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Background and Objective We used the Symptom Checklist 90-Revised (SCL-90-R) to compare the psychosomatic symptom profiles between periodic limb movement disorder (PLMD) and restless legs syndrome (RLS) patients. Methods Twenty consecutive drug-naïve RLS patients, 20 age- and sex-matched patients with PLMD and healthy controls were enrolled. Questionnaires evaluating sleep (Pittsburgh Sleep Quality Index, and Insomnia Severity Index), depression (Beck Depression Inventory II), and psychosomatic symptoms (SCL-90-R) were administered. Polysomnography was performed in the patients with PLMD or RLS. Results The mean age of the subjects was 57.5 ± 10.9 years, and half of the subjects were male. Compared with the patients with RLS, the patients with PLMD exhibited a reduced total sleep time (276.6 ± 41.3 vs. 322.4 ± 42.9, p = 0.04) and a decreased proportion of REM sleep (12.5 ± 6.6 vs. 17.8 ± 7.8, p = 0.009). The patients with RLS exhibited higher SCL-90-R T-scores on the somatization (post hoc p < 0.001), obsessive-compulsive (post hoc p < 0.001), interpersonal sensitivity (post hoc p = 0.003), anxiety (post hoc p = 0.005), and psychoticism (post hoc p = 0.004) domains than the controls. Compared to the controls, the patients with PLMD exhibited higher SCL-90-R scores only in hostility (post hoc p = 0.016). Somatization in the RLS patients was significantly worse than that in the PLMD patients (post hoc p = 0.003). Conclusions The results of our study demonstrate that psychosomatic distress is greater in RLS patients and lesser in PLMD patients. Somatization was a distinguishing symptom between RLS and PLMD.

Lingual paralysis can result from damage to both upper and lower motor neurons. However, since the hypoglossal nucleus is innervated from both hemispheres simultaneously, unilateral lingual paralysis caused by upper motor neuron has rarely been reported. We report a case which a patient isolated unilateral lingual paralysis due to supranuclear infarction. A 50-year-old right-handed woman was admitted to our hospital due to suddenly developed dysarthria. Her tongue deviated to the right on protrusion without fasciculation or atrophy. A brain MRI showed focal lesion in the left corona radiate and basal ganglia.

ObjectiveTo investigate the frequency distribution of various craniofacial skeletal patterns in a large Korean adult obstructive sleep apnea (OSA) population, and to find a relationship between craniofacial risks and respiratory and sleep characteristics.MethodsA total of 1226 OSA patients (mean age of 44.9±13.3 years) were included in this retrospective cross-sectional study. All subjects were evaluated for gender and age using fourteen polysomnographic, five cephalometric, two comorbid variables, and three self-reported indexes. Frequency analysis was used to screen the distribution of main skeletal patterns and subtypes. Intergroup comparisons were performed using independent t-test, chi-square test or analysis of variance. Univariable regression analysis was done to find a relationship between skeletal risks and OSA characteristics.ResultsThe frequency distribution of skeletal patterns was as follows: sagittally 57.2%, 32.3%, and 10.5% of Class II, Class I, and Cass III; vertically 54.0%, 26.7%, and 19.3% of hyperdivergent, normodivergent, and hypodivergent type, respectively. Polysomnographic, symptomatic, and comorbid variables showed no differences among patients with different skeletal patterns. Conversely, skeletal variables showed no differences according to OSA severity. The prevalence of highly risky skeletal pattern of hyperdivergent Class II was more likely to be females (OR 4.52, P < .01) and less obese (OR 3.21, P < .01), irrelevant to OSA and sleep characteristics.ConclusionCharacteristic frequency distributions of skeletal patterns and subtypes were observed in adult OSA patients however, no statistical association was found between the skeletal patterns and OSA characteristics due to the large interindividual variation.

