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Lu V, Zhang J, Thahir A, Lim JA, Krkovic M. 537 Open vs Closed Pilon Fractures: Comparison of Management, Outcomes, and Complications. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aim
Despite the low incidence of pilon fractures, their high impact nature presents difficulties in surgical management/recovery. Current literature is varied, with no universal treatment algorithm. We aim to highlight differences in treatment, outcomes, complications between open and closed pilon fractures.
Method
This retrospective study was conducted at a major trauma centre, including patients over 5-year period. 135 patients were included (open:48, closed:87). Primary outcome was AOFAS score at 3-, 6- and 12-months post-injury. Secondary outcomes include time to partial weight-bear (PWB) and full weight-bear (FWB), bone union time, follow-up time. Post-operative complications were collected.
Results
Open fractures had lower AOFAS score 3 months post-injury, longer bone union time, and time to FWB. For both open and closed fractures, compared to ORIF patients, those treated with fine wire fixator (FWF) had lower AOFAS scores 3- and 6-months post-injury. Closed fracture patients treated with ORIF had shorter bone union time, time to PWB and FWB. Patients with AO/OTA 43A fractures needed shorter time to PWB and FWB than those with 43C fractures. Common complications (closed:open) were superficial infection (22%:54%), post-traumatic arthritis (25%:16%), non-union (11%:24%).
Conclusions
Open fractures, with more extensive soft tissue damage, were likely more suited for FWF, rather than ORIF (18% of open vs 72% of closed were treated with ORIF). Due to greater associated trauma, more frequent complications, and delayed definitive fixation, open fractures had lower AOFAS scores. Nevertheless, use of staged approach involving temporary external fixation, followed with ORIF or FWF achieved low complication rates and good functional recovery.
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Affiliation(s)
- V Lu
- University of Cambridge, Cambridge, United Kingdom
| | - J Zhang
- University of Cambridge, Cambridge, United Kingdom
| | - A Thahir
- University of Cambridge, Cambridge, United Kingdom
| | - J A Lim
- University of Cambridge, Cambridge, United Kingdom
| | - M Krkovic
- University of Cambridge, Cambridge, United Kingdom
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Zhou A, Girish M, Lim JA, Thahir A, Krkovic M. 33 Impact of Disruption of Tibio-Fibular Joints During Distraction Osteogenesis on Knee and Ankle Joint Function. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aim
The aim of this study is to investigate whether a disruption of proximal and/or distal tibio-fibular joint correlates to patient’s function and osteoarthritis.
Method
Retrospective analysis of 44 patients with lower limb bone defects treated by tibial corticotomy and distraction osteogenesis was conducted. Analysis of lower limb x-rays before surgery, immediately post-surgery and after frame removal permitted calculations of changes in tibial length and changes in fibula position relative to the tibia at the proximal and distal tibio-fibular joints. X-rays before and after treatment were also graded for osteoarthritis severity using Alhbäck's classification. Functional ability was scored using the American Orthopaedic Foot & Ankle Society (AOFAS) score and the Knee society score (KSS).
Results
15 patients showed a decrease in the distance between fibular tip and distal tibia, 5 showed no change and 12 showed an increase at the end of the treatment. No statistical significant association was noted with KSS or AOFAS score (p > 0.05), however one patient with a large distance increase exhibited severe radiological exacerbation of knee osteoarthritis. The distal corticotomy group achieved significantly higher length of new bone (p < 0.001) and were more likely to have exacerbation of knee osteoarthritis (p < 0.05). Conversely, proximal corticotomy group were significantly more likely to show an exacerbation of ankle osteoarthritis (p < 0.05).
Conclusions
Attempts should be made not to disrupt the tibio-fibular joints during bone transport, but disruption does not necessarily correlate to poorer outcomes. Our results show that lengthening index reduces with larger bone defects, suggesting that radical debridement/resection may not negatively affect the healing index.
