119 research outputs found
Clinical, Neuroimaging and Neurophysiologic Evidences of Restless Legs Syndrome as a Disorder of Central Nervous System
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.OAIID:oai:osos.snu.ac.kr:snu2008-01/104/2014017262/3SEQ:3PERF_CD:SNU2008-01EVAL_ITEM_CD:104USER_ID:2014017262ADJUST_YN:NEMP_ID:A079623DEPT_CD:801CITE_RATE:0FILENAME:rls is a disease of cns.pdfDEPT_NM:์ํ๊ณผCONFIRM:
A Case with Sleep Related Eating Disorder
Sleep-related eating disorders (SRED) comprise a spectrum of parasomnia and eating disorders, in which nocturnal arousals from sleep are followed by rapid and compulsory. Here we report a patient who showed unexpected and bizarre eating behavior with somnambulistic mental state during polysomnography.์๋ฉด๊ด๋ จ์ญ์์ฅ์ (Sleep related eating disorders, SRED) ๋ ์๋ฉด์ ํ๋ ๋์ค ์ ์์ ๊นจ์ด๋ ๋ถ์์์ ์ด๊ฑฐ๋ ํต์ ํ ์ ์๋ ๋ฐฉ์์ผ๋ก ์์์ ์ญ์ทจํ๊ฑฐ๋ ์๋ฃ์๋ฅผ ๋ง์๋ ์ฝํ๊ฐ ๋ฐ๋ณตํ์ฌ ๋ฐ์ํ๋ ์งํ์ด๋ค. ์ฝํ ๋์ค ํ์๋ค์ ๋๋ถ๋ถ ๊ฐ์ฑ ์ํ๊ฐ ์ฝ๊ฐ ์ ํ๋์ด ์๊ฑฐ๋ ๋๋ฌธ ๊ฒฝ์ฐ ์์ ์ด ๊นจ์ด ์๋ ๊ฒฝ์ฐ๋ ์์ง๋ง ๋๊ฐ ์์นจ์ ๊ฐ์ฑํ์์ ๋ ์ด๋ฌํ ์ฝํ๋ฅผ ๊ธฐ์ตํ์ง ๋ชปํ๋ค.1,2,4,7 ์ด๋ฌํ ์๋ฉด์ฅ์ ๋ ์ฃผ๋ก 20๋์์ ํธ๋ฐํ๋ฉฐ ๋ชฝ์ ๋ณ ๋ฑ ๋ค๋ฅธ ์ฌ๊ฑด ์๋ฉด์ ๋ณ๋ ฅ์ด๋ ๋ง์ฑ์งํ์ ๊ฐ์ง๊ณ ์๋ ์ฌ์๋ค์์ ํํ ๊ฒ์ผ๋ก ๋ณด๊ณ ๋๊ณ ์๋ค. ์ง๋จ์ ์๋ฉด๋ค์๊ฒ์ฌ๊ฐ ํ์์์๋ ์๋์ง๋ง ์ฝ 80%์ ํ์๊ฐ ์๋ฉด๋ค์๊ฒ์ฌ๋ฅผ ํตํด ์ง๋จ๋๋ค. ์ ์๋ค์ ์์์ ์ผ๋ก SRED๊ฐ ์์ฌ์ด ๋๋ ํ์์์ ์๋ฉด๋ค์๊ฒ์ฌ๋ฅผ ํตํด ์ฝํ๊ฐ ๊ธฐ๋ก๋ 1์๋ฅผ ๊ฒฝํํ์๊ธฐ์ ๋ฌธํ ๊ณ ์ฐฐ๊ณผ ํจ๊ป ๋ณด๊ณ ํ๋ค.OAIID:oai:osos.snu.ac.kr:snu2008-01/102/2014017262/9SEQ:9PERF_CD:SNU2008-01EVAL_ITEM_CD:102USER_ID:2014017262ADJUST_YN:NEMP_ID:A079623DEPT_CD:801CITE_RATE:0DEPT_NM:์ํ๊ณผSCOPUS_YN:NCONFIRM:
Aphasic Status Epilepticus๏ผTwo Cases
Background & Significance๏ผAphasic status epilepticus is an uncommon presentation of a simple partial status epilepticus characterized by prolonged speech impairment with clinical-EEG correlation in the absence of an altered level of consciousness. There has been no published report in Korea. This study reports two adult patients with prolonged aphasia and EEG abnormalities. Cases๏ผTotal three episodes of aphasic status epilepticus were documented in two patients. Patients were right-handed 58-year-old and 79-year-old women. The cause was intracranial plasma cell granuloma involving left temporal lobe and old left temporo-parietal hemorrhage respectively. Aphasic symptoms of these patients were characterized by difficult comprehension and jargon speech with clear consciousness. The duration of aphasia ranged 9-14 days. EEG showed continuous periodic lateralized sharp waves in one patient and discrete rhythmic theta to alpha activities in left temporo-parieto-occipital region in the other patient. Comments๏ผAlthough rare in adults, aphasic status epilepticus should be considered in the differential diagnosis of aphasia.OAIID:oai:osos.snu.ac.kr:snu2000-01/102/2014017262/3SEQ:3PERF_CD:SNU2000-01EVAL_ITEM_CD:102USER_ID:2014017262ADJUST_YN:NEMP_ID:A079623DEPT_CD:801CITE_RATE:0DEPT_NM:์ํ๊ณผSCOPUS_YN:NCONFIRM:
EEG Patterns of High dose Pilocarpine-Induced Status Epilepticus in Rats
Background : We studied EEG changes during pilocarpine-induced status epilepticus(SE), a widely used model whose EEG characteristics have not been fully described previously.
Methods : Male Sprague-Dawley rats weighing 250-350 grams were used as subjects. SE was induced 5-7 days after placement of chronic epidural electrodes, using 360-380 mg/Kg pilocarpine IP. Rats were observed with continuous EEG recording
following pilocarpine injection until end of the SE episode.
Results : SE occurred in 10/12 rats studied. SE began with a series of discrete seizures 11.1ยฑ3.93 minutes after pilocarpine injection. 5.2ยฑ2.71 seizures occurred over 10.9ยฑ4.62 minutes, until the EEG converted to a waxing and waning pattern, during which the amplitude and frequency of epileptiform activity increased. After 1.4ยฑ1.82 minutes, a pattern of continuous high amplitude rapid spiking was established. Continuous spiking continued for 3.4ยฑ0.48 hours with a very gradual decline in amplitude and frequency, until periodic epileptiform discharges(PEDs) began to occur. The EEG consisted primarily of PEDs for another 7.4ยฑ3.09 hours, until electrographic generalized seizures began to occur. These continued for 5.8ยฑ4.82 hours until death. Duration of SE was 17.0ยฑ5.88 hours. Flat periods were a prominent feature during all EEG patterns in this model.
Conclusion : EEG features distinctive in pilocarpine SE(but not unique to it) include flat periods during all patterns and resumption of continuous spiking episodes after the onset of PEDs. The sequence of discrete seizures to waxing and waning to continuous spiking to PEDs was identical to that which has been described in humans and other animal models.OAIID:oai:osos.snu.ac.kr:snu2000-01/102/2014017262/1SEQ:1PERF_CD:SNU2000-01EVAL_ITEM_CD:102USER_ID:2014017262ADJUST_YN:NEMP_ID:A079623DEPT_CD:801CITE_RATE:0DEPT_NM:์ํ๊ณผSCOPUS_YN:NCONFIRM:
Two Patients with Epilepsy Induced by Complex Thinking
Reflex epilepsies are distinct but not clearly understood clinical entity. Various cerebral activities induced by simple stimulation including visual, auditory, somatosensory stimulation, as well as diverse functional tasks such as reading, calculation, complex thinking are believed to be seizure-inducing factors. We experienced two patients whose seizures were readily precipitated by complex, strenuous thinking. Both patients was teen-aged boy at the onset of seizure(13, and 15 years of age each) with normal physical and mental growth. Although first seizure was precipitated by watching TV and playing puzzles in each patient, initial diagnosis was idiopathic generalized epilepsy, possibly juvenile myoclonic epilepsy(JME). For the first few years, seizures were infrequent but mostly precipitated by the tasks needs concentration such as playing computer games, decision-making, mathematics, reading, or during the examination. EEG revealed various thinking process including reading hard books, drawing complex figure, complex calculation induced epileptic discharges even if it usually needs certain period of concentration. Phenytoin, valproic acid, clonazepam, vigabatrin, and lamotrigine sometimes abated their seizures but none of these made them seizure-free. Complex reflex epilepsy induced by thinking was proposed to be a separate type of epilepsy or a variant of JME. Age, sex, stereotypic seizure-inducing factors, clinical course, and refractory epilepsies in these patients highly suggested this type of epilepsy as a variant of JME but its refractoriness and unique provocation still needs more speculation.OAIID:oai:osos.snu.ac.kr:snu2000-01/102/2014017262/4SEQ:4PERF_CD:SNU2000-01EVAL_ITEM_CD:102USER_ID:2014017262ADJUST_YN:NEMP_ID:A079623DEPT_CD:801CITE_RATE:0DEPT_NM:์ํ๊ณผSCOPUS_YN:NCONFIRM:
Unilateral Restless Legs Syndrome
ํ์ง๋ถ์์ฆํ๊ตฐ์ ํ์ง์ ์์ง์ด๊ณ ์ถ์ ์ถฉ๋์ด ์๊ณ ๋ถํธํ๊ฑฐ๋ ๊ธฐ๋ถ ๋์ ๋๋์ด ๋๋ฐ๋๋ฉฐ, ์ด๋ฌํ ์ถฉ๋์ด๋ ๊ฐ๊ฐ ์ฆ์์ด ์ฌ๊ฑฐ๋ ์๊ฑฐ๋ ๋๋ ๊ฒ์ฒ๋ผ ํ๋์ด ์ ์ ๋ ๋ฐ์ํ๊ฑฐ๋ ์
ํ๋๋ค. ์ด๋ฌํ ์ฆ์์ ์์ง์ด๋ฉด ๋ถ๋ถ์ ์ผ๋ก ํน์ ์์ ํ๊ฒ ์ฌ๋ผ์ง๋ฉฐ, ๋ฎ๋ณด๋ค๋ ๋ฐค์ ์
ํ๋๊ฑฐ๋ ๋ฐค์๋ง ๋ํ๋๋ ๊ฒ์ ํน์ง์ด๋ค. ํ์ง๋ถ์์ฆํ๊ตฐ์ ์ฆ์์ ๋๊ฐ ์์ธก ํ์ง์์ ๋น์ทํ๊ฒ ๋ํ๋์ง๋ง ์ ์ฒด ํ์์ 29%๋ ํ์ชฝ์์ ์ฆ์์ด ๋ ์ฌํ๊ฒ ๋ํ๋๋ค. ํ์ง๋ง ์ง๊ธ๊น์ง ํธ์ธก ํ์ง์ ์ฆ์์ด ๊ตญํ๋ ๊ฒฝ์ฐ๋ ์ธ ๊ฑด์ ์ฆ๋ก๊ฐ ์์๋ค.3 ์ ์๋ค์ ํ์ง๋ถ์์ฆํ๊ตฐ์ ์ง๋จ๊ธฐ์ค์ ๋ง๊ณ , ์ด์ฐจ์ ์์ธ์ด ์์ผ๋ฉฐ ํธ์ธก ์ํ์ง์ ๊ตญํ๋ ํน๋ฐํ์ง๋ถ์ ์ฆํ๊ตฐ์ ์ฆ๋ก๋ฅผ ๊ฒฝํํ์๊ธฐ์ ๋ณด๊ณ ํ๋ค.OAIID:oai:osos.snu.ac.kr:snu2012-01/102/2014017262/14SEQ:14PERF_CD:SNU2012-01EVAL_ITEM_CD:102USER_ID:2014017262ADJUST_YN:YEMP_ID:A079623DEPT_CD:801CITE_RATE:0DEPT_NM:์ํ๊ณผSCOPUS_YN:NCONFIRM:
Basic elelctrophysiology of the electroencephalography
Although neuroimaging techniques and other diagnostic procedures has been developed, electroencephalography (EEG) is still very important for the evaluation of various brain diseases and functional studies of human brain. EEG is formed mainly by spatial and temporal summations of postsynaptic potentials generated from a large population of pyramidal cells that can be considered as a collection of oscillating dipoles. EEG shows continuous rhythmic oscillation depending on sleep-waking state. Alpha rhythms are generated in cortical areas acting as epicenters with local spread, although the precise cellular mechanism is still unknown. Its been known that neurons in the nucleus reticular thalami are the pacemakers of sleep spindle. Alterations in the circuit of the reticular nuclei-thalamocortical relay neuron-cortical neuron are responsible for generalized spike and wave complexes. At the intracellular level, large paroxysmal depolarizing shifts produce focal epileptic spikes. Slow waves of EEG appear to be related to thalamocortical and/or corticothalamic deafferentation. The interpretation of routine EEG requires a well training from a qualified EEG teacher and reading adequate amount of EEG under supervision. Frequent misinterpretations of routine EEG have been observed in both local clinics and general hospitals. The most common findings of normal routine EEG misinterpreted as abnormal are normal variants and artifacts of various sources. There are considerable variations of normal EEG rhythms and pseudoepileptiform discharges. Eyeball movements produce prominent or subtle EEG changes over the frontal regions that are sometimes hard to be differentiated from abnormal slow waves over that region. Systematic approach was described for a good interpretation of routine EEG.OAIID:oai:osos.snu.ac.kr:snu2003-01/102/2014017262/3SEQ:3PERF_CD:SNU2003-01EVAL_ITEM_CD:102USER_ID:2014017262ADJUST_YN:NEMP_ID:A079623DEPT_CD:801CITE_RATE:0DEPT_NM:์ํ๊ณผSCOPUS_YN:NCONFIRM:
Comparison of sleep quality and polysomnographic findings in patients with RLS according to the presence of periodic limb movments during sleep
Objectives: Although it has been reported that periodic limb movements during sleep (PLMS) is present up to 80% in patients with restless legs syndrome (RLS), it is unclear that PLMS could influence on sleep quality and excessive daytime sleepiness (EDS) in patient with RLS. To investigate influence of PLMS on sleep quality and EDS, we analyzed sleep quality and EDS in patient with RLS. Methods: Fifty five RLS pa\-tients were included in this study. RLS was diagnosed according to International Restless Legs Syndrome Study Group criteria. Patients were classified