The aim of this study was to examine social anxiety in South Korean adults with epilepsy and to identify associated factors.This was a cross-sectional, multicenter study in South Korea. Social anxiety was assessed using short forms of the Social Phobia Scale (SPS-6) and Social Interaction Anxiety Scale (SIAS-6). The SPS-6 scores ≥9 and SIAS-6 scores ≥12 were considered indicative of social phobia and social interaction anxiety, respectively. The Patient Health Questionnaire-9 (PHQ-9); Stigma Scale-Revised (SS-R); Disclosure Management Scale; Family Adaptation, Partnership, Growth, Affection, Resolve (F-APGAR) scale; and a questionnaire assessing knowledge about epilepsy were also used.Of a total of 219 patients with epilepsy, 21% and 11% had SPS-6 scores ≥9 and SIAS-6 scores ≥12, respectively. In logistic regression analysis, SPS-6 scores ≥9 were independently associated with SS-R scores of 4-9 (odds ratio [OR]: 8.626, 95% confidence interval [CI]: 2.515-29.587, p = .001), SS-R scores 1-3 (OR: 5.496, 95% CI: 1.757-17.197, p = .003), and PHQ-9 scores ≥10 (OR: 4.092, 95% CI: 1.823-9.185, p = .001). In contrast, SIAS-6 scores ≥12 were related only to PHQ-9 scores ≥10 (OR: 8.740, 95% CI: 3.237-23.599, p .001). Belonging to a dysfunctional family and lack of knowledge about epilepsy tended to be associated with social phobia (p = .071) and social interaction anxiety (p = .090), respectively. Epilepsy-related variables were not related to social anxiety.Social anxiety is not rare in patients with epilepsy. In this study, social phobia was associated with perceived stigma and depressive symptoms, whereas social interaction anxiety was related only to depressive symptoms in patients with epilepsy.

Purpose Literature regarding family stigma related to epilepsy is scarce. This study investigated the prevalence of family stigma and depressive symptoms and the associated factors among the family members of patients with epilepsy. Methods In a cross-sectional study, Stigma Scale–Revised score ≥ 4 and Patient Health Questionnaire-9 score ≥ 10 were considered indicative of moderate-to-severe stigma and depressive symptoms, respectively. Stepwise logistic regression analyses were performed. Results Of the 482 family members, a mean age was 47.1 ± 9.4 years, and 73.4% were female. Of the patients, a mean age was 25.5 ± 16.7 years, and 45.0% were female. Idiopathic generalized epilepsy and focal epilepsy were noted in 22.4% and 65.6% of patients, respectively. Family stigma and depressive symptoms were noted in 10.0% and 11.2% of family members, respectively. Family stigma was significantly associated with high seizure frequency and being a sibling or offspring of a patient independent of their depressive symptoms. By contrast, depressive symptoms in family members were significantly associated with polytherapy, being parents of a patient, and neurological comorbidities independent of family stigma. In a subset of patients and their family, patients had higher proportion of stigma and depressive symptoms than their family. Depressive symptoms and stigma among patients were significantly correlated with those among parents, but not spouse. Conclusion Family stigma is common in families with epilepsy and is closely related to depressive symptoms. Frequent seizures, polytherapy, neurological comorbidities, and the relationship to a patient may be factors that are independently associated with family stigma and depressive symptoms in family members.

Somatosensory reflex epilepsy is induced by repetitive cutaneous contact of a circumscribed body area with a tight time-lock between somatosensory stimulation and seizure. We describe the case of a 27-year-old man with seizures induced by repetitive tapping on the sole of the right foot. Simultaneous video-EEG monitoring and surface electromyography was performed during a seizure triggered by repetitive tapping on the right sole aspect using a hammer. Stimulation produced a tingling sensation on the right sole that extended to the right lower leg. This was followed by motor Jacksonian march of the right leg. [Published with video sequence on www.epilepticdisorders.com].

Background and purpose Long-term videoelectroencephalogram (video-EEG) monitoring is performed to diagnose an epileptic seizure and to investigate the differential diagnosis of paroxysmal events. To provoke an epileptic seizure, an exercise method is performed in some cases during long-term video-EEG recording in the epilepsy monitoring unit (EMU). The purpose of this study was two-fold: to assess the frequency and severity of adverse events associated with the use of an exercise bicycle and to find a way to safely use it in the EMU. Methods A retrospective survey was performed on all epileptic seizure videos recorded in the EMU from January 2012 to December 2013. Three hundred and fifty patients were included in this study. Results Eleven patients experienced an epileptic seizure while riding the exercise bicycle in the EMU. One patient's foot got stuck between the cycling pedal and its strap, and one patient fell off the exercise bicycle during the epileptic seizure. However, there were no serious adverse events over two years. Conclusion Epileptic seizures were not frequent while riding the exercise bicycle, and serious injuries did not occur. But, there is a need to improve the safety in the EMU to control the potentially dangerous factors associated with the use of the exercise bicycle and to continuously monitor the patients with help from the staff.

