자가면역 뇌염에서 코르티코스테로이드 치료

선우준상 대한신경집중치료학회 2017 대한신경집중치료학회지 Vol.10 No.2

An increasing number of neuronal autoantibodies which target cell surface or synaptic proteins have been discovered over the last decade. Autoimmune encephalitis refers to this new category of autoimmune-mediated neurological disorders, which involve the central nervous system. Recent studies have established that autoimmune encephalitis is now the major cause of encephalitis, which was previously considered to be encephalitis of an unknown etiology. Moreover, the fact that autoimmune encephalitis is potentially treatable with immunomodulating therapy has changed the paradigm for the diagnosis and treatment of acute encephalitis syndrome. We herein review the pathophysiology, clinical manifestations, diagnosis, and treatment of autoimmune encephalitis with a focus on corticosteroid therapy as the first-line immunotherapy. In addition, regarding the diagnostic approach, we emphasize the differentiation between autoimmune and infectious encephalitis, because this distinction is not necessarily clear-cut in real clinical practice and should be considered when determining the initiation and type of immunotherapy

급성 뇌경색 환자의 경구 항응고제 치료에서 5 mg과 10 mg 와파린 부하 용량의 비교

선우준상,권형민,문혜진,남현우,이용석 대한뇌졸중학회 2010 Journal of stroke Vol.12 No.2

Background: In the initiation of oral anticoagulant, rapid achievement of therapeutic level without excessive anticoagulation is required, but unfortunately there have been few studies on warfarin initiation protocol in acute stroke patients. The objective of our study was to investigate the feasibility of warfarin initiation regimens for patients with acute ischemic stroke comparing two different loading doses. Methods: We retrospectively analyzed the patients who admitted with acute cerebral infarction or transient ischemic attack between November 2007 and June 2009. A total of 67 patients were found to start anticoagulation with 10 mg or 5 mg of warfarin for the first two consecutive days. We assessed the time in days to a therapeutic international normalized ratio (INR) (≥2.0), the proportion of INR within 2.0 to 3.0, and functional and safety outcomes. Results: Thirty patients received 10 mg of warfarin, and 37 patients received 5 mg. Baseline characteristics of both groups were similar. Time to therapeutic INR of 10 mg group was earlier about 0.7 day (3.96±1.16 vs. 4.70±0.92, P=0.008). The proportion of patients with therapeutic INR in 10 mg group was higher at day 3 (40.0% vs. 5.4%, P=0.001). The groups did not differ in the proportion of patients with INR greater than 3.0 (33.3% vs. 29.7%, P=0.752). There was only patient with one major bleeding in 5-mg group. Conclusion: A 10 mg loading dose of warfarin produces more rapid achievement of therapeutic INR. Further prospective research is needed to establish the possible contribution of warfarin initiation regimen to the successful anticoagulation in patients with acute ischemic stroke. (Korean J Stroke 2010;12:48-53)

Comorbid Depression Is Associated with a Negative Treatment Response in Idiopathic REM Sleep Behavior Disorder

선우준상,김영지,변정익,김태준,전진선,이순태,정근화,박경일,주건,김만호,이상건,김한준,Carlos H. Schenck,정기영 대한신경과학회 2020 Journal of Clinical Neurology Vol.16 No.2

Background and Purpose: The first-line medications for the symptomatic treatment of rapid eye movement sleep behavior disorder (RBD) are clonazepam and melatonin taken at bedtime. We aimed to identify the association between depression and treatment response in patients with idiopathic RBD (iRBD). Methods: We reviewed the medical records of 123 consecutive patients (76 males; age, 66.0± 7.7 years; and symptom duration, 4.1±4.0 years) with iRBD who were treated with clonazepam and/or melatonin. Clonazepam and melatonin were initially administered at 0.25–0.50 and 2 mg/day, respectively, at bedtime, and the doses were subsequently titrated according to the response of individual patients. Treatment response was defined according to the presence or absence of any improvement in dream-enacting behaviors or unpleasant dreams after treatment. Results: Forty (32.5%) patients were treated with clonazepam, 56 (45.5%) with melatonin, and 27 (22.0%) with combination therapy. The doses of clonazepam and melatonin at followup were 0.5±0.3 and 2.3±0.7 mg, respectively. Ninety-six (78.0%) patients reported improvement in their RBD symptoms during a mean follow-up period of 17.7 months. After adjusting for potential confounders, depression was significantly associated with a negative treatment response (odds ratio=3.76, 95% confidence interval=1.15–12.32, p=0.029). Conclusions: We found that comorbid depression is significantly associated with a negative response to clonazepam and/or melatonin in patients with iRBD. Further research with larger numbers of patients is needed to verify our observations and to determine the clinical implications of comorbid depression in the pathophysiology of iRBD.

