규칙적인 운동과 타우린 투여가 seizure 유발 쥐 해마의 nNOS, NGF, BDNF에 미치는 영향

이진경(JinKyungLee),안응남(EungNamAn) 한국체육학회 2008 한국체육학회지 Vol.47 No.2

본 연구는 규칙적인 유산소 운동과 taurine 투여의 전처치가 seizure 유발 시 해마의 nNOS, NGF, BDNF 단백질의 발현 변화와 seizure activity 그리고 mortality의 변화에 미치는 효과를 규명하는데 있다. 이를 위해 ICR계 36마리 mice를 대상으로 통제군(n=9), 운동군(n=9), taurine 투여군(n=9), 운동과 taurine 투여를 병행한 복합처치군(n=9)으로 무선 배정하였다. 그 후 집단에 따라 8주간 수영운동, taurine 투여 그리고 수영운동과 taurine 투여를 병행한 후 24시간 후에 복강 내 PTZ(35-40mg/kg)를 투여하여 seizure를 유발하였다. 그 후 실험동물의 seizure activity와 mortality 그리고 해마에서 nNOS, NGF, BDNF를 살펴본 결과 전처치로서 규칙적인 수영운동과 taurine 투여 집단이 통제집단에 비해 seizure 유발 예방효과에 긍정적인 효과가 있는 것으로 나타났으며, 특히 수영운동과 taurine 투여를 병행한 복합집단이 가장 유용한 효과가 있는 것으로 나타났다. 이러한 결과는 규칙적인 운동이나 taurine 특히 운동과 taurine의 병행은 seizure를 억제하고 나아가 nNOS의 발현 감소와 NGF, BDNF의 발현 증가에 효과적인 것으로 사료된다. The purpose of this study is to find out the effect of regular aerobic exercise and taurine supplementation on nNOS, NGF and BDNF protein revelation variety of hippocampus in induced seizure. For the study, 36 white mice of ICR species were divided into four groups: the control group, the exercise group, the taurine supplemented group and taurine supplemented-exercise group, after the swimming exercise for 8 week, all groups injected PTZ (35-40mg/kg) to seizure induced. After the period, a brain cell injury was analyzes through seizure activity, mortality, nNOS, NGF and BDNF. The result showed that a brain cell injury was facilitated when seizure activity increased. However, it was found that performing regular exercise, taurine supplementation and exercise combined taurine reduced seizure activity, increased NGF and BDNF, decreased nNOS so that it suppress brain cell injury. This results suggested that combined treatment of swimming exercise and taurine supplementation might give a benefical effect on suppress seizure and decreased nNOS, increased revelation NGF and BDNF.

경련을 주소로 응급실을 방문한 아이의 임상양상과 입원과의 관계

윤성관,김은영,양은석,문경래,박상기,박영봉,노영일,조수형,Yoon, Sung Kwan,Kim, Eun Young,Yang, Eun Seok,Moon, Kyung Rye,Park, Sang Kee,Park, Young Bong,Rho, Young Il,Cho, Soo Hyeong 대한소아청소년과학회 2003 Clinical and Experimental Pediatrics (CEP) Vol.46 No.10