Epilepsia partialis continua is a rare epileptic syndrome observed in patients with brain structural lesions and metabolic disorders. We report a patient with non-ketotic hyperglycaemia presenting as epilepsia partialis continua with reversible focal brain lesions. An 83-year-old woman visited our hospital due to sudden and repetitive left facial twitching lasting for two days. Initial laboratory data revealed serum glucose, osmolality, and sodium levels of 631 mg/dl, 310 mOsm/l, and 130 mEq/l, respectively. EEG was normal. Brain MRI showed low signal changes in the right frontal subcortical area and high signal changes in the surrounding right frontal cortical areas on T2-weighted, fluid-attenuated inversion recovery, and diffusion-weighted images. No seizures recurred after correcting blood glucose levels, hydrating the patient, and infusing valproate (900 mg/day). Follow-up MRI, six months later, showed complete resolution of the signal changes in the right frontal cortical and subcortical areas and no clinical seizures. When considering non-ketotic hyperglycaemia with epilepsia partialis continua in an elderly patient, early diagnosis and administration of the appropriate therapy is very important in order to decrease morbidity.

Purpose The purpose of this study was to evaluate differences in stigma, disclosure management of epilepsy, and knowledge about epilepsy between patients with epilepsy who recognized and did not recognize the new Korean term for epilepsy. Methods This was a cross-sectional, multicenter study. The Stigma Scale-Revised, the Disclosure Management Scale, the Patient Health Questionnaire-9, and a questionnaire assessing knowledge about epilepsy were used. The set of questionnaires had two versions, using either the old or new name for epilepsy. Multivariate logistic regression analyses were used. Results A total of 341 patients with epilepsy and 509 family members were recruited. Approximately 62% of patients felt some degree of epilepsy-related stigma. Mild stigma, severe concealment of epilepsy diagnosis, and increased knowledge about epilepsy were independently identified as factors associated with recognition of the new term in patients. Recognition of the new term was more prevalent in patients and family members with higher education, female family members, and family members having patients with younger age at seizure onset and shorter duration of epilepsy. There were no significant differences between the two types of questionnaires. About 81% of patients and 93% of family members had a positive attitude about renaming epilepsy. Conclusion The use of the new Korean term for epilepsy (cerebroelectric disorder) increased knowledge about epilepsy but did not reduce stigma and concealment of epilepsy diagnosis in Korean adults with epilepsy. Higher education may be an important factor for knowing the new term in patients and family members.

Summary Purpose Antiepileptic drugs (AEDs) may cause adverse effects on bone metabolism and bone mineral density (BMD). The aim of this study is to determine the effect of oxcarbazepine (OXC) monotherapy on biochemical markers of bone metabolism and BMD in epilepsy patients. Methods Forty-one new onset drug naive epilepsy patients were recruited (19 females, 22 males; mean age: 28.2±8.4 years). We measured biochemical markers of bone metabolism (serum calcium, phosphate, bone alkaline phosphatase, parathyroid hormone, osteocalcin, insulin-like growth factor (IGF)-1, C-telopeptide, Vitamin D3 levels) and BMD by DEXA (dual energy X-ray absorptiometry) method in all patients before and after a long-term OXC monotherapy. Results Most of biochemical markers were not changed significantly, but serum calcium ( p =0.0087) and bone specific ALP was reduced ( p =0.0499) significantly after OXC monotherapy in epilepsy patients. BMD at the lumbar spine (L2 to L4) was significantly increased after OXC monotherapy ( p =0.0001), revealed by repeated measures ANOVA with Bonferroni's correction of confounders including sex, age, average dose, and treatment duration. However, BMD at the lumbar spine (L2 to L4) was significantly increased ( p =0.012) only in female patients in each gender analysis. Conclusions This study demonstrates that a long-term OXC monotherapy does not appear to have harmful effect on bone health in drug naive epilepsy patients.

Objectives Primary restless leg syndrome (RLS) and periodic limb movements in sleep (PLMS) frequently co-exist, obscuring the boundaries between the two conditions. In such instances, a study of secondary cases with focal lesions such as post-stroke RLS and PLMS (psRLS and psPLMS, respectively) can be helpful in identifying characteristics of the individual conditions. Materials and Methods Patients who had suffered strokes and who subsequently developed psRLS or psPLMS were recruited. To determine the overall features of psRLS/PLMS, historical cases were selected from the literature. All cases with either psRLS or psPLMS alone were further analyzed to elucidate the distinctive pathomechanisms of the two conditions. Results Six patients with either psRLS or psPLMS were recruited from our hospital; two patients had both conditions contemporaneously. The literature contains details on 30 cases of psRLS or psPLMS. The causative lesion was most frequently located in the pons. We found that psRLS was more often bilateral, and usually detected later in time. Lesions in both the pontine base and tegmentum (together) were associated with unilateral psPLMS, whereas lesions in the corona radiata and adjacent basal ganglia were associated with bilateral RLS. Lesions confined to the corona radiata resulted in either unilateral or bilateral RLS. Conclusions The observed differences in the clinical and radiological features of psRLS and psPLMS suggest that the pathophysiologies of the two conditions are distinct. Further research is needed to understand the pathophysiologies of primary RLS and PLMS.