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Affiliation(s)
- A Zhou
- University of Cambridge, Cambridge, United Kingdom
| | - M Girish
- University of Cambridge, Cambridge, United Kingdom
| | - J A Lim
- University of Cambridge, Cambridge, United Kingdom
| | - A Thahir
- Cambridge University Hospitals, Cambridge, United Kingdom
| | - M Krkovic
- Cambridge University Hospitals, Cambridge, United Kingdom
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Kim E, Cho MR, Byun SH, A Lim J, Chae S, Choi WK, Kim I, Kim J. Sympathetic predominance before tourniquet deflation is associated with a reduction in arterial blood pressure after tourniquet deflation during total knee arthroplasty. Physiol Res 2021; 70:401-412. [PMID: 33982581 DOI: 10.33549/physiolres.934639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
High dependency of arterial blood pressure (ABP) on enhanced sympathetic activity, which maintains vascular tone, leads to hypotension after hemodynamic insults that blunt the sympathetic activity. Therefore, we hypothesized that sympathovagal balance before tourniquet deflation (TD) determines the extent of a reduction in ABP after TD during total knee arthroplasty (TKA). Fifty-four hypertensive female patients undergoing TKA under spinal anesthesia were analyzed. The sympathovagal balance [low-to-high frequency ratio of heart rate variability (LF/HF)] before TD was defined as (LF/HF during 5 min before TD-preanesthetic LF/HF)/preanesthetic LF/HF (%). An increase in its value represents a shift in sympathovagal balance toward sympathetic predominance. The percent change in the mean ABP (MAP) after TD was defined as (minimum MAP during 10 min after TD-averaged MAP during 5 min before TD)/averaged MAP during 5 min before TD (%). Simple linear regression was performed to assess the correlation between the sympathovagal balance before TD and change in MAP after TD. The correlation was also assessed by multiple linear regression controlling for age, duration of tourniquet inflation, and spinal anesthesia-induced hypotension. Thirty-two minutes (on average) after tourniquet inflation, the MAP was decreased by 12.1 (-3.0 to 47.9) % [mean (range)] upon TD (P<0.001). The sympathovagal balance before TD was negatively proportional to the change in MAP after TD in both simple and multiple linear regression models (R2=0.323 and 0.340, P<0.001). A shift in sympathovagal balance toward sympathetic predominance before TD is associated with a decrease in ABP after TD.
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Affiliation(s)
- E Kim
- Department of Anesthesiology and Pain Medicine, Daegu Catholic University Medical Center, School of Medicine, Daegu Catholic University, Daegu, Republic of Korea.
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Yu HH, Lim JA, Lee KB, Lee Y. Improved Measurements of the Physical Properties of Oriental Lacquers Using Atomic Force Microscopy and a Nanoindenter. Polymers (Basel) 2021; 13:polym13091395. [PMID: 33925850 PMCID: PMC8123403 DOI: 10.3390/polym13091395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 04/23/2021] [Accepted: 04/23/2021] [Indexed: 01/27/2023] Open
Abstract
Researchers have widely investigated Oriental lacquers to identify the chemical composition and have elucidated corresponding polymerization mechanisms using rigorous analytical techniques. However, researchers generally test the physical properties of Oriental lacquers by conventional methods that are perhaps overly simplistic. Here, we propose accurate and quantitative methods for evaluating the physical properties of Korean, Vietnamese, and Myanmarese lacquer films using atomic force microscopy (AFM), a nanoindenter, and a 90° peel tester. We obtained surface images of the lacquers in accordance with drying time using scanning electron microscopy and AFM. The Korean lacquer film exhibited fast hardening speed, enhanced hardness, and strong adhesion strength compared with the other lacquers, although the Myanmarese lacquer film had a smoother surface than the Korean lacquer film. We used our characterization approach for evaluating a mixed Korean/Myanmarese (50/50 w/w) lacquer. Our proposed measurement techniques for Oriental lacquer films provided results that agreed with qualitative results from conventional tests. Force–distance curves in AFM and force–displacement with nanoindenter for Oriental lacquer films showed more accurate and quantitative data on the mechanical properties. Thus, researchers will find our approach useful when they optimize the chemical compositions and improve the physical properties of Oriental lacquer films for industrial applications.