목 적 : 경련을 주소로 응급실을 찾아온 아이의 나이, 경련의 유형, 경련의 지속시간 등 경련의 임상 양상과 입원율과의 관계를 알아보고, 응급실에서 검사의 이상 여부와 이에 따른 입원율과의 관계를 알아보고자 하였다. 방 법 : 2000년 1월부터 2002년 6월까지 조선대학교병원 응급실을 방문한 소아 4,865명 중 경련이 주소인 180명(3.7%)을 대상으로 후향적으로 조사하였다. 경련을 주소로 응급실을 방문한 환아의 나이, 경련의 빈도, 유형, 지속시간을 분석하고 임상 양상에 따른 입원율과 응급실에서 시행한 검사(CT나 MRI 등의 방사선학적 검사와 뇌척수액 검사) 결과와 입원율을 비교 분석하였다. 결 과 : 응급실을 방문한 4,865명의 환아 중 경련이 증상인 환아는 180명(3.7%)이었다. 가장 흔한 경련의 양상은 단순 열성경련(52.2%)이었다. 경련 환아의 48.9%가 입원하였으며 연령과 성, 방사선학적 검사나 뇌척수액 검사의 이상 유무와 입원율과는 관련성이 없었다(P>0.05). 경련의 형태에 따른 입원율은 간질 중첩증 82.4%(14/17), 복합열성경련 63.6%(14/22)로 다른 형태의 경련에 비하여 통계학적으로 의의있게 높았다(P<0.05). 경련의 지속시간에 따르는 입원율은 5분 이내가 41.2%, 5-15분 60%, 15-30 58.8%, 30-60분 85.7%, 60분 이상이 66.7%이었다(Fig. 3). 경련의 지속 시간이 길어질수록 입원율은 통계학적으로 의의 있게 높았다(P<0.05). 경련의 빈도에 따른 입원율은 첫번째 발작인 경우 40.9%(45/110), 재발인 경우가 61.4%(43/70)이었다. 경련이 재발인 경우가 첫 경련에 비하여 입원율이 유의하게 높았다(P<0.05). 결 론 : 경련을 주소로 응급실을 방문한 소아 환자의 입원율은 48.9%이었다. 경련의 형태 중 간질 중첩증과 복합 열성 경련인 경우, 경련의 지속 시간이 길수록 입원율이 높았다. 또한 경련이 재발인 경우가 첫 경련인 경우보다 입원율이 높았다. Purpose : To review the seizure-related complaints and analyze the relationship between admission rates and clinical features in children who had visited the emergency department with seizures. Methods : Retrospectively, we reviewed 180 patients(male 100, female 80) suffering from seizures, who had visited to the emergency department of Chosun University Hospital from January 2000 to June 2002. We have analyzed the correlation between admission rate and clinical features such as age, seizure type, seizure duration and individual laboratory findings(CT or MRI, and CSF). Results : Out of 4,865 total children who visited the emergency department, 180 patients(3.7%) were seizure related. The most common seizure type was simple febrile seizure(52.2%). The admission rate of children with seizures was 48.9%. The admission rate according to age, sex and abnormal laboratory findings revealed no significant correlations(P>0.05). There was a significant correlation between admission and both status epilepticus 82.4%(14/17) and complex febrile seizure 63.6%(14/22) (P<0.05). According to the duration of convulsions, admission rates were 41.2% when within five minutes, 60% when six-15 minutes, 58.8% when 16-30 minutes, 85.7% when 30 minutes, to one hour and 66.7% when above one hour of duration. According to the seizure frequency, admission rates of recurrent seizure patients(61.4%=43/70) was higher compared to the first time seizure patients(40.9%=45/110). Conclusion : We found that the admission rate of children visiting the emergency department for seizure treatment was 48.9% and significantly correlated with duration, type and frequency of seizure.

Clinical Significance of Hyperlactatemia and Acidosis in Patients with Suspected Generalized Convulsion

