하지불안증후군이 중추신경계 질환임을 시사하는 임상적, 신경영상학적, 신경생리학적 증거들에 관하여

정기영 대한임상신경생리학회 2008 Annals of Clinical Neurophysiology Vol.10 No.2

Restless legs syndrome (RLS) is a sensorimotor neurological disorder in which the primary symptom is a compelling urge to move the legs, accompanied by unpleasant and disturbing sensations in the legs. Although pathophysiologic mechanism of RLS is still unclear, several evidences suggest that RLS is related to dysfunction in central nervous system involving brain and spinal cord. L-DOPA, as the precursor of dopamine, as well as dopamine agonists, plays an essential role in the treatment of RLS leading to the assumption of a key role of dopamine function in the pathophysiology of RLS. Patients with RLS have lower levels of dopamine in the substantia nigra and respond to iron administration. Iron, as a cofactor in dopamine production, plays a central role in the etiology of RLS. Functional neuroimaging studies using PET and SPECT support a central striatal D2 receptor abnormality in the pathophysiology of RLS. Functional MRI suggested a central generator of periodic limb movements during sleep (PLMs) in RLS. However, to date, we have no direct evidence of pathogenic mechanisms of RLS.

임상신경생리 분야에서의 신경생리적 검사법의 응용

이광우,박경석 대한임상신경생리학회 1999 Annals of Clinical Neurophysiology Vol.1 No.1

Since Hans Berger reported the first paper on the human electroencephalogram in 1920s, huge technological advance have made it possible to use a number of electrophysiological approaches to neurological diagnosis in clinical neurology. In majority of the neurology training hospitals they have facilities of electroencephalography(EEG), electromyography(EMG), evoked potentials(EP), polysomnography(PSG), electronystagmography(ENG) and, transcranial doppler(TCD) ete. Clinicials and electrophysiologists should understand the technologic characteristics and general applications of each electrophysiological studies to get useful informations with using them in clinics. It is generally agreed that items of these tests are selected under the clinical examination, the tests are performed by the experts, and the test results are interpretated under the clinical background. Otherwise these tests are sometimes useless and lead clinicians to misunderstand the lesion site, the nature of disease, or the disease course. In this sense the clinical utility of neurophysiological tests could be summerized in the followings. First, the abnormal functioning of the nervous system and its environments can be demonstrated when the history and neurological examinations are equivocal. Second, the presence of clinically unsuspected malfunction in the nervous system can be revealed by those tests. Finally the objective changes can be monitored over time in the patient's status. Also intraoperative monitoring technique becomes one of the important procedures when the major operations in the posterior fossa or in the spinal cord are performed. In 1996, the Korean Society for Clinical Neurophysiology(KSCN) was founded with the hope that it will provide the members with the comfortable place for discussing their clinical and academic experience, exchanging new informations, and learning new techniques of the neurophysiological tests. The KSCN could collaborate with the International Federation of Clinical Neurophysiology(IFCN) to improve the level of the clinical neurophysiologic field in Korea as will as in Asian region.1 In this paper the clinical neurophysiological tests which are commonly used in clinical neurology and which will be delt with and educated by the KSCN i the future will be discussed briefly in order of EEG, EMG, EP, PSG, TCD, ENG, and Intraoperative monitoring.

근력약화 시 감각신경활동전위진폭의 감소를 보인 갑상샘독성주기마비 1예

박소영,조중양,박종관,이동하,조용진,김한준,홍근식 대한임상신경생리학회 2007 Annals of Clinical Neurophysiology Vol.9 No.1

주기마비(periodic paralysis)는 반복되는 일시적인 근력 저하를 특징으로 하는 질환으로 일차성 주기마비와, 이차성 주기마비로 나눌 수 있다. 이차성 주기마비 중 갑상샘독성주기마비의 발병빈도는 입원한 갑상샘 중독 환자의 1.9%에서 발생하며 서양에 비해 동양에서 흔한 것으로 알려져 있다.1 갑상샘항진증에 합병된 저칼륨혈증주기마비는 일시적인 근력저하를 보이는 임상증상, 생화학적검사에서 저칼륨혈증과 갑상샘호르몬 변화, 신경전도검사에서 복합근활동전위진폭의 감소 등으로 진단한다. 저자들은 갑상샘독성주기마비 환자에서 근력약화 시에 신경전도검사상 복합근활동전위진폭의 감소와 함께 감각신경활동전위진폭의 감소를 경험하였기에 보고한다.

에틸린 글리콜 중독 이후 나타난 지연성 다발성뇌신경병 및 다발신경뿌리신경병

김민수,김선영,권지현,김욱주,정현철 대한임상신경생리학회 2013 Annals of Clinical Neurophysiology Vol.15 No.2

Multiple cranial and peripheral neuropathies as a delayed sequellae of ethylene glycol poisoning is a less well known clinical entity and its information about long-term electrophysiological and clinical outcomes is limited. We report a 45-year-old male who presented with acute renal failure and subsequently developed multiple cranial neuropathy, respiratory failure, and flaccid tetraparesis. Through sequential electrophysiological studies, we would like suggest that the main pathophysiology of ethylene glycol-related neuropathy is a demyelinating polyradiculoneuropathy with secondary axonal degeneration.