Carotid intima-media thickness (IMT) is a surrogate marker for evaluating atherosclerotic vascular diseases. The phosphodiesterase inhibitor cilostazol attenuates the increase in carotid IMT in diabetes patients. We studied whether cilostazol can reduce the progression of carotid IMT in symptomatic ischemic stroke patients. From our prospective registry of acute ischemic stroke patients who were admitted during a 4.5-year period, follow-up carotid ultrasound was performed in a random sample of survivors. Patients were divided into two groups: the cilostazol group, who continued cilostazol treatment during the follow-up period; and the control group, who were prescribed antiplatelets other than cilostazol. Analysis of covariance and propensity score-matched analysis were used to evaluate the difference between groups. Among a total of 1,049 cases in our registry, 208 patients were utilized to construct two comparable sets by propensity score analysis, including 101 who received cilostazol and 107 who took antiplatelet medication without cilostazol. Both maximum and mean carotid IMT values were significantly reduced in the cilostazol group but increased in the control group (maximum left –0.048 ± 0.186 vs. 0.022 ± 0.163 mm, p = 0.001; maximum right –0.037 ± 0.173 vs. 0.050 ± 0.200 mm, p = 0.001; mean left –0.052 ± 0.102 vs. 0.023 ± 0.112 mm, p

Received December 14, 2011 Revised December 24, 2011 Accepted December 26, 2011 Address for correspondence Won Chul Shin, MD Department of Neurology, College of Medicine, Kyung Hee University, 892 Dongnam-ro, Gangdong-gu, Seoul 134-727, Korea Tel: +82-2-440-6166 Fax: +82-2-440-7243 E-mail: shinwc@khu.ac.kr Exploding head syndrome is a rare nocturnal disorder that the patient experiences a loud sound. The events occur usually during a period of drowsiness preceding sleep. The polysomnography studies in exploding head syndrome are very rare. We report a case of exploding head syndrome that a total of 8 typical episodes were recorded in polysomnography. A 51 years old female was admitted due to nocturnal loud sound from 2 month ago. There was no headache and no history of sleep problems. During the polysomnography, the events recorded 8 times, 6 of the events occurred during waking time prior to sleep onset, 2 developed in N1 sleep. In our case, the events appear to arise from early drowsiness with predominant alpha rhythm, with interspersed theta activity. J Korean Sleep Res Soc 2011;8:45-47

Hemichorea-hemiballism (HCHB) was infrequently related to cortical lesions such as tumor or infarction. Although functional derangement of the basal ganglia (BG) or the thalamus (Th) was suggested, pathomechanism of HCHB secondary to cortical lesions remains uncertain. We recruited the patients with HCHB secondary to cerebrovascular diseases, excluding other causes such as hyperglycemia. All the patients were studied with brain magnetic resonance imaging/angiography (MRI/MRA) and single-photon emission computed tomography (SPECT). Those with only cortical abnormalities in neuroimaging studies were sorted out as the cases of cortical HCHB. Statistical parametric mapping (SPM) analysis of SPECT was performed to investigate the pathomechanism of cortical HCHB. Ten patients (three males and seven females) were included in our study. Six patients had acute BG lesions with SPECT abnormalities, and one had old BG lesions with abnormal SPECT. Three patients were classified as cortical HCHB with lesions only in the frontal and parietal cortices in MRI and SPECT. SPM analysis revealed additional hypoperfusion in frontal areas, leaving BG and Th free of any perfusion abnormalities. Although cortical HCHB was strictly defined by MRI and SPECT, cortical HCHB was not uncommon (30 %). Further analysis showed intertwined networks among the frontal and parietal lobes for cortical HCHB. Cortical dysfunction is important in the pathogenesis of cortical HCHB even without significant involvement of BG and Th.