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Affiliation(s)
- Hye Hyun Yu
- Advanced Analysis Center, Korea Institute of Science and Technology, Seoul 02792, Korea;
| | - Jung-Ah Lim
- Center for Opto-Electronic Materials and Devices, Korea Institute of Science and Technology, Seoul 02792, Korea;
| | - Kang-Bong Lee
- National Agenda Research Division, Korea Institute of Science and Technology, Seoul 02792, Korea;
| | - Yeonhee Lee
- Advanced Analysis Center, Korea Institute of Science and Technology, Seoul 02792, Korea;
- Correspondence: ; Tel.: +82-2958-5971; Fax: +82-2958-5969
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Lee WJ, Lee ST, Shin YW, Lee HS, Shin HR, Kim DY, Kim S, Lim JA, Moon J, Park KI, Kim HS, Chu K, Lee SK. Teratoma Removal, Steroid, IVIG, Rituximab and Tocilizumab (T-SIRT) in Anti-NMDAR Encephalitis. Neurotherapeutics 2021; 18:474-487. [PMID: 32880854 PMCID: PMC8116457 DOI: 10.1007/s13311-020-00921-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
In anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis, we analysed the efficacy of a combined immunotherapy protocol consisting of teratoma removal, steroid, intravenous immunoglobulin (IVIG), rituximab and tocilizumab (T-SIRT). This cohort study included seventy-eight consecutive patients treated for anti-NMDAR encephalitis between Jan 2014 and Oct 2019 in a national referral hospital. Detailed 2-year disease time course was analysed using Clinical Assessment Scale for Autoimmune Encephalitis (CASE) scores at every 2 weeks for 12 weeks from baseline, every month for the next 3 months and then every 3 months. Treatment regimens at each time point were categorized as SI, SIR, or SIRT with/without teratoma removal (T). Adverse events were classified according to the Common Terminology Criteria for Adverse-Events (CTCAE v5.0), where a severe adverse event was defined as an adverse event with CATAE grade 4. In a linear mixed model analysis, using the SIRT regimen was more effective than SIR or SI regimens in lowering CASE scores (P < 0.001 and P = 0.001, respectively). The presence of teratoma (P = 0.001), refractory status epilepticus (P < 0.001) and a higher CASE score at baseline (P < 0.001) predicted a higher CASE score at each time point. Completion of the (T)-SIRT regimen within 1 month of onset resulted in better 1-year improvements in CASE score (P < 0.001) and modified Rankin scale scores (P = 0.001), compared to those of using other regimens within 1 month or delaying teratoma removal for more than 1 month. Pneumonia was a frequent adverse event (52/78, 66.7%) in the whole study population and neutropenia was frequent during SIRT (11/52, 21.2%), but the regimen was well tolerated in most patients. We concluded that the early application of combined immunotherapy consisting of T-SIRT had better efficacy than was found for delayed or partial application of this combination in anti-NMDAR encephalitis.
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Affiliation(s)
- Woo-Jin Lee
- Department of Neurology, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Soon-Tae Lee
- Department of Neurology, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Yong-Won Shin
- Department of Neurology, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
- Center for Hospital Medicine, Seoul National University Hospital, Seoul, South Korea
- Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea
| | - Han Sang Lee
- Department of Neurology, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Hye-Rim Shin
- Department of Neurology, Dankook University Hospital, Cheonan, South Korea
| | - Do-Yong Kim
- Department of Neurology, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
- Laboratory for Neurotherapeutics, Center for Medical Innovations, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Soyun Kim
- Department of Neurology, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
- Laboratory for Neurotherapeutics, Center for Medical Innovations, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Jung-Ah Lim
- Department of Neurology, Cham Joeun Hospital, Gwangju, South Korea
| | - Jangsup Moon
- Department of Neurology, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
- Laboratory for Neurotherapeutics, Center for Medical Innovations, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Kyung-Il Park
- Department of Neurology, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
- Laboratory for Neurotherapeutics, Center for Medical Innovations, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
- Department of Neurology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, South Korea
| | - Hee Seung Kim
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, South Korea
| | - Kon Chu
- Department of Neurology, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea.
- Laboratory for Neurotherapeutics, Center for Medical Innovations, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea.
| | - Sang Kun Lee
- Department of Neurology, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea.
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Lim JA, Moon J, Kim TJ, Jun JS, Park B, Byun JI, Sunwoo JS, Park KI, Lee ST, Jung KH, Jung KY, Kim M, Jeon D, Chu K, Lee SK. Correction: Clustering of spontaneous recurrent seizures separated by long seizure-free periods: An extended video-EEG monitoring study of a pilocarpine mouse model. PLoS One 2020; 15:e0240544. [PMID: 33021996 PMCID: PMC7537895 DOI: 10.1371/journal.pone.0240544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Jang Y, Kim TJ, Moon J, Yang TW, Kim KT, Park BS, Lim JA, Jun JS, Lee ST, Jung KH, Park KI, Jung KY, Chu K, Lee SK. HLAs associated with perampanel-induced psychiatric adverse effects in a Korean population. Sci Rep 2020; 10:13667. [PMID: 32788606 PMCID: PMC7423598 DOI: 10.1038/s41598-020-70601-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/29/2020] [Indexed: 11/23/2022] Open
Abstract
Perampanel (PER) is a new-generation antiepileptic drug that has an occasional but significant shortcoming, psychiatric adverse effects (PAEs). Recently, antiepileptic drug-related adverse reactions, such as skin rash and even PAEs, have been discovered to be correlated with certain human leukocyte antigen (HLA) types. Thus, we aimed to analyze specific HLA alleles as risk factors for PER-PAEs. We prospectively enrolled 17 patients with epilepsy who were prescribed PER between May 2016 and Jul 2018 at Seoul National University Hospital and developed PAEs while taking PER. Their HLA types were analyzed compared to those of 19 patients in the PAE-tolerant group and the general Korean population. In silico docking was performed with two different computational programs, AutoDock Vina and SwissDock, to theoretically evaluate the binding affinity of PER in the grooves of the specific HLA alleles. The HLA-DQB1*06:01, DRB1*08:03, and B*54:01 alleles were significantly associated with the patients who developed PER-PAEs compared with the general Korean population (odds ratio [OR] 3.94, p = 0.008, OR 9.24, p = 0.037, and OR 3.25, p = 0.041, respectively). As a haplotype, the combination of the three alleles was significantly more frequent in the PER-PAE group than in both the PER-tolerant group and the general Korean population. DQB1*06:01 and B*54:01 also demonstrated higher docking scores with PER than other alleles. This is the first study to analyze the association of PER-PAEs with specific HLA genotypes. Our results suggest that an HLA-associated genetic predisposition and a possible immunological mechanism are involved in the occurrence of PER-PAEs.