into two groups according to the presence of PLMS. Group I (n=32) consisted of RLS patients without PLMS. Group II (n=23) consisted of RLS patients with PLMS. The severity of RLS symptom was assessed using International RLS Study Group Rating Scale (IRLS). Sub\-jective sleep quality was assessed by Pittsburgh Sleep Quality Index (PSQI), Athens Insomnia Scale (AIS), and Epworth Sleepiness Scale (ESS). Serum ferritin level and polysomnographic parameters were also com\-pared between both groups. Results: Mean age was significantly higher in RLS patients with PLMS (p<0.05). IRLS, PSQI, ESS and AIS were not significantly different between groups. Among sleep parame\-ters on polysomnography only PLM related variables were significantly higher in RLS patients with PLMS. Conclusions: Our study suggests that presence of PLMS in patient with RLS has no significant negative effect on sleep quality and excessive daytime sleepiness.OAIID:oai:osos.snu.ac.kr:snu2011-01/102/2014017262/6SEQ:6PERF_CD:SNU2011-01EVAL_ITEM_CD:102USER_ID:2014017262ADJUST_YN:NEMP_ID:A079623DEPT_CD:801CITE_RATE:0DEPT_NM:์ํ๊ณผSCOPUS_YN:NCONFIRM:
Transient Hyperorality during Automotor Seizure in a Patient with Right Temporal Lobe Epilepsy
Klรผver-Bucy Syndrome (KBS) is consisting of hyperorality, emotional blunting, hypersexuality, altered dietary habits, visual and auditory agnosia. It has been reported in variable neurological diseases. However, only a few cases reported in epilepsy. We report a patient with unilateral temporal lobe epilepsy who presents transient hyperorality during seizure. A 46-year-old man has complex partial seizures which were abdominal aura followed by hyperorality and hand automatisms. Hyperorality was characterized by putting patients hand or seizure button into his mouth. Brain MRI demonstrated right hippocampal sclerosis. The interictal and ictal SPECT suggested right temporal lobe dysfunction, and PET showed bitemporal hypometabolism. Rhythmic ictal activities were arising from right temporal region when patient presented hyperorality. We speculate that transient hyperorality in this patient could be a symptom of KBS. This case suggests that transient KBS can be occurred in a unilateral temporal lobe epilepsy when ictal discharges cause bitemporal dysfunction during temporal lobe seizureOAIID:oai:osos.snu.ac.kr:snu2008-01/102/2014017262/3SEQ:3PERF_CD:SNU2008-01EVAL_ITEM_CD:102USER_ID:2014017262ADJUST_YN:NEMP_ID:A079623DEPT_CD:801CITE_RATE:0DEPT_NM:์ํ๊ณผSCOPUS_YN:NCONFIRM:
Laryngeal Stridor in a Patient with Multiple System Atrophy
Sleep-related breathing disorders have been extensively reported as a frequent and major problem in patients with multiple system atrophy (MSA). Laryngeal stridor and obstructive sleep apnea are the most common sleep disordered breathing in MSA. We report laryngeal stridor in a patient with multiple system atrophy. A 56-year-old man presented with abnormal breathing sound different from snoring during sleep noticed by his bed partner. He is unaware of his nocturnal stridor. Polysomnography showed obstructive sleep apnea and laryngeal stridor. Laryngoscopy during wakefulness detects normal movement of vocal cord. CPAP (continuous positive airway pressure) eliminated laryngeal stridor and obstructive sleep apnea with pressures of 9 cmH2O.OAIID:oai:osos.snu.ac.kr:snu2007-01/102/2014017262/8SEQ:8PERF_CD:SNU2007-01EVAL_ITEM_CD:102USER_ID:2014017262ADJUST_YN:NEMP_ID:A079623DEPT_CD:801CITE_RATE:0DEPT_NM:์ํ๊ณผSCOPUS_YN:NCONFIRM:
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