Background and Purpose There has been no nationwide population-based study of the prevalence of self-perceived snoring/apnea in Korean adolescents. The purpose of this study was to estimate prevalence of self-perceived snoring/apnea in Korean high-school students and to evaluate their association with daytime sleepiness. Methods An online survey was used to investigate 12,672 students at 75 high schools across the 15 nationwide districts of South Korea. The variables were obtained using a self-reported questionnaire. The students answered questions about self-perceived snoring/apnea during the past 30 days. Daytime sleepiness was measured using a validated Korean version of the Epworth Sleepiness Scale, which was modified for adolescents. Covariates were the sex, school grade, frequency of self-perceived snoring/apnea, body mass index, sleep duration during a school day, and subjective perception of sleep duration. Results The prevalence of self-perceived snoring/apnea was 22.8% (26.4% for males vs. 18.8% for females, p

Aims: To estimate the effect of levetiracetam (LEV) on cognitive function and mood status in newly diagnosed epilepsy patients. Methods: Fifty-five drug-naïve epilepsy patients (M:F ratio = 31:24; mean age = 30.9 years) were included. All patients underwent two neuropsychological (NP) tests, one before receiving LEV and then another 12.9 ± 5.0 months after starting LEV monotherapy. We evaluated general cognitive function, verbal/visual attention and memory, linguistic and visuospatial functions, frontal lobe function, and mood status. Repeated-measures regression and generalized estimating equation models were applied to assess the effects of all the confounding variables such as seizure control, average LEV dose, duration of epilepsy, inter-test interval, and subtype of epilepsy syndrome. Results: LEV monotherapy over 1 year revealed significant improvements in the following domains of NP tests with the correction of possible confounding variables: verbal and visual attention, psychomotor speed, mental flexibility, executive function, verbal fluency and word generation. No NP domains showed any significant decrease. Conclusion: Our study suggested that LEV monotherapy had no harmful effect on cognitive function in drug-naïve patients with epilepsy.

We report a case of multiple cerebral infarctions as the first symptom of hypereosinophilia with Clonorchis sinensis infestation. The patient showed hypereosinophilia and elevated cardiac enzyme, and the egg test of C. sinensis was positive. CT scans of the chest and the abdomen revealed eosinophilic infiltration in both lung and liver. Over a period of six weeks after praziquantel medication, he recovered. C. sinensis infestation which is endemic in East Asian countries should be considered as a cause of multiple microembolic stroke associated with idiopathic hypereosinophilic syndrome.

Few studies have examined white matter hyperintensities (WMH) along the cognitive continuum between single-domain amnestic mild cognitive impairment (sd-aMCI) and Alzheimer's disease (AD). The aims of our study were to explore relationships between the extent and location of WMH and disease severity along the cognitive continuum and to determine whether differences in the distribution of WMH could be predictive of specific patterns of cognitive impairment. We compared cognitive function, vascular risk factors, and regional (frontal lobe, parieto-occipital [PO] lobe, temporal lobe, periventricular [PV] white matter and deep white matter) WMH volume in 37 patients with mild AD, 23 patients with sd-aMCI, and 24 age-matched and education-matched normal controls. A quantitative volumetric method was applied to measure WMH burden. Total and regional WMH burdens, except for those in the temporal lobe, were significantly correlated with age (p

Background and purpose The aims of this study were to elucidate the cognitive functions of narcoleptics and determine whether intelligence protects against cognitive dysfunction and depressive mood in these patients. Methods Sixty-six subjects (33 narcoleptics, 33 controls) were administered a battery of neuropsychological tests and an individual standardized intelligence test. The cognitive functions of the narcoleptic patients and the healthy controls were compared, as were those of high-IQ and mid-to-low-IQ narcoleptic patients. Results Narcoleptics exhibited significantly lower scores in the Corsi Block-Tapping Test forward and backward, and the digit symbol tests, and significantly higher Beck Depression Inventory scores than the controls. However, verbal attention, verbal-visual long-term memory, and executive function task scores did not differ significantly between patients and controls. The mid-to-low-IQ patient group had lower mean digit span backward test, phonemic and semantic fluency Controlled Oral Word Association Test and Korean version of the Boston Naming Test scores, and a higher total score and general depressive symptoms subscales Beck Depression Inventory score than the high-IQ patient group. However, controls exhibited no IQ-related differences in cognitive performance or depressive mood. Patients in the high-IQ group exhibited impaired visual attention and working memory as compared with controls. Conclusions The findings of the present study show that narcolepsy patients have deficits in visual attention and visual working memory, and tend to feel more general depressive symptoms but not somatic symptoms than their control, nonnarcoleptic counterparts. In addition, it appears that higher intelligence protects against cognitive dysfunction and depressive mood.