혈소판 감소성 자반증을 동반한 수두 2례

은백린,송해준 최신의학사 1994 最新醫學 Vol.37 No.12

Destructive Encephalopathy를 보인 Incontinentia Pigmenti 1예

한진규,최재철,박민규,박건우,은백린,정지태,이대희 대한신경과학회 1998 대한신경과학회지 Vol.16 No.5

melkersson-Rosenthal 증후군 1례

피대훈,나요원,장기영,서우근,이기형,은백린 대한소아과학회 2002 小兒科 Vol.45 No.10

Comparative trial of low- and high-dose zonisamide as monotherapy for childhood epilepsy

Eun, So-Hee,Kim, Heung Dong,Eun, Baik-Lin,Lee, In Kyu,Chung, Hee Jung,Kim, Joon Sik,Kang, Hoon-Chul,Lee, Young-Mock,Suh, Eun Sook,Kim, Dong Wook,Eom, Soyong,Lee, Joon Soo,Moon, Han Ku Elsevier 2011 SEIZURE Vol.20 No.7

<P><B>Abstract</B></P><P><B>Purpose</B></P><P>To evaluate the effectiveness of zonisamide (ZNS) as monotherapy in children with newly diagnosed epilepsy.</P><P><B>Methods</B></P><P>This randomized, multicenter trial included a 2–4-week titration and a 24-week maintenance phase after randomization to low-(3–4mg/kg/day) or high-(6–8mg/kg/day) dose groups as target maintenance dosages. The primary outcome measure was the seizure-free rate over 6 months, while a secondary measure was the change in cognition and behavior from screening to the end of the maintenance phase.</P><P><B>Results</B></P><P>Out of 125 patients enrolled, 90 (49 low-dose and 41 high-dose) completed the study. Forty-one patients (63.1%) in the low-dose group and 34(57.6%) in the high-dose group achieved 6 months’ freedom from seizures (<I>p</I>=0.66). After treatment, the picture arrangement subtest improved in the low-dose group (<I>p</I>=0.047) while the vocabulary subtest worsened in the high-dose group (<I>p</I>=0.020). Comparing between the two groups, the vocabulary subtest in the high-dose group was significantly worse than that in the low-dose group (<I>p</I>=0.002). Social competence, somatic complaints, depression/anxiety and delinquent and aggressive behavior in the low-dose group were significantly improved (<I>p</I><0.05). Moreover, total social competence, somatic complaints, delinquent behavior, externalizing, and total behavior problems were significantly more improved in the low-dose group than the high-dose group (<I>p</I><0.05).</P><P><B>Conclusions</B></P><P>ZNS is an effective monotherapy for newly diagnosed childhood epilepsy. Lower doses of ZNS have a similar efficacy and more beneficial neurocognitive effects compared to higher doses. When prescribing higher doses of ZNS, one must be aware of the possible manifestation of problems associated with language development, such as those affecting vocabulary acquisition.</P>

The Neuroprotective Effects of the Platelet-Activating Factor Antagonist BN 52021 on Hypoxic-ischemic Brain Injury in the Immature Rat

Baik Lin Eun 대한소아신경학회 1997 대한소아신경학회지 Vol.5 No.1

Purpose : Platelet-activating factor (PAF) is overproduced in ischemic brain. Although post-ischemic PAF antagonist administration protects the mature brain in some models, little is known about the effects of PAF antagonists in the immature brain. We hypothesized that the PAF antagonist BN 52021 would attenuate perinatal cerebral hypoxic-ischemic injury. Methodes : To elicit focal hypoxic-ischemic brain injury, seven day old (P7) rats(n=111) underwent right carotid ligation, followed by 2.5-3.25 h hypoxia (FiO2=0.08). BN 52021 neuroprotection was evaluated in 3 groups of experiments: ① 25mg/kg/dose, 0 and 2 h post-hypoxia, ② 25mg/kg/dose immediately before and 1 h after hypoxia, ③ post-hypoxia-ischemia treatment with BN 52021 12.5, 25 or 50mg/kg/dose in 2 doses 0 and 2 h after hypoxia. All experiments included concurrent vehicle-injected controls. To quantitate severity of injury, bilateral regional cross-sectional areas (groups 1 and 2) or hemisphere weights (group 3) were evaluated on Pl2. Results : Both pre- and post-hypoxic treatment with BN 52021 (25mg/kg/dose, 2 serial doses) decreased the incidence of cerebral infarction from 90% to about 30%(p<0.02, Fisher's exact test). Measurement of cross-sectional areas confirmed neuroprotection and indicated some benefit of pre- over post-hypoxic-ischemic treatment in hippocampus and cortex. Over the dose range tested, the neuroprotective effect of BN 52021 administration was not dose-dependent. In contrast, BN52021 did not attenuate NMDA-induced hippocampal excitotoxic injury in P7 rats. Conclusions : Either prophylactic or ""rescue"" administration of PAF antagonists decreases the incidence and severity of brain injury associated with an episode of perinatal cerebral hypoxia-ischemia.