유우성,이성우,박종수,문성우,최성혁,홍윤식 대한응급의학회 2012 대한응급의학회지 Vol.23 No.6

Purpose: To determine the clinical usefulness of lactic acidosis in an evaluation of patients with suspected generalized convulsion. Methods: This was retrospective cohort study. The correlation between the lactate level and the time to blood gas analysis (ABGA) was analyzed in patients who had a final diagnosis of seizure to exclude the time effect on the spontaneous clearance of lactate. The patient’s data in the true seizure group and false seizure group was then compared. The receiver operating characteristics (ROC) curve of lactate,pH and base deficit for diagnosing true seizure was drawn. The sensitivity and specificity of the presence of hyperlactatemia or acidosis for a diagnosis of seizure and predicting epileptiform discharge at electroencephalography (EEG) was analyzed. Results: Of the 173 patients suspected of having generalized convulsion, 136 patients were diagnosed with a true seizure on hospital discharge and patients whose ABGA was performed within 60 minutes after seizure showed a significantly higher arterial lactate level, lower arterial pH and base deficit than the patients whose ABGA was performed after 60 minutes of seizure onset. 62 patients whose ABGA was performed 60 minutes after symptom onset were excluded. Finally, of 111 patients, 89 patients with true seizure showed a significantly higher arterial lactate level, lower arterial pH and base deficit than the 22patients with false seizure. The ROC curve of lactate, pH and base deficit showed a significant area under the curve for diagnosing true seizure. The presence of hyperlactatemia or acidosis showed high sensitivity for diagnosing true seizure and expecting epileptiform EEG when they were measured with 60 minutes after symptom onset. Conclusion: In patients with suspected generalized convulsion,upon presentation to the ED within 60 min of symptom onset, the presence of hyperlactatemia or acidosis increased the likelihood of a true seizure and might be an objective indicator for further evaluations of seizure. On the other hand, normal lactate levels and no acidosis could not exclude a true seizure.

Duration of Recognized Fever Before Febrile Seizure Can be a Predictive Factor for the Development of Complex Febrile Seizures

Se Ryung Yang,Min Hyung Kim,Na Mi Lee,Dae Yong Yi,Sin Weon Yun,Soo Ahn Chae,In Seok Lim,Eung Sang Choi 중앙대학교 의과대학 의과학연구소 2016 中央醫大誌 Vol.41 No.2

Purpose: A history of complex febrile seizure is associated with an increased risk to develop epilepsy. We examined the correlation between complex febrile seizures and duration of recognized fever prior to the onset of febrile seizure. Methods: This retrospective study included 680 children admitted to Chung-Ang University Hospital with febrile seizures between January, 2010 and December, 2014. Children were assigned to 4 groups based on the time of fever detection: Group 1 (at the time of seizure), Group 2 (<24 h prior to seizure), Group 3 (between 24 and 48 h prior to seizure), and Group 4 (>48 h prior to seizure). Results: A significant correlation was observed between the duration of recognized fever prior to the onset of febrile seizures and occurrence of complex febrile seizure (p = 0.005). Maximum temperatures before seizure and during seizure did not differ between the groups (p = 0.192 & p = 0.095, respectively). Complex febrile seizure was more common in Group 3 than in any other group. Additionally, on dividing the patients into those with fever duration <24 h and ≥24 h, incidence of complex febrile seizures in the latter group was higher. Incidence of complex febrile seizures in Group 3 was the highest among the groups even when the analysis was restricted t o patients having their first attack of febrile seizure. Conclusion: The duration of recognized fever prior to febrile seizures may be a risk factor for complex febrile seizures. Children having fever 24~48 hours prior to febrile seizure had a significantly higher incidence of complex febrile seizures.

최근 3년간(2004-2006년) 마산삼성병원 응급실로 내원한 소아환자중 급성 발작으로 인한 환자들에 대한 임상적 고찰

이원덕,이주석,이준화,조경래 대한소아청소년과학회 2008 Clinical and Experimental Pediatrics (CEP) Vol.51 No.4

Purpose:The purpose of this study was to evaluate acute childhood seizures, one of the most important causes of emergency room visits, to provide appropriate medical services. Methods:We reviewed the medical records of 433 (4.6%) pediatric patients with acute seizures that visited the emergency room at Masan Samsung hospital from 2004 to 2006. Results:The male to female ratio was 1.4:1 and the mean age was 40.9±34.9 months range. The order of geographical distribution was Masan, Changwon, Haman, and others. Fever was present in 40.6% of patients; December (14.8%) was the most frequent month for visits and generalized tonic clonic seizures (62.7%) were the most common type of seizure. The average frequency and duration of the seizure was 1.5±1.0 and 6.7±13.2 minutes respectively. Febrile seizures were present in 69.7% of patients and afebrile seizures in 30.3%. The causes of the febrile seizures were acute pharyngotonsillitis (44.6%), acute bronchitis, gastroenteritis, pneumonia, urinary tract infection, and unknown origin, in order of frequency. The most common cause of an afebrile seizure was epilepsy (71.5%) followed by a benign convulsion with mild gastroenteritis (BCwMG), sequela of a perinatal brain injury or brain malformation, and acute CNS infection. Evaluation of the causes of an acute seizure according to age showed that febrile seizures, epilepsy, and the sequela of perinatal brain injuries were more common between 2 and 6 years of age and epilepsy, febrile seizures and acute CNS infection, in order of frequency, were common between 6 and 15 years of age. Many patients, 49.4%, were discharged without admission. Conclusion:The common characteristics of pediatric patients presenting to the emergency room were male gender, an age between 2-6 years, presenting during the month of December, with generalized tonic clonic seizures due to acute pharyngitis. The most common presentation for the group less than 6 years of age was a febrile seizure and in the group more than 6 years of age, it was epilepsy. In many cases, the seizures stopped by the time the family presented to the emergency room. (Korean J Pediatr 2008;51:420-425) Purpose:The purpose of this study was to evaluate acute childhood seizures, one of the most important causes of emergency room visits, to provide appropriate medical services. Methods:We reviewed the medical records of 433 (4.6%) pediatric patients with acute seizures that visited the emergency room at Masan Samsung hospital from 2004 to 2006. Results:The male to female ratio was 1.4:1 and the mean age was 40.9±34.9 months range. The order of geographical distribution was Masan, Changwon, Haman, and others. Fever was present in 40.6% of patients; December (14.8%) was the most frequent month for visits and generalized tonic clonic seizures (62.7%) were the most common type of seizure. The average frequency and duration of the seizure was 1.5±1.0 and 6.7±13.2 minutes respectively. Febrile seizures were present in 69.7% of patients and afebrile seizures in 30.3%. The causes of the febrile seizures were acute pharyngotonsillitis (44.6%), acute bronchitis, gastroenteritis, pneumonia, urinary tract infection, and unknown origin, in order of frequency. The most common cause of an afebrile seizure was epilepsy (71.5%) followed by a benign convulsion with mild gastroenteritis (BCwMG), sequela of a perinatal brain injury or brain malformation, and acute CNS infection. Evaluation of the causes of an acute seizure according to age showed that febrile seizures, epilepsy, and the sequela of perinatal brain injuries were more common between 2 and 6 years of age and epilepsy, febrile seizures and acute CNS infection, in order of frequency, were common between 6 and 15 years of age. Many patients, 49.4%, were discharged without admission. Conclusion:The common characteristics of pediatric patients presenting to the emergency room were male gender, an age between 2-6 years, presenting during the month of December, with generalized tonic clonic seizures due to acute pharyngitis. The most common presentation for the group less than 6 years of age was a febrile seizure and in the group more than 6 years of age, it was epilepsy. In many cases, the seizures stopped by the time the family presented to the emergency room. (Korean J Pediatr 2008;51:420-425)

소아 야간 발작의 임상적 고찰

이준수(Jun Su Lee),김정(Jung Kim),유황재(Hwang Jae Yoo) 대한소아신경학회 2002 대한소아신경학회지 Vol.10 No.2

