

Objectives : This study was performed to define clinical character of peripheral facial nerve injury. Methods : 36 patients was identified with peripheral facial nerve injury among 1128 patients who visited the Facial Palsy Center in Kyung Hee University Hospital at Gang-dong between January 2010 and November 2011. We reviewed the medical records including gender, age, cause, symptom, period of treatment, and axonal loss. Results : Most common cause of peripheral facial nerve injury was iatrogenic surgery, followed by direct trauma, neoplastic disorders. Patients with facial nerve injury commonly complain about facial palsy(ipsilateal or bilateral), followed by paresthesia, facial spasm, facial pain, auricular pain. Peripheral facial nerve injury group showed worse electrophysiological pattern and younger onset age compared with Bell's palsy group. Conclusion : This study was designed for 36 patients and further studies are necessary.

안면마비 후유증 및 평가 방법에 대한 고찰

이정우,권신애,김민정,송지연,김필군,서병관,우현수,박동석,백용현 대한침구의학회 2011 대한침구의학회지 Vol.28 No.2

Objectives : The purpose of this study is research on facial palsy sequelae and evaluating scale that have studied insufficiently until now. Methods : We researched on the symptoms, epidemiology and evaluating scale of facial palsy sequelae. For this, we searched the research papers on facial palsy sequelae and the clinical papers that find out the effect of treatment by evaluating facial palsy sequelae. Results : The symptoms of facial palsy sequelae are synkinesis, contracture, spasm, crocodile tears syndrome, tearing decrease, gustation impairment, hearing impairment, tinnitus, hyperacusis, etc. Among these, synkinesis, contracture, spasm and crocodile tears syndrome are the most frequently observed broadly. The poor prognosis factor of facial palsy can be the risk factor of facial palsy sequelae. For example, severe degeneration of facial nerve can be the risk factor of facial palsy sequelae. Most of clinical papers on facial palsy sequelae have used NRS(numeric rating scale) as evaluating scale. But NRS is very subjective scale. The scales of Stennert, Peitersen, Murata et al. can evaluate facial palsy sequelae grossly. Sunnybrook scale, Sydney scale, SAQ(synkinesis assessment questionnaire), the scale of Kim, the scale of Scott, HFS-7(hemi facial spasm), HFS-36 and Schirmer’s test can evaluate the respective symptoms of facial palsy sequelae. Conclusions : The symptoms of facial palsy sequelae are synkinesis, contracture, spasm, crocodile tears syndrome, etc. Most of clinical papers on facial palsy sequelae have used NRS as evaluating scale. There were some scales that can evaluate facial palsy sequelae grossly and respectively. In future, we will need more progressed study of facial palsy sequelae and evaluating scale.