Neuroprotection and Disease Modification in Immature Brain

( Baik-lin Eun ) 대한응급의학회 2017 대한응급의학회 학술대회초록집 Vol.2017 No.2

영유아 건강검진 사업의 이해

은백린(Baik Lin Eun),김성우(Seong Woo Kim),김영기(Young Key Kim),김정욱(Jung Wook Kim),문진수(Jin Soo Moon),박수경(Su Kyoung Park),성인경(In Kyung Sung),신손문(Son Moon Shin),유선미(Sun Mi Yoo),은소희(So Hee Eun),이혜경(Hea Kyoung Le 대한소아신경학회 2007 대한소아신경학회지 Vol.15 No.2

한국형 Ages and Stages Questionnaire (K-ASQ) 발달선별검사의 문항 적절성 평가

은백린(Baik-Lin Eun),정희정(Hee Jung Chung),조신해(Sinhae Cho),김진경(Jin Kyung Kim),신손문(Son Moon Shin),이지훈(Ji Hoon Lee),최지은(Jieun Choi),김영아(Young Ah Kim),오경자(Kyung Ja Oh) 대한소아신경학회 2014 대한소아신경학회지 Vol.22 No.2

목적: K-ASQ 발달선별검사는 1980년 미국의 Oregon 대학에서 개발된 ASQ 2판을 한국 실정에 맞게 표준화 한 것으로 부모가 작성하는 영ㆍ유아 모니터링 시스템이다. 이 검사는 2007년 11월부터 시작된 영유아 건강 검진에서 발달장애의 가능성이 있는 영유아를 조기에 선별하기 위한 선별검사도구로서 이용되고 있다. 본 연구는 새로운 영유아 발달선별검사 도구를 개발을 위한 선행 연구로써 기존에 실시된 K-ASQ 발달선별 검사 자료의 통계분석을 통해 K-ASQ 문항의 적절성을 평가하였다. 방법: 1,696명[남아 877명(51.7%), 여아 819(48.3%)]을 대상으로 기존에 국내에서 실시된 K-ASQ 자료의 통계분석을 통하여 문항의 적절성을 평가하였다. 분석에 포함된 표본은 각 월령군별로 남녀가 각각 50여 명씩 수집하였다. 결과: K-ASQ 자료의 분석 결과 ① 선별검사로서의 난이도 및 규준의 적절성은 K-ASQ 규준 자료와 현재 검진대상샘플의 점수를 비교할 때 샘플의 점수가 규준보다 다소 높은 경향이 있었다. ② 요인 구조의 적합도가 전반적으로 부족하였으며 특히 문제해결 및 사회성 부분에서의 적합도가 현저히 떨어 졌다 (문제해결[x²=41.063, P<0.01, CFI=0.929, TLI=0.834, RMSEA=0.152], 개인-사회성[x²=55.208, P<0.01, CFI=0.817, TLI=0.573, RMSEA=0.182]). ③ 문항의 발달적 민감성을 평가한 결과 월령대에 따라 점수 차이가 유의하지 않은 문항들이 발견되었다. 결론: 선별검사로서 K-ASQ 문항의 적절성은 대체로 양호하였으나 일부 월령대와 영역에서 다소 부족하였으며, 현재 측정 문항으로는 문제해결 및 개인-사회성 요인을 바람직하게 추정하고 있지 못하다고 판단된다. 우리나라 영유아를 대상으로 신뢰할 수 있고 타당도 높은 새로운 영유아 발달선별검사 도구의 개발이 필요하겠다. Purpose: Since National Health Screening Program for Infants and Children in Korea started from November, 2007, the need to design a new tool that can timely identify infants and chlildren with possible delayed development has been emphasized. The developmental screening devices currently used in Korea are mostly adapted from foreign tests and could be considered inappropriate for children growing in a different cultural background. Therefore, we assessed the appropriateness of Korean- Ages and Stages Questionnaires (K-ASQ) items in Korean infants and children, as a preliminary study to develop a new developmental screening test tool. Methods: Data on K-ASQ tests that were performed in multicenters as a National Health Screening Program in Korea were analyzed to measure ① the item difficulty and norm relevance ② the goodness of fit for factor structure ③ the sensitivity of item for developmental evaluation. A total of 1,696 subjects, 877 boys (51.7%) and 819 girls (48.3%) were studied and with about 50 boys and 50 girls for each age of months, the sample was relatively evenly distributed. Results: Analysis of K-ASQ data showed that ① The subjects scored higher when compared to the K-ASQ's original criteria. ② The suitability of confirmative factor structure was insufficient, especially problem solving [x²=41.063, P<0.01, CFI (Comparative Fit Index)=0.929, TLI (Turker-Lewis index)=0.834, RMSEA (Root Mean Square Error Approximation)=0.152] and personal-social domains (x²=55.208, P<0.01, CFI=0.817, TLI=0.573, RMSEA=0.182). ③ Some questions did not show significant difference in the sensitivity of item for developmental evaluation among monthly age groups. Conclusion: According to the analysis of previous K-ASQ data, the appropriateness of the questionnaires is good in general, but some questions of problem-solving and personal social domains are not appropriate. We suggested the development of a new developmental screening test tool, which is suitable for Korean infants and children.