중심성 두개저 골수염에 의한 양측 설하신경마비

선우준상,손유리,문혜진,박홍균,홍윤호 대한신경과학회 2010 대한신경과학회지 Vol.28 No.4

Bilateral hypoglossal nerve palsy is a rare clinical presentation. We report a case of central skull base osteomyelitis (SBO)presenting with complete tongue paralysis in a 53-year-old man who was not diabetic or immunocompromised. Magnetic resonance imaging demonstrated characteristic features including abnormal contrast enhancement in the clivus (T1-weighted images). Blood tests revealed elevated acute-phase reactants and leukocytosis, which prompted prolonged antibiotic treatment. He responded well to the antibiotics, which together with typical clinical and imaging findings led to the diagnosis of bacterial SBO.

Differential Effect of Light Emitting Diode Light on Electroencephalographic Oscillations in Young and Old Healthy Subjects

선우준상,이상훈,차광수,김태준,변정익,정기영 대한수면연구학회 2017 Journal of sleep medicine Vol.14 No.2

Objectives: To investigate brain oscillatory characteristics according to brightness and color temperature of light emitting diode (LED) light in young and elderly subjects. Methods: We analyzed 22 young (age, 29.0±5.2 years) and 23 elderly (age, 64.8±4.5 years) healthy subjects. A LED light source was used with a combination of two color temperature (6,500 K vs. 3,000 K) and two brightness (700 lx vs. 300 lx) conditions. Participants were exposed to each light condition in relaxed wakefulness. Then, we analyzed power spectral density and functional connectivity from eye-open electroencephalography. Results: A main effect of brightness on delta (p=0.044) and theta (p=0.038) power was significant in the elderly subjects. Bright light enhanced delta and theta power in the frontal region. By contrast, power spectral density of young subjects was affected by color temperature; high color temperature significantly increased beta-band power of the central region (p=0.034). Regarding functional connectivity, a significant effect of color temperature was observed in delta (p=0.006) and beta (p=0.046) frequencies. High color temperature light enhanced beta connectivity of young subjects (p=0.007), while not affecting that of elderly subjects (p=0.979). Conclusions: The present study demonstrated that spectral power and functional connectivity as well as subjective feelings are affected by the brightness and color temperature of LED light. These results might help us to understand the neurophysiological effects of light and identify the optimal indoor lighting conditions for an individual’s environment.

성인 폐쇄수면무호흡의 치료 개괄

선우준상,양광익 대한수면연구학회 2017 Journal of sleep medicine Vol.14 No.1

Obstructive sleep apnea (OSA) is a common disorder characterized by obstructive apneas, hypopneas, and respiratory effort related arousals during sleep. Treatment of OSA is important because untreated patients have potential adverse clinical outcomes, such as excessive daytime sleepiness, metabolic dysfunction, cardiovascular disease, and mortality. Therefore, OSA should be considered as a chronic disease that requires long-term and multidisciplinary care. Positive airway pressure (PAP) therapy is the mainstay of treatment for OSA in adults. Alternative therapies include oral appliance, behavioral modification, and upper airway surgery. The treatment of OSA in adults is reviewed here with focus on PAP therapy.

Reduced Flicker Lighting Enhances Theta-Band Phase Synchrony during Working Memory Tasks

선우준상,이상헌,정기영 대한수면연구학회 2021 Journal of sleep medicine Vol.18 No.1

Objectives: We analyzed theta-band phase synchrony (TBPS) under reduced and ordinary flicker lighting to determine the effect of light flickers on neurocognitive processes. Methods: Nineteen healthy participants (mean age, 30.4±4.5 years; male, 63.2%) performed the Sternberg working memory tasks with eventrelated potential recording under reduced and control flicker conditions, respectively. We measured the P300 amplitude during memory retrieval, and for TBPS analysis, we calculated the weighted phase lag index within the P300 time window. Furthermore, we used standardized low-resolution brain electromagnetic tomography (sLORETA) to determine differences in functional cortical source connectivity between the two flicker conditions. Results: The hit rate (F1,18=0.862, p=0.365), reaction time (F1,18=0.021, p=0.887), and P300 amplitude (F1,18=3.992, p=0.061) did not differ between the two flicker conditions. However, connectivity analysis at the scalp level showed that TBPS under reduced flicker lighting was significantly higher than that under control flicker lighting at higher memory loads (p=0.002). Cortical source imaging with sLORETA confirmed that reduced flicker lighting significantly increased TBPS between the left prefrontal cortex and right hippocampus compared with control flicker lighting (false discovery rate<0.1). Conclusions: Reduced flicker lighting enhanced TBPS during the working memory task compared with control flicker lighting. Reduced flicker light may improve cognitive functioning by facilitating information transfer within the brain network. Flicker conditions should be considered when optimizing lighting, especially in environments demanding high-level cognitive performance.