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Affiliation(s)
- Yoonhyuk Jang
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Tae-Joon Kim
- Department of Neurology, Ajou University School of Medicine, Suwon, South Korea
| | - Jangsup Moon
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea.,Rare Disease Center, Seoul National University Hospital, Seoul, South Korea
| | - Tae-Won Yang
- Department of Neurology, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, South Korea
| | - Keun Tae Kim
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Byeong-Su Park
- Department of Neurology, Ulsan University Hospital, Ulsan, South Korea
| | - Jung-Ah Lim
- Department of Neurology, Chamjoeun Hospital, Gwangju, South Korea
| | - Jin-Sun Jun
- Department of Neurology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Soon-Tae Lee
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Keun-Hwa Jung
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Kyung-Il Park
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea.,Department of Neurology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, South Korea
| | - Ki-Young Jung
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Kon Chu
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea.
| | - Sang Kun Lee
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea.
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Kang TH, Lee SW, Hwang K, Shim W, Lee KY, Lim JA, Yu WR, Choi IS, Yi H. All-Inkjet-Printed Flexible Nanobio-Devices with Efficient Electrochemical Coupling Using Amphiphilic Biomaterials. ACS Appl Mater Interfaces 2020; 12:24231-24241. [PMID: 32353230 DOI: 10.1021/acsami.0c02596] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Nanostructured flexible electrodes with biological compatibility and intimate electrochemical coupling provide attractive solutions for various emerging bioelectronics and biosensor applications. Here, we develop all-inkjet-printed flexible nanobio-devices with excellent electrochemical coupling by employing amphiphilic biomaterial, an M13 phage, numerical simulation of single-drop formulation, and rational formulations of nanobio-ink. Inkjet-printed nanonetwork-structured electrodes of single-walled carbon nanotubes and M13 phage show efficient electrochemical coupling and hydrostability. Additive printing of the nanobio-inks also allows for systematic control of the physical and chemical properties of patterned electrodes and devices. All-inkjet-printed electrochemical field-effect transistors successfully exhibit pH-sensitive electrical current modulation. Moreover, all-inkjet-printed electrochemical biosensors fabricated via sequential inkjet-printing of the nanobio-ink, electrolytes, and enzyme solutions enable direct electrical coupling within the printed electrodes and detect glucose concentrations at as low as 20 μM. Glucose levels in sweat are successfully measured, and the change in sweat glucose levels is shown to be highly correlated with blood glucose levels. Synergistic combination of additive fabrication by inkjet-printing with directed assembly of nanostructured electrodes by functional biomaterials could provide an efficient means of developing bioelectronic devices for personalized medicine, digital healthcare, and emerging biomimetic devices.