경련발작을 동반한 은행중독증 2례

이은경(Eun Kyoung Lee),이용주(Yong Joo Lee),이근래(Kuen Lae Lee),김은주(Eun Ju Kim),은백린(Baik Lin Eun) 대한소아신경학회 1995 대한소아신경학회지 Vol.2 No.2

Two cases of acute Ginkgo Biloba intoxication in a nineteen month old girl and two years old girl were presented. The patients were admitted with clinical manifestations of abrupt vomiting, generalized tonic convulsion which were developed after ingestion of significant amounts of Ginkgo. Laboratory works revealed no specific findings. These patients were treated with supportive cares such as parenteral fluid administration and close observation. The were discharged with complete improvements on the second and third day of admission.

간질 환아에서 항경련제 투여가 혈청 지질치에 미치는 영향

은백린(Baik-Lin Eun) 대한소아신경학회 1995 대한소아신경학회지 Vol.2 No.2

연구배경 : 대부분 장기간 동안 항경련제 치료를 받아야 하는 간질 환자는 약물의 직접적인 부작용뿐만 아니라, 치료적 혈중 농도에서도 내분비 및 대사장애 등에 따른 이차적인 부작용을 경험하게 된다. 특히 많은 항경련제들이 간의 대사 효소를 유도하는 특성(hepatic enzyme-inducing properties)을 가지므로 주로 간에서 합성, 분해되는 지질치에 변화가 있을 수 있다. 이에 저자는 간질 환아에서 항경련제 투여가 혈청 지질치에 미치는 영향을 알아보기 위하여 본 연구를 시행하였다. 대상 및 방법 : 1994년 3월부터 9월까지 고려의대부속 안산병원 소아과에서 항경련제 투여를 받고 있는 환자들 중 3개월 이상 투약한 58명을 대상으로 하였으며, 대조군은 과거에 간질의 병력 또는 항경련제를 복용한 경험이 없고 간기능 검사등 혈청 지질치에 영향을 줄만한 요인이 없는 소아 74명으로 하였다. 치료군은 투여한 항경련제 종류에 따라 phenobar-bital 치료군(n=19명), carbamazepine 치료군(n=21명), valproic acid 치료군(n=9명), 복합 치료군(n=9명)의 네 군으로 분류하였다. 복합 치료군은 pheno-barbital, carbamazepine, valproic acid, phenytoin clonazepam 가운데 두가지 이상의 약제를 투여하였다. 검사 전날 저녁 식사 후 물을 제외한 모든 음식을 금식시키고 다음 날 아침 채혈을 하였다. 검사 종목은 total cholesterol, high density lipoprotein cho-lesterol, triglyceride, apolipoprotein A-1, apolipo-protein B, lipoprotein(a) 및 혈액내 약물 농도, 간기능 검사 등이며 low density lipoprotein cholesterol과 Atherogenic Index는 공식을 이용하여 구하였다. 결과 : 1. 치료군의 연령은 평균 7.5±3.6세이었고, 대조군은 7.6±4.1세로 비슷한 연령 분포이었다. 2. 치료군의 전체 평균 지질치는 total cholesterol, LDL-C, Apo A-1, Apo B, Lp(a) 등이 대조군보다 유의하게 높았다. 3. phenobarbital 치료군에서 total cholesterol, HDL-C, LDL-C, Apo A-1, Apo B, Lp(a) 등이 대조군에 비해 유의하게 높았다. 4. carbamazepine 치료군에서는 total choleste-rol, Apo A-1, Apo B, LP(a) 등이 대조군에 비해 유의하게 높았다. 5. valproic acid 치료군에서는 triglyceride와 HDL-C가 대조군에 비해 유의하게 낮았고, Apo-B와 LP(a)는 유의하게 높았다. 6. 복합 치료군에서는 total cholesterol, LDL-C, Apo A-1, Apo B, LP(a) 등이 대조군에 비해 유의하게 높았다. 7. 약물 투여 기간과 혈중 농도에 따른 혈청 지질치의 유의한 차이는 없었다. 결론 : 간질 환아에서 항경련제 치료는 각각 다른 영역에서 콜레스테롤 대사에 영향을 미쳐 혈청 지질치의 변동을 초래할 수 있으므로 주기적인 혈청 지질치의 검사가 필요하며, 필요한 경우 식이 요법등 이에 대한 예방책을 강구해야 할 것으로 사료된다. Background : Epilepsy in children often requires lifelong therapy. However, in addition to the therapeutic effects that antiepileptic drugs have in the brain, its use is associated with many metabolic changes in patients with epilepsy. The present work was carried out to evaluate the effects of different anticonvulsants on serum lipids profile in epileptic children. Method : We determined serum levels of total cholesterol, high-density lipoprotein cholesterol(HDL-C), low-density lipoprotein cholesterol(LDL-C). triglycerides, apolipoprotein A-1(Apo A-1), apolipoprotein B(Apo B). and lipoprotein(a)(Lp(a)) in 74 healthy children and in 58 epileptic children who had been receiving phenobarbital(n=19), carbamazepine(n=21), valproic acid(n=9), and combination of these(n=9) for 3 months to 9.2 years(mean 23 months). Result : 1. In epileptic patients, the mean age(7.5 years) was similar to that of controls(7.6 years). 2. In relation to controls, children receiving antiepileptic drugs showed significantly increased values of total cholesterol, LDL-C, Apo A-1, Apo B, and Lp(a) levels. 3. In the groups receiving phenobarbital, total cholesterol, HDL-C, LDL-C, Apo A-1, Apo B, and Lp(a) levels were higher than in the control groups. 4. In the groups receiving carbamazepine, total cholesterol, Apo A-1, Apo B, and Lp(a) levels were higher than in the control groups. 5. Valproate-treated patients showed significantly lower levels of triglycerides and HDL-C and significantly higher levels of Apo B and Lp(a) than did controls. 6. In the groups receiving treatment with polytherapy, total cholesterol, LDL-C, Apo A-1, Apo B, and Lp(a) levels were higher than in the control groups. 7. None of the variables considered was significantly correlated with time elapsed since the start of treatment or with drug concentration in serum. Conclusion : Our results suggest a need for careful monitoring of serum lipids profile and, in necessary, prescription of diet treatment in epileptic children receiving antiepileptic drugs.