목 적:야간발작은 임상에서 흔히 마주치는 질환이지만, 소아에서는 그 연구가 드물어 야간발작을 보인 환아들의 임상적 특징 및 치료 및 경과를 조사하여 치료에 대한 도움이 되고자 본 연구를 시작하였다. 방 법:2001년 1월부터 2001년 12월까지 마산삼성병원 소아과에 간질로 진단받고 치료 중인 환아 중에 수면시에만 발작을 보인 31례의 환아들의 연령 및 성비, 발작 형태, 뇌파소견, 뇌영상소견, 치료 및 경과에 대해 조사하였다. 결 과: 1) 남녀의 성비는 의미 있는 차이는 없었고, 발생 연령은 3세에서 12세까지였다 2) 발작형태는 부분발작이 30례(96.8%)였으며, 이 중에 2차성 전신화 발작이 21례(67.7%)로 대부분이었다. 3) 뇌파 소견상 부분발작 30례 중에 중심측두부 간질파를 보인 경우가 17례(54.8%)로 가장 많았으며, 후두부가 5례(16.1%), 중심부가 4례(12.9%)였다. 뇌영상검사상 비정상 소견을 보인 경우는 없었다. 4) 원인은 양성롤란딕간질이 24례, 양성후두엽간질이 5례, 야간 전두엽 간질이 1례, 각성시 강직간대성 간질이 1례의 순으로 나타났다. 5) 28례(90.3%)에서 단독요법만으로도 발작이 조절되었으며, 3례는 add-on therapy로서 2가지 약물을 사용한 후에 더 이상의 발작은 없었다. 결 론: 소아에서 야간 발작은 대부분 2차성 전신화 발작 형태를 보이는 부분발작으로서 치료에 대한 반응 및 예후가 양호한 질환이므로 항경련제 치료에 있어 valproic acid보다는 carbamazepine 이나 oxcarbazepine을 단독 요법으로 사용하는 것이 효과적일 것으로 사료된다. Purpose: Nocturnal seizure is a common seizure disorder in childhood. But there are a few study about nocturnal seizure. To be a great of help, We investigated clinical characteristics, response of treatment and prognosis of nocturnal seiuzure in childhood. Methods: From January to December 2001, We selected patients who had nocturnal seizure in epilepsy patients. Total 31 patients was selected and we investigated age distribution, sex ratio, type of seizure, EEG finding, brain imaging study, treatment and prognosis. Results: Man and woman's ratio was no significant difference, and age distribution was mostly from 3 years old to 12 years old. Partial seizure was showed in 30 patients (96.8%). Among that patients secondary generalization of partial seizure was showed in 21 patients(67.7%). In EEG, epileptiform discharges in centrotemporal region were showed in 17 patients(54.8%), occipital region in 5 patients(16.1%), central region in 4 patients (12.9%). Brain imaging studies were normal in all patients. The most common cause of nocturnal seizure was benign childhood epilepsy with centrotemporal spikes(24 patients, 77.4%). Benign childhood epilepsy with occipital paroxysms were showed 5 patients(16.1 %). Nocturnal frontal lobe epilepsy was showed 1 patient(3.2%). 28 patients(90.3%) were treated with monotherapy. They has been no seizure during 6 months after treatment. 3 patients(9.7%) were treated with two AED therapy. They has been also no seizure during 6 months after add-on therapy. Conclusion: Nocturnal seizure in childhood was mostly occurred from 3 years old to 12 years old. Mostly they were partial seizure with secondary generalization and good response on AED medication and good prognosis. Therefore carbamazepine or oxcarbazepine monotherpy is more effective than valproic acid.

외상후 발작의 위험인자에 대한 조사

이재학,배학근,윤석만,도재원,이경석,윤일규,최순관,변박장 순천향의학연구소 2001 Journal of Soonchunhyang Medical Science Vol.7 No.1

Risk Factors for Posttraumatic Seizure The authors evaluate the risk factors for posttraumatic seizures. this prospective study was performed in a series of 470 head injured patient from January 1996 to Decomber 1998. The patients who were dead within 1 week of injury or children from 3 years old and under were excluded. There were 358 male and 112 female with a mean age of 35.2±22.8 years (range, 4-88 years). The results were as follows : 1). Of the 470 patients, pasttraumatic seizure occurred in 48 patients(10.2%): early seizure in 28(6%) and late seizure in 20 patients(4.2%). 2). The clinical risk factors for posttraumatic seizure were poor consciousness at admission, presence of brainstem herniation signs, poor GCS score, and posttraumatic amnesia more than 24 hours after trauma(p<0.001). 3). The radiological risk factors for posttraumatic seizure were subdural hematoma(p<0.001), intracerebral hematoma (p<0.02), mutiple intracranial CT lesions(p<0.001), or delayed lesions on follow-up CT scans(p<0.001). the incidence of seizure increased according to the severity of diffuse brain lesion(p<0.001), and the seizure rate in mass lesion was higher than that in diffuse lesion(p<0.001). 5). Hypoxia and coagulopathy had a statistically significant influence on posttraumatic seizure(p<0.05). Hypoxia had a infuence on occurrence of late seizure(p<0.05). 6). The incidence of posttraumatic seizure signiticantly increased in surgical group compared with coservative group(p<0.001) and significantly increased in patient who underwent decompressive craniectomy compared with those who underwent craniotomy(p<0.001) 7). Preventive administration of antiepileptic drugs decreased the incidence of early seizure, but did not affect on the reduction of late seizure. 8). Multivariate logistic regression analysis showed the subdural hematoma, GCS score, delayed lesion, and intracerebral hematoma in order of importance for seizure risk. in conclusion, the risk factors affecting on the occurrence of seizure were clinical status at admission, CT lesions, and severity of diffuse brain inJury. Considering that hypoxia affected on the late seizure, it is necessary to detect and treat it immediately after trauma. In addition, the patients who underwent decompressive craniectomy should be carefully followed to evaluate the risk of late seizure. Even though preventive administration of antiepileptic drugs had a tendency to decrease the incidence of early seizure, it is unclear whether administration of antiepileptic drugs can reduce the incidence of posttraumatic seizures. Prospective study will be needed in the selected patients.

소아에서 First Unprovoked Seizure 후 간질발작 재발에 대한 전향적 연구

유상호(Sang-Ho Yoo),송준영(Jun-Young Song),김성환(Sung-Hwan Kim) 대한소아신경학회 1999 대한소아신경학회지 Vol.7 No.1

Purpose : Epilepsy is generally defined as a chronic condition characterized by recurrent unprovoked seizure. It is still controversial whether the long-term antiepileptic drugs(AED) treatment will be necessary in children with first unprovoked seizure. Cognitive and behavioral side effects of AEDs are especially important in developing children. Therefore the rationale of AED treatment in the children with first unprovoked seizure depends upon the seizure recurrence rate and presence of risk factors related with seizure recurrence. We are going to evaluate the risk of seizure recurrence and risk factors after a first unprovoked seizure in children. Methods : One hundred fifty eight patients presented with a first unprovoked seizure from July, 1994 to June, 1999 were prospectively followed by regular epilepsy clinic visit or telephone interview for a mean of 27 months. We analyzed overall recurrence risk and risk factors of seizure recurrence(EEG finding, etiology of seizure, seizure type, history of prior febrile convulsions, neurodevelopmental status prior to first seizure, presence of a Todd's paresis, family history of seizures, a seizure occuring while asleep, and duration of seizure) by Cox's proportional hazards model and Kaplan-Meier survival analysis. Results : In 158 patients with first unprovoked seizure, 61 (39%) patients experienced subsequent seizure. The cumulative risk of seizure recurrence was 28.5, 37.6, and 42.3% at 6, 12, and 18 months. The median time to recurrence was 3 months, with 72% of recurrence occurring within 6 months, 92% within 1 year, and 100% within 2 years. On univariate analysis, risk factors for seizure recurrence included an etiology of seizure and abnormal EEG. In idiopathic cases, the risk factor was an EEG abnormality. Conclusion : Many of the children with a first unprovoked seizure will not have recurrences. The recurrence risk of a first unprovoked seizure in children have statistically correlated with the etiology of seizure(cryptogenic and symptomatic) and abnormal EEG. Children with an idiopathic first seizure and a normal EEG have a particularly favorable prognosis 목 적 : 부모 관리하에 있는 소아는 간질발작으로 인한 손상의 위험이 적고, 장기적 항경련제 치료시 약물로 인한 인지기능장애 및 행동장애 같은 부작용이 발달과정에 있는 소아에서 중요하기 때문에 장기적인 항경련제 치료를 결정할 때 신중하여야 한다. 따라서 첫 간질발작이 있었던 소아 환자에서 간질발작의 재발율과 이에 관계되는 위험인자들을 조사하여 첫 간질발작시 장기적 항경련제 치료에 대한 지침을 주고자 본 연구를 시행하였다. 방 법 : 1994년 7월부터 1999년 6월까지 첫 간질발작 후 7일 안에 내원한 158명(남아 84명, 여아 74명)을 대상으로 발작의 재발 여부에 대한 전향적 연구를 시행하였다. 평균 27개월(1개월-5년)간 추적관찰 하였으며 간질발작의 재발율과 재발에 관계되는 위험인자들(뇌파, 간질발작의 원인, 발작유형, 간질발작의 가족력, 열성경련의 과거력, 첫 발작 전 환자의 신경운동 발달상태, 수면 중 간질발작 여부, Todd 마비의 여부, 발작의 지속시간)을 Cox's proportional hazards model과 Kaplan-Meier survival analysis를 이용해 분석하였다. 결 과 : 1) 전체 158명 환자 중 61명(39%)에서 발작의 재발이 있었고 Kaplan-Meier 생존분석을 이용해 시간에 따른 발작의 재발 위험성은 첫 발작 후 6개월 28.5%, 12개월 37.6%, 18개월에 42.3%이었다. 2) 재발이 생긴 환자 61명에서 첫 발작 후 재발이 생긴 시기는 6개월 이하 44명(72%), 6-12개월 12명(20%), 1-2년 5명(8%)으로 재발의 92%가 첫 발작 후 1년 이내 발생하였다. 3) 뇌파검사 소견이 정상인 환자 76명 중 18명 (24%)에서 재발이 생겼으나 비정상인 환자는 82명 중 43명(52%)에서 재발이 발생해 뇌파검사 소견은 재발에 영향을 미치는 통계적으로 유의한 위험인자 (P<0.001)다. 또한 82명의 뇌파검사 소견이 비정상인 환자에서 비간질성 이상뇌파 소견을 보인 환자는 12명 중 2명(17%)이 재발이 생겼고 간질성 뇌파가 발견된 환자는 70명 중 41명(59%)에서 재발이 발생하였다(P<0.001). 4) 특발성 간질발작 환자는 75명 중 22명(29%)에서 재발이 생겼고 잠인성 간질발작 환자는 79명 중 36명(46%), 증후성 간질발작 환자는 4명 중 3명(75%)에서 재발이 발생해 간질발작의 원인이 재발의 위험인자로 통계적인 유의한 의미가 있었다. 결 론 : 첫 간질발작 후 재발율은 39%이었으며 이상 뇌파소견과 간질발작의 원인이 재발에 관계되는 예후인자임을 강조하며 첫 간질발작시 특히 뇌파검사 소견이 정상이며 특발성 간질발작인 경우는 재발율이 낮기 때문에 즉각적인 항경련제 치료를 시작하기보다는 재발이 생긴 경우에 치료를 시작하는 것이 바람직하다고 생각된다.

