Ictal Hyperperfusion of Brain Structures Related to Ictal Dystonic Posturing in Temporal Lobe Seizures

Although dystonic posturing (DP) during temporal lobe seizures is known to be related to basal ganglia activation, the mechanism of the dystonic posturing has not been investigated in greater details . Methods: Thirty-two patients with mesial temporal lobe epilepsy (TLE) underwent ictal and interictal SPECTs. They were classified into two groups: 1) DP with ictal dystonia during ictal SPECT (N=15) and 2) Non-DP without dystonia (N=17). Ictal-interictal SPECT subtraction was performed as follows: co-registration, intensity normalization, subtraction, thresholding and then an overlay to SPGR MRI. The presence and intensity of ictal hyperperfusion were determined in frontal lobe, basal ganglia, temporal lobe and insular cortex. Results: The incidences of ictal hyperperfusion in DP vs. Non-DP were caudate nucleus [80.0%(12/15 patients) vs. 0% (0/17), p=0.001], putamen [93.3% (14/15) vs. 48.2% (8/17), p=0.005], globus pallidus [53.3% (8/15) vs. 23.5% (4/17), p=0.082], thalamus [80.0% (12/15) vs. 41.2% (7/17), p=0.026], insular cortex [46.7% (7/15) vs.23.5% (4/17), p=0.051], orbitofrontal [46.7% (6/15) vs. 35.3% (7/17), p=0.053], medial frontal [6.7% (1/15) vs. 18.7% (2/17), p=0.621], dorsolateral frontal [13.3% (2/15) vs. 18.7%(2/17), p=0.737] in the hemisphere of epileptic side. In patients who showed ictal hyperperfusion in striatum and thalamus, the average intensity of hyperperfusion in DP vs. Non-DP was caudate nucleus 1.67 vs. 0.0, putamen 2.20 vs. 1.05, globus pallidus 1.2 vs. 0.65, thalamus 2.00 vs. 0.88 in the epileptic hemisphere. Conclusions: Caudate nucleus as well as putamen appeared to be important for producing ictal dystonia during TLE seizures. The greater intensity of ictal hyperperfusion in putamen, caudate nucleus and thalamus seems to be related to ictal dystonia.OAIID:oai:osos.snu.ac.kr:snu2003-01/102/2014017262/5SEQ:5PERF_CD:SNU2003-01EVAL_ITEM_CD:102USER_ID:2014017262ADJUST_YN:NEMP_ID:A079623DEPT_CD:801CITE_RATE:0DEPT_NM:의학과SCOPUS_YN:NCONFIRM:

The Effect of hypothermia on the infarction and ischemia-induced proteolysis of neuronal cytoskeletal proteins in a rat model of focal cerebral ischemia

학위논문(박사)--서울대학교 대학원 :의학과 신경외과학전공,1997.Docto

Parallel interference cancellation for CDMA systems with adaptive antenna array

학위논문(석사) - 한국과학기술원 : 전기및전자공학과, 1998.2, [ ii, 56 p. ]한국과학기술원 : 전기및전자공학과

Memory Lateralizing Values of Different Stimulus Types in Wada Test

Background: We studied the accuracy, lateralization criteria of Wada test in patients with temporal lobe epilepsy(TLE). We also evaluated material specific memory and determined the stimulus which can classify best between right and left TLE among four different types of stimuli. Methods: We examined Wada memory performance in 33 patients(15 left, 18 right) with TLE who underwent surgery and who were good seizure outcome at least 1 year follow-up. Twelve stimuli consited of figures, written words, geometric designs and real objects were presented after Amytal injection. The recognition memory test was performed at 10 minutes after the injection and hemisphere memory performance of each stimulus and total stimuli were obtained by(number of stimuli recognized / number of stimuli presented x 100%). Classification rate, best stimulus for lateralization, and suitable lateralization criteria were determined by discriminant analysis and Chi-square test. Hemispheric memory difference of each stimulus was analyzed by paired-sample Student's t-test in left temporal lobectomy(LTL) and right temporal lobectomy(RTL) groups. Results: No significant difference was observed in pre-Wada memory score and in IQ between LTL and RTL group. The classification rate of Wada test in terms of lateralization by discriminant analysis was 81.82%. The accuracy was 75.8% at 10% and 15% lateralization criteria and was 63.6% and 45.5% at 20% and 25% lateralization criteria, respectively. Figure was the most useful among four types of stimuli to classify TLE. Analysis of hemispheric memory according to stimuli revealed that memory difference between hemisphere was significant only for figure in LTL group(p=0.027). In RTL group, all 4 stimulus types had significant hemispheric memory difference (figure, p=0.000; written word, p=0.000; geometric design, p=0.000; real object, p=0.000). Conclusions: Wada test is a reliable method for lateralizing seizure foci in TLE. To get optimal results, lateralization criteria should be determined by statistica Key Words: Wada test, lateralization, material specific memory, TLE which have an influence on lateralizing seizure foci.OAIID:oai:osos.snu.ac.kr:snu1998-01/102/2014017262/3SEQ:3PERF_CD:SNU1998-01EVAL_ITEM_CD:102USER_ID:2014017262ADJUST_YN:NEMP_ID:A079623DEPT_CD:801CITE_RATE:0DEPT_NM:의학과SCOPUS_YN:NCONFIRM:

Electro-clinico-pathologic Relations of Epileptogenic Foci in Cavernous Angioma

Background and Purpose: Cavernous angiomas are frequently encountered in patients with intractable partial epilepsies. Cavernous angioma can make highly epileptogenic foci and dual pathology. Although it is generally thought that the epileptogenic activity originated in neuronal populations adjacent to the lesion, little is known as to the exact location of the epilepsies on electophysiologic, clinical and pathologic view. We investigated nine intractable epilepsy patients with cavernous angioma regarding relation of EEG, semiology and pathology to verify where are the epileptogenic foci in cavernous angioma. Methods: We included 9 intractable epilepsy patients with cavernous angioma who had been were undergone video-EEG monitoring. They were aged from 15 to 49 years(average:36.7+15.7)and had cavernous angioma in temporal, frontal lobe, or multiple areas(temporal:7, frontal:1, multiple:1 patients). Four patients had invasive EEG study including subdural and/or depth electrodes. Six patients had undergone epilepsy surgery. We analyzed seizure history, semiology of their seizures, interictal and ictal EEG. To know dual pathology, MRI including hippocampal volumetry, invasive EEG, and pathology were studied. Results: Four patients had multiple auras. Eight patients had complex partial seizures and one had right foot clonic seizure, which were related with the location of cavernous angioma. In scalp EEG, ictal recording showed definite EEG changes, but 3 patients had no definite EEG change in some seizures. In invasive EEG with subdural and/or depth electrodes , interictal spikes were more frequently detected than scalp EEG and ictal EEG revealed not only 3 different ictal onset zones in 3 patients but also EEG seizures without clinical events in 3 patients. Regarding dual pathology, mesial temporal involvement was detected in 2 patients in MRI. Among 6 surgery patients 4 patients including 3 patients with normal hippocampus in MRI had hippocampal or dentate gyral change in pathology. Among 4 patients with invasive ictal EEG, 3 patients including 1 patient with normal hippocampus in MRI and pathology had mesial temporal involvement in ictal onset zones. Conclusion: Cavernous angiomas can make multiple epileptogenic foci around themselves and often dual pathology of hippocampus, which can be easily detected by invasive ictal EEG but not by imaging and even by pathology. And the foci can have frequent EEG seizures, which do not make clinical events. Precise localization of epileptogenic foci in cavernous angioma were needed to have good medical and surgical treatments.OAIID:oai:osos.snu.ac.kr:snu1998-01/102/2014017262/1SEQ:1PERF_CD:SNU1998-01EVAL_ITEM_CD:102USER_ID:2014017262ADJUST_YN:NEMP_ID:A079623DEPT_CD:801CITE_RATE:0DEPT_NM:의학과SCOPUS_YN:NCONFIRM:

Guidelines for the Management of Unruptured Intracranial Aneurysm

Intracranial aneurysmal rupture causes subarachnoid hemorrhage which usually leads to fatality or severe disability. Treatment of unruptured intracranial aneurysms (UIAs) can substantially reduce the risk of rupture and prevent the grave consequences, but the risk of prophylactic treatment cannot be ignored. UIAs have diverse characteristics and management strategy needs to be tailored according to their location, size and clinical status. In the absence of level I evidence, the treatment guidance often relied on experts opinions and experience. Knowledge of the natural course and management risks of individual aneurysms can help to guide treatment decision, but the natural history is still controversial and risks are not clearly defined. The Korean Society of Cerebrovascular Surgeons (KSCVS) decided to issue a Korean version of UIA management guideline as a framework for the treatment decision and as a basis for future studies, following Guideline Development Manual of the Clinical Research Center for Stroke (CRCS). The organized committee systematically reviewed relevant literature and major guidelines published between January 2000 and July 2010 and took a developmental strategy of adaptation rather than de novo methods. On the basis of interpretation of the published evidences, recommendations were synthesized, and the level of evidence and the grade of recommendation were determined using the methods adapted from those of the US Agency for Healthcare Policy and Research and CRCS. The current guideline focuses on three domains of natural history, diagnosis and treatment of UIAs. The hierarchy of evidence and the recommendation grading indicate the current level by the literature and do not indicate the necessity or the prohibition of a certain clinical practice. Accordingly, this guideline cannot provide the answer for every clinical situation and should not take precedence over the clinical judgment of responsible physicians for individual patients. The final judgment regarding the care of a particular patient must be made by the physician and patient in light of circumstances specific to that patient. This is the first version of the UIA management guideline in Korea and new evidences will be timely and continuously updated in the future guidelines.N