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Affiliation(s)
- Tae-Hyung Kang
- Post-Silicon Semiconductor Institute, Korea Institute of Science and Technology, Seoul 02792, Republic of Korea
- Department of Materials Science and Engineering, Seoul National University, Seoul 08826, Republic of Korea
| | - Seung-Woo Lee
- Department of Fine Chemistry, Seoul National University of Science and Technology, Seoul 01811, Republic of Korea
| | - Kyowook Hwang
- Department of Fine Chemistry, Seoul National University of Science and Technology, Seoul 01811, Republic of Korea
| | - Wonbo Shim
- Department of Materials Science and Engineering, Seoul National University, Seoul 08826, Republic of Korea
| | - Ki-Young Lee
- Post-Silicon Semiconductor Institute, Korea Institute of Science and Technology, Seoul 02792, Republic of Korea
| | - Jung-Ah Lim
- Post-Silicon Semiconductor Institute, Korea Institute of Science and Technology, Seoul 02792, Republic of Korea
| | - Woong-Ryeol Yu
- Department of Materials Science and Engineering, Seoul National University, Seoul 08826, Republic of Korea
| | - In-Suk Choi
- Department of Materials Science and Engineering, Seoul National University, Seoul 08826, Republic of Korea
| | - Hyunjung Yi
- Post-Silicon Semiconductor Institute, Korea Institute of Science and Technology, Seoul 02792, Republic of Korea
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Jun JS, Kim R, Jung HM, Byun JI, Seok JM, Kim TJ, Lim JA, Sunwoo JS, Kim HJ, Schenck CH, Yang KI, Jung KY. Emotion dysregulation in idiopathic rapid eye movement sleep behavior disorder. Sleep 2020; 43:5573800. [PMID: 31553439 DOI: 10.1093/sleep/zsz224] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 08/01/2019] [Indexed: 11/12/2022] Open
Abstract
STUDY OBJECTIVES To characterize emotion regulation strategies in patients with idiopathic REM sleep behavior disorder (iRBD) and to explore whether these strategies are associated with clinical symptoms. METHODS In this cross-sectional multicenter study, a total of 94 polysomnography-confirmed iRBD patients (mean age, 67.6 years; men, 56%) and 50 healthy controls (mean age, 65.4 years; men, 48%) completed the Cognitive Emotion Regulation Questionnaire (CERQ), the Korean version of the RBD questionnaire-Hong Kong (RBDQ-KR), the Buss-Durkee Hostility Inventory (BDHI), the second edition of the Beck Depression Inventory (BDI-II), and the Korean version of the Montreal Cognitive Assessment (MoCA-K). RESULTS The iRBD group had lower CERQ adaptive scores than the control group, whereas the CERQ maladaptive scores were not significantly different between the groups. Among the CERQ adaptive subscales, the scores for positive refocusing, refocusing on planning, and positive reappraisal were significantly lower in the iRBD group than in the control group. Higher CERQ adaptive scores were correlated with lower scores on RBDQ-KR factor 1 (dream-related) and the BDI-II and higher MoCA-K scores but were not correlated with RBDQ-KR factor 2 (behavioral manifestation) or BDHI scores. Among the dream content-related items of RBDQ-KR factor 1, the CERQ adaptive score was associated only with frequent nightmares. No correlation was found between CERQ maladaptive scores and any variable except for a positive correlation with BDI-II scores. CONCLUSIONS Our results provide evidence of emotion regulation deficits in iRBD patients. Furthermore, these results were linked to dream-related factors, especially nightmares, along with depressive symptoms and cognitive impairment.
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Affiliation(s)
- Jin-Sun Jun
- Department of Neurology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Ryul Kim
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hye-Min Jung
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jung-Ick Byun
- Department of Neurology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Jin Myoung Seok
- Department of Neurology, Soonchunhyang University College of Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
| | - Tae-Joon Kim
- Department of Neurology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jung-Ah Lim
- Department of Neurology, Chamjoeun Hospital, Gwangju, Republic of Korea
| | - Jun-Sang Sunwoo
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Han-Joon Kim
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Carlos H Schenck
- Minnesota Regional Sleep Disorders Center, and Department of Psychiatry, Hennepin County Medical Center and University of Minnesota Medical School, Minneapolis, MN
| | - Kwang Ik Yang
- Department of Neurology, Soonchunhyang University College of Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
| | - Ki-Young Jung
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
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Sunwoo JS, Cha KS, Byun JI, Kim TJ, Jun JS, Lim JA, Lee ST, Jung KH, Park KI, Chu K, Kim HJ, Kim M, Lee SK, Kim KH, Schenck CH, Jung KY. Abnormal activation of motor cortical network during phasic REM sleep in idiopathic REM sleep behavior disorder. Sleep 2019; 42:5184577. [PMID: 30445515 DOI: 10.1093/sleep/zsy227] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Indexed: 11/14/2022] Open
Abstract
Study Objectives We investigated electroencephalography (EEG) power spectral density and functional connectivity during phasic and tonic rapid eye movement (REM) sleep, and examined any differences between patients with idiopathic REM sleep behavior disorder (iRBD) and controls. Methods EEG data from 13 people with iRBD (mean age, 66.3 years; men, 84.6%) and 10 controls (mean age, 62.3 years; men, 70%) were analyzed. We selected thirty 3 s miniepochs of both tonic and phasic REM sleep. We estimated relative power for six frequency bands. For functional connectivity analysis, we calculated weighted phase lag index (wPLