Hematoma-Related Nonhabitual Seizures during Subdural Electrode Monitoring

Hwang, Kyoung Jin,Joo, Eun Yeon,Hong, Seung Bong,Seo, Dae Won Korean Neurological Association 2018 Journal of Clinical Neurology Vol.14 No.3

Effect of Vitamin D Deficiency on the Frequency of Headaches in Migraine

Song, Tae-Jin,Chu, Min-Kyung,Sohn, Jong-Hee,Ahn, Hong-Yup,Lee, Sun Hwa,Cho, Soo-Jin Korean Neurological Association 2018 Journal of Clinical Neurology Vol.14 No.3

<P><B>Background and Purpose</B></P><P>The risk of vitamin D deficiency varies with the season. The frequency of vitamin D deficiency in migraine patients and its association with migraine are unclear.</P><P><B>Methods</B></P><P>We retrospectively evaluated first-visit migraine patients between January 2016 and May 2017, and investigated the demographics, season, migraine subtypes, frequency, severity, and impact of migraine, psychological and sleep variables, climate factors, and vitamin D levels. The nonfasting serum 25-hydroxyvitamin D concentration was measured to determine the vitamin D level, with deficiency of vitamin D defined as a concentration of <20 ng/mL.</P><P><B>Results</B></P><P>In total, 157 patients with migraine aged 37.0±8.6 years (mean±standard deviation) were analyzed. Their serum level of vitamin D was 15.9±7.4 ng/mL. Vitamin D deficiency was present in 77.1% of the patients, and occurred more frequently in spring and winter than in summer and autumn (89.1%, 85.7%, 72.4%, and 61.7%, respectively; <I>p</I>=0.008). In multivariate Poisson regression analysis, monthly headache was 1.203 times (95% confidence interval=1.046–1.383, <I>p</I>=0.009) more frequent in patients with vitamin D deficiency than in those without deficiency after adjusting for demographics, season, migraine subtype, depression, anxiety, and sleep quality. These associations were consistently noted in subgroup analysis of episodic migraine (odds ratio=1.266, <I>p</I>=0.033) and chronic migraine (odds ratio=1.390, <I>p</I>=0.041).</P><P><B>Conclusions</B></P><P>Our study found that a larger number of monthly days with headache was related to vitamin D deficiency among migraineurs. Future studies should attempt to confirm the causal relationship between vitamin D deficiency and migraine.</P>

The Closing-in Phenomenon in Alzheimer's Disease and Vascular Dementia

Chin, Juhee,Lee, Byung Hwa,Seo, Sang Won,Kim, Eun-Joo,Suh, Mee K.,Kang, Sue J.,Na, Duk L. Korean Neurological Association 2005 Journal of Clinical Neurology Vol.1 No.2

<P><B>Background and Purpose</B></P><P>The closing-in phenomenon is the tendency to draw near or on the target when copying figures, which has been found mostly in patients with Alzheimer's disease (AD). We attempted to quantify the degree of closing-in and to compare it between patients with AD and vascular dementia (VaD).</P><P><B>Methods</B></P><P>The subjects (55 AD, 39 VaD and 38 normal controls) were asked to copy the figure of alternating square and triangle, starting at the designated point and continuing from left to right. The patients with AD and VaD did not differ in age, education, severity of dementia or Rey Complex Figure Test copy score. The proximity (Y-axis) of the subject's drawing to the target was plotted at intervals of 2 mm along the X-axis and the degree of closing-in was computed from the slope of the regression line.</P><P><B>Results</B></P><P>The AD and VaD patients showed a steeper slope than the controls. There was no significant difference, however, in the magnitude of closing-in of the AD and VaD patients. When closing-in was defined as a slope that was greater than the mean+2SD of the slope observed for the controls, 32.7% of the AD and 25.6% of the VaD patients showed closing-in.</P><P><B>Conclusions</B></P><P>Our study, using a new method of measuring the degree of closing-in, suggests that this phenomenon is not specific to AD.</P>

Primary Diffuse Leptomeningeal Gliomatosis: Report of a Case Presenting with Chronic Meningitis

Kim, Sung-Hun,Jun, Dong-Chul,Park, Jin Se,Heo, Jae-Hyeok,Kim, Sung-Min,Kim, Juhan,Paek, Sun Ha,Kim, Manho Korean Neurological Association 2006 Journal of Clinical Neurology Vol.2 No.3

<P>Neoplastic meningitis occurs in approximately 5% of patients with cancer. Primary diffuse leptomeningeal gliomatosis is a rare condition whereby a glioma arises from heterotopic cell nests in the leptomeninges. We report here a case presenting with clinical features similar to those of chronic infectious meningitis without positive cerebrospinal fluid cytology. Neurological signs in our patient deteriorated progressively without responding to antitubercular, antiviral, or antibiotic therapy. Leptomeningeal biopsy sampling revealed the condition to be primary diffuse leptomeningeal gliomatosis.</P>

Predictors of Suicidal Ideation in People with Epilepsy Living in Korea

Lim, Hye-Won,Song, Hyun-Seok,Hwang, Yang-Ha,Lee, Ho-Won,Suh, Chung-Kyu,Park, Sung-Pa,Kwon, Soon-Hak Korean Neurological Association 2010 Journal of Clinical Neurology Vol.6 No.2

<P><B>Background and Purpose</B></P><P>The risk of suicide or suicide attempts is reported higher in people with epilepsy (PWE) than in the general population. Although epileptic, psychiatric, and psychosocial factors are known risk factors for suicide or suicide attempt, no studies have evaluated the predictors of the severity of suicidal ideation-which is a warning sign for suicide attempts-in PWE. Therefore, we measured the severity of suicidal ideation and its risk factors.</P><P><B>Methods</B></P><P>Consecutive PWE who were medicated with antiepileptic drugs (AEDs) and attended epilepsy clinic were included in the study. The subjects completed self-reported questionnaires, which included the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Symptom Checklist-90-Revised (SCL-90-R), and Scale for Suicide Ideation-Beck (SSI-Beck). We compared the patients' demographic and clinical variables, and BDI, BAI, and SCL-90-R scores with their SSI-Beck score, and used our findings to determine the predictors for suicidal ideation.</P><P><B>Results</B></P><P>In total, 257 PWE were enrolled in the study. SSI-Beck scores correlated strongly with several seizure-related variables, duration of education, IQ, BDI and BAI scores, and nine domains of the SCL-90-R questionnaire. However, the strongest predictor for suicidal ideation was BDI score (β=0.41, <I>p</I><0.001), followed by several SCL-90-R domains, such as obsessive-compulsive (β=-0.39, <I>p</I><0.001), depression (β=0.38, <I>p</I><0.001), hostility (β=0.22, <I>p</I>=0.002), paranoid ideation (β=0.17, <I>p</I>=0.01), and IQ (β=-0.10, <I>p</I>=0.017). These variables explained 59% of the variance in the SSI-Beck score. The seizure-related variables that influenced the BDI score were seizure frequency, duration of education, MRI abnormality, and number of AEDs. However, these variables explained only 18% of the variance in the BDI score.</P><P><B>Conclusions</B></P><P>Major risk factors for suicidal ideation in PWE were depressive and psychiatric symptoms rather than seizure-related variables. Therefore, clinicians should focus on screening for depression and other psychiatric problems and treat them appropriately in order to reduce suicidal behavior in PWE. Since seizure-related variables also exhibited a minor role in determining depressive symptoms, stronger seizure-related risk factors for depression should be sought, such as seizure severity or psychosocial factors, to minimize suicidal behavior.</P>

Prognostic Role of Serum Levels of Uric Acid in Amyotrophic Lateral Sclerosis

Oh, Seong-il,Baek, Soojeong,Park, Jin-Seok,Piao, Liying,Oh, Ki-Wook,Kim, Seung Hyun Korean Neurological Association 2015 Journal of Clinical Neurology Vol.11 No.4

<P><B>Background and Purpose</B></P><P>It has been suggested that oxidative stress is one of the pathomechanisms underlying amyotrophic lateral sclerosis (ALS), and thus antioxidants such as uric acid (UA) that could reduce oxidative stress might be beneficial in the prevention or treatment of this disease. The objective of this study was to prospectively investigate serum UA levels in Korean ALS patients and to relate them to disease progression.</P><P><B>Methods</B></P><P>ALS patients and healthy controls who were individually well-matched for sex, age, and body mass index (BMI) underwent blood testing for serum UA levels, and analyzed whether UA levels were correlated with the disease status of the patients, as defined by the ALS Functional Rating Scale-Revised (ALSFRS-R).</P><P><B>Results</B></P><P>The study included 136 ALS patients and 136 matched controls. The UA level was lower in the ALS patients (4.50±1.17 mg/dL, mean±SD) than in the controls (5.51±1.22 mg/dL; <I>p</I><0.001). Among the ALS patients, the level of UA acid was inversely correlated with the rate of disease progression (decrease in ALSFRS-R score). Kaplan-Meier analysis revealed that a better survival rate was more strongly correlated with top-tertile levels of serum UA than with bottom-tertile levels (log-rank test: <I>p</I>=0.035).</P><P><B>Conclusions</B></P><P>ALS patients had lower serum UA levels than did healthy individuals. UA levels in ALS were negatively correlated with the rate of disease progression and positively associated with survival, suggesting that UA levels contribute to the progression of ALS. UA levels could be considered a biomarker of disease progression in the early phase in ALS patients.</P>

Opsoclonus-Myoclonus Syndrome Associated with Mumps Virus Infection

Kang, Bong-Hui,Kim, Jae-Il Korean Neurological Association 2014 Journal of Clinical Neurology Vol.10 No.3