신생아 경련과 관련된 요인들과 예후와의 관계

송명숙(Myoung Sook Song),강의자(Yee Ja Kang),박인승(In Seung Park),최혜진(Hae Jin Choeh),김선준(Sun Jun Kim) 대한소아신경학회 1994 대한소아신경학회지 Vol.2 No.1

During the neonatal period, as at laster ages, seizures are a symptom of an acute disturbance of the brain. Seizures in the newborn are less well organized than in older infants and children, and a variety of atypical fits may occur as an isolated manifestation of convulsive activity. Apnea in known to be one of the more common phenomena of an atypical neonatal seizures represent a high risk for neonatal death or neurodevelopmental sequelae for both preterm and fullterm infants. The purpose of the present report was to describe electroclinical features of neonatal seizures and their relation the developmental outcome. To study the clinical prognosis of the neonatal seizure, we carried out a retrospective review on medical records of 36 neonates who were admitted to the Dept. of Pediatrics, Tae jon Eul Ji General Hospital between September 1992 and July 1994. The results from the study are summarized as follows 1) Male to female ratio were 1.8:1. The onset of 11cases of neonatal seizure appeared within 24hours of life, 14cases in 2nd-3rd days. Two-third of neonatal seizure occurred within 3rd day of life. 2) The most frequent cause of neonatal seizure was hypoxic ischemic encephalopathy(30%) and hypocalcemia(24%), and followed by hypoglycemia(17%), sepsis(8%), hypernatremia(6%), intracranical hemorrage. Herpes simplex encephalitis in order of frequency. The most favorable outcome resulted from neonates with hypocalcemia(handicap-:3 of 11:27%) and the worst outcome resulted from neonates with intracranial hemorrhage(handicap-:100%) and hypoxic ischemic encephalpathy(handicap-:12 of 15:80%). 3) The most frequent type of neonatal seizure was subtle(28%) and focal clonic type(28%), followed by general tonic type(17%) and multifocal clonic type in order of frequency. The patients with subtle seizure and general tonic seizure had an unfavorable outcome. The rate of neurologic handicap was 80% in subtle seizure and 67% in general tonic seizure. 4) The result of EEG finding was normal (18%) and abnormal(82%). In abnormal EEG finding. 10(35.7%) of 28 patients with moderately to markedly abnormal EEG backgrounds had an unfavorable prognosis and the incidence of neurologic handicap was 90%(9 of 10). 5) The Apgar score at 5min was recorded in 25cases(69%) and 56%(13 of 25) of neonates had scores of 6 or less : birth asphyxia. 77% of birth asphyxia developed neonatal seizure in the first three days. Therefore, the five minute Apgar score in neonates who had seizure was highly associated(P<0.05)with neurologic handicap and a good predictor of death or significant neurologic sequelae. 6) The follow-up results were that 14cases(38.8%) showed normal behavioral states and 17 cases (47.2%) showed neurologic sequelae which were cerebral palsy in 6cases(35.3%) and neurodevelopmental delay in 11cases(64.7%).

假押留 審理에 관한 小考

김상영 부산대학교 법학연구소 2010 법학연구 Vol.51 No.1

For the purpose of protecting the rights of creditors, the provisional seizure procedure uses the submission of documents and a simple questioning process that speeds up the process. The provisional seizure is approved or rejected without giving the borrower or joint guarantors an opportunity to present objections. If the provisional seizure is approved, the court registers the provisional seizure for real estate. For seizures of salaries and other monetary items, the creditor submits an application for execution to the executing agency, which then performs the provisional seizure. (After the preliminary seizure order is issued, it is possible to submit an statement of objection. But the preliminary seizure order will remain on the register, making it difficult in some cases for that party to subsequently obtain loans from a bank or other lender.)By the way Courts in Korea have a great number of provisional seizure cases that have originated in the generous and rash attitude of the judges who approve most of provisional seizure cases conventionally and have suffered from the abuse of provisional seizure by malicious creditors. In order to reduce a great number of provisional seizure cases it is essential that the judges in the provisional seizure procedure see the provisional seizure procedure in a new light. In other words the judges need to treat the provisional seizure procedure properly and sincerely. That is why I assert definitely that the judges in the provisional seizure procedure have to meet with actually and question a creditor.