Association between Restless Legs Syndrome Symptoms and Self- Reported Hypertension: a Nationwide Questionnaire Study in Korea

선우준상,김원주,주민경,양광익 대한의학회 2019 Journal of Korean medical science Vol.34 No.16

Background: The association between restless legs syndrome (RLS) and hypertension remains controversial. We investigated the relationship between RLS and hypertension in a nationwide sample of the Korean adult population. Methods: This was a cross-sectional questionnaire-based study including 2,740 adults aged 19 years or more. Subjects who met the four essential International RLS Study Group criteria and reported symptoms occurring at least once a week were defined as the RLS group. The presence of hypertension was defined as a self-reported history of physician- diagnosed hypertension. We conducted multiple logistic regression analysis to determine the independent association between RLS symptoms and self-reported hypertension after adjusting for potential confounding factors. Results: Among the 2,740 subjects, 68 (2.5%; 95% confidence interval [CI], 1.9%–3.1%) were found to have RLS with a symptom frequency of at least once a week. The prevalence of self-reported hypertension was 30.9% (95% CI, 20.5%–42.0%) in the RLS group, which was significantly higher than that in controls (12.4%; 95% CI, 11.2%–13.6%; P < 0.001). Multiple logistic regression analysis showed that the adjusted odds ratio for self-reported hypertension in the RLS group was 2.10 (95% CI, 1.12–3.93) compared to controls. In addition to RLS symptoms, old age, being overweight, low education level, diabetes mellitus, and short sleep duration were significantly associated with self-reported hypertension. Conclusion: RLS symptoms occurring at least once a week is independently associated with a higher prevalence of self-reported hypertension in the adult Korean population. Further research will confirm the clinical implication of the present results and the causal relationship between RLS and hypertension.

폐쇄수면무호흡 환자에서 졸음운전 관련 교통사고 예방을 위한 제안

선우준상,조재욱,임수환,김대영,구대림,임희진,김혜윤,김경민,양광익,대한수면연구학회 대한수면연구학회 2021 Journal of sleep medicine Vol.18 No.3

Obstructive sleep apnea (OSA) is known to be associated with various health concerns, including sleepiness, fatigue, cognitive dysfunction, diminished quality of life, hypertension, cardiovascular diseases, and stroke. OSA-induced sleepiness at the wheel reduces vigilance and driving performance, which significantly increase the risk of motor vehicle accidents. Sleepiness-induced motor vehicle accidents are characterized by high morbidity and mortality. OSA is a well-established significant risk factor for drowsy driving-related motor vehicle accidents, which can be prevented through appropriate treatment. However, currently no clinical guidelines or regulations are available for evaluation or management of the risk of motor vehicle accidents in patients with OSA in Korea. In this review, we discuss the risk of motor vehicle accidents in patients with OSA, the effects of positive airway pressure therapy as a preventive measure to reduce this risk, and the published recommendations for OSA in other countries with regard to fitness to drive. We propose recommendations for screening, evaluation, and treatment of OSA with regard to the risk of motor vehicle accidents, which would serve as useful practical guidelines for sleep specialists in clinical practice. Further research is warranted to establish optimal strategies for effective improvements in OSA-related traffic safety.

Comparative Analysis of Pupillometry in Idiopathic Rapid Eye Movement Sleep Behavior Disorder and Parkinson’s Disease

선우준상,Kim Han-Joon,정기영 대한수면학회 2022 sleep medicine research Vol.13 No.3

Background and Objective Pupillary light reflex (PLR) abnormalities have been reported in patients with Parkinson’s disease (PD). However, few studies have been conducted on the abnormality of PLR in patients with idiopathic rapid eye movement sleep behavior disorder (iRBD), which is a prodromal stage of α-synucleinopathy. We herein quantitatively analyzed the PLR of iRBD using an automated pupillometer, and compared the results with those of PD.Methods In this cross-sectional study, we prospectively enrolled 27 patients with polysomnography-confirmed iRBD, and 23 patients with PD. Pupillometry was performed three times in each eye, alternating left and right. We compared seven pupillometric parameters between the iRBD and PD patients.Results Maximum and minimum pupil diameters were significantly larger in PD patients than in iRBD patients. However, the other pupillometric parameters, such as mean constriction velocity, maximum constriction velocity, reflex amplitude, latency, and mean dilation velocity, did not differ between the two groups. Among iRBD patients, the pupillometric parameters were not correlated with any clinical characteristics related to autonomic dysfunction or neurodegeneration.Conclusions We found that the pupillary constriction and dilation in response to light of iRBD were not different from those of PD. These findings suggest that autonomic pupillary dysfunction already existed in the prodromal stage of α-synucleinopathy to a degree comparable to that in PD. Larger pupil diameters in PD than in iRBD may reflect the pharmacological effect of dopaminergic medications. Future studies are needed to elucidate the association between the PLR abnormalities and the risk of phenoconversion in iRBD.