<P><B>Background</B></P><P>Opsoclonus-myoclonus syndrome (OMS) is a rare neurological disorder that is characterized by involuntary eye movements and myoclonus. OMS exhibits various etiologies, including paraneoplastic, parainfectious, toxic-metabolic, and idiopathic causes. The exact immunopathogenesis and pathophysiology of OMS are uncertain.</P><P><B>Case Report</B></P><P>We report the case of a 19-year-old male who developed opsoclonus and myoclonus several days after a flu-like illness. Serological tests revealed acute mumps infection. The findings of cerebrospinal fluid examinations and brain magnetic resonance imaging were normal. During the early phase of the illness, he suffered from opsoclonus and myoclonus that was so severe as to cause acute renal failure due to rhabdomyolysis. After therapies including intravenous immunoglobulin, the patient gradually improved and had fully recovered 2 months later.</P><P><B>Conclusions</B></P><P>This is the first report of OMS associated with mumps infection in Korea. Mumps infection should be considered in patients with OMS.</P>

Embolic Infarction Associated with Cardiac Amyloidosis

Cho, Kyung-Hee,Cho, Yong Mee,Kim, Jong S. Korean Neurological Association 2005 Journal of Clinical Neurology Vol.1 No.1

<P>Embolic cerebral infarction due to cardiac amyloidosis is rare. We report two patients with amyloidosis who developed cerebral infarcts. These embolic infarcts were probably related to cardiac involvement of amyloidosis, which was based on results of myocardial biopsy (Patient 1), and kidney biopsy and characteristic echocardiographic features including granular sparkling, restrictive cardiomyopathy and the presence of mural thrombus (Patient 2). Diffuse amyloid infiltration of the heart may have lead to impairment of myocardial function and subsequent mural thrombosis. Cardiomyopathy due to cardiac amyloidosis should be recognized as one of the causes of cardioembolic infarction.</P>

Intracranial Atherosclerosis: Incidence, Diagnosis and Treatment

Kim, Jong S.,Kang, Dong-Wha,Kwon, Sun U. Korean Neurological Association 2005 Journal of Clinical Neurology Vol.1 No.1

<P>Intracranial atherosclerosis is considered a cause of approximately 8% of all strokes in the western society. However, its frequency is much higher in Asian countries. In our hospital-based study, among the patients who had angiographic abnormalities, the frequency of intracranial atherosclerosis was approximately 70% far exceeding that of extratracranial atherosclerosis. Symptomatic atherosclerotic diseases were most often found in the middle cerebral artery. Generally, it has been shown that obesity and hyperlipidemia are related to extracranial diseases while advance hypertension is associated with intracranial diseases. However, these results have not always been replicated, and certain genetic factors may be related with the ethnic differences in the location of atherosclerosis. Recent studies using diffusion weighted MRI showed that the main mechanisms of stroke in patients with intracranial atherosclerosis are the branch occlusion, artery to artery embolism and both. The intracranial stenosis, especially symptomatic one, is not a static condition and may progress or regress in a relatively short period of time. Progressive stenosis of intracranial arteries is clearly related to the development of ischemic events. The annual risk of stroke relevant to the stenosed intracranial vessel is approximately 8%. In retrospective studies including ASID, anticoagulation was found to be superior to aspirin in reducing the stroke events. However, a recent prospective study failed to confirm the superiority of anticoagulation over aspirin in patients with intracranial stenosis. Moreover, anticoagulation resulted in excessive central nervous system bleeding as compared to aspirin. Because aspirin alone seems to be insufficient in the prevention of progression of intracranial stenosis, a combination of antiplatelets has been tried. Recently, we found that a combination of aspirin + cilostazol was superior to aspirin monotherapy in the prevention of progression of symptomatic intracranial stenosis. However, further studies are required to find out the best combination of antiplatelets for symptomatic intracranial stenosis. The effect of other atheroma stabilizers such as statins should also be properly evaluated. Angioplasty/stent is another important option for the relatively severe intracranial stenosis. According to previous studies, immediate success rate has reached up to 90%. If patients are carefully selected, and procedures done by experienced hand, angioplasty/stent can be of benefit especially in relatively young patients with proximal, short-segment, severe symptomatic stenosis. However, this procedure is not without complications or long-term re-stenosis. Further studies are required to elucidate the best therapeutic strategy in patients with intracranial atherosclerosis.</P>

Current Issues in Migraine Genetics

Lee, Jee-Young,Kim, Manho Korean Neurological Association 2005 Journal of Clinical Neurology Vol.1 No.1

<P>Migraine often runs in families and is associated with both genetic and environmental factors. Clinical and genetic heterogeneity as well as the influence of environmental factors have hampered the identification of the gene responsible for migraine disorder. Family/twin studies suggest the presence of hereditary susceptibility. Several different types of mutations or association studies with genetic polymorphism in neurotransmitters, inflammatory cytokines, homocysteine metabolism, mitochondria, or other risk genes in cerebrovascular disorders have been reported. Recently, progress of molecular genetics in familial hemiplegic migraine has provided important insights, a channelopathy, and now extending to a growing list of membrane excitability disorders. Further identification of candidate genes for migraine and exploring the correlation between phenotype and genotype are expected in the future for the understanding of migraine pathophysiology.</P>