MEG의 임상적용

박현미 대한임상신경생리학회 2000 Annals of Clinical Neurophysiology Vol.2 No.1

Magnetoencephalography(MEG)는 대뇌에서 형성되는 자장을 측정하는 비침습적인(noninvasive) 방법으로 정상적, 비정상적 뇌의 전기생리학적(electrophysiologic) 기능을 알아내는 검사이다. 이러한 MEG의 전기생리학적 신호는 뇌 자기공명영상(MRI)과 합성하여 해부학적인 연개성의 정보를 제공받을 수 있는데 이것을 Magnetic Source Imaging(MSI) 이라 한다. 현재 MEG는 기본적인 고유 뇌기능연구 뿐만 아니라 뇌병변질환에서도 임상적으로 많은 유용성을 제공하고 있으며, 대뇌 수술시 필요한 뇌피질 고유기능 영역화(presurgical functional mapping), 경련성 환자에서 간질파(epileptiform discharge)의 기록, 두부외상(trauma), 노졸중(stroke), 치매(dementia) 등에서의 ALFMA(abnormal low frequency of magnetic activity)의 정보를 얻을 수 있는 것이 임상적 적용의 대표적인 예이다. 그 외 정신과영역이나, 소오 뇌질환, 그리고 신생아 뇌질환에 이르기까지 적용범위는 굉장히 다양하다. 뇌피질의 구(sulcus)에 위치한 신경세포에서 발생하는 미약한 자장을 측정하는 검사이기에 자장 세기의 특성상 특수 감지기(detector, sensor)가 필요하다. 감지된 자장을 분석하여 뇌 자기공명영상과 합치기까지 MEG의 기술적인 부분은 다른 뇌 영상처리방법과는 여러 가지 면에서 차이가 있다. 최근 들어 전체 뇌의 영역의 자장을 한꺼번에 감지 할 수 있는 Whole head multichannel system의 도입으로 좀더 적극적인 임상 적용이 가능하리라 본다. 전기생리학적 기능과 해부학적 영역을 동시에 알 수 있는, 시간적, 공간적 해상력이 뛰어난 검사로 향후 뇌신경생리기능 연구에 좀더 나은 정보를 제공하리라 보며 기본적 개념과 임상적 의의를 간략히 소개 하고자 한다.

양측으로 발현한 마르쿠스 건 턱-윙크 현상 1예

강봉수,민주홍,허재혁,김민정,이광우 대한임상신경생리학회 2006 Annals of Clinical Neurophysiology Vol.8 No.2

Marcus Gunn jaw winking phenomenon has been thought to result from a congenitally abnormal innervation of the levator palpaebrae muscle by a branch of the trigeminal nerve. A 22-year old man presented with bilateral eyelid elevation on the chewing or eating since infancy. Neurological examination showed bilateral Marcus Gunn Jaw wingking phenomenon in this patient. We referred this patient to the department of ophthalmology and plastic surgery for levator resection or orbicularis oculi muscle flap. We report bilateral Marcus Gunn jaw winking phenomenon, although unilateral disorder is the most common form of trigemino-oculomotor synkinesis. Neurologists should be aware of this phenomenon for decision of proper management and take detailed neurologic examination for elucidating the association of other cranial nerves.

양성돌발성두위현훈의 단기적인 예후 : 예비연구

정상욱,장형렬,김광기 대한임상신경생리학회 2006 Annals of Clinical Neurophysiology Vol.8 No.1

[증례] 재발 Miller Fisher증후군 1예

이효민,석정임,이동국 대한임상신경생리학회 2007 Annals of Clinical Neurophysiology Vol.9 No.1

Miller Fisher syndrome (MFS) is a variant of Guillian-Barre syndrome (GBS) characterized by the triad of ophthalmoplegia, ataxia, and areflexia. Although recurrent GBS is a well known entity, the recurrence of MFS is extremely rare. Here we report an unusual case of recurrent MFS. Initially, the patient had presented with ophthalmoplegia, ataxia, areflexia, and tingling sensation of all extremities. After resolution of the first episode, the patient presented with atypical MFS characterized by ataxia, areflexia, and tingling sensation without ophthalmoplegia.

1형 복합국소통증증후군에 병발한 하지불안 증후군

박강민,김상진,배종석,우철호 대한임상신경생리학회 2007 Annals of Clinical Neurophysiology Vol.9 No.1

The pathomechanisms involved in both restless legs syndrome (RLS) and complex regional pain syndrome type I (CRPS I) are still controversial whether they are central or peripheral origins. We recently encountered a patient who had an unusual coexistence of both RLS and CRPS I, and both of which showed good responses to sympathetic block. These findings suggest the role of peripheral mechanisms, especially unmyelinated small autonomic fiber, in both RLS and CRPS I

뇌출혈이 발생하고 13개월째 플러스주기측향화 간질양방전을 보인 환자 1예

최지혜,권오영,최낙천,임병훈,박기종,강희영 대한임상신경생리학회 2006 Annals of Clinical Neurophysiology Vol.8 No.1

Periodic lateralized epileptiform discharges(PLEDs) are usually seen in acute and subacute cerebral lesions. Occasionally PLEDs could be observed in persistent structural lesions. We observed PLEDs-plus in a patient with right basal ganglionic hemorrhage, at 10 months and 13 months after the stroke. The patients suffered two seizures 3 months and 5 days before recording of EEG. PLEDs-plus may persist as an interictal abnormal finding and the rhythmic discharge of that may be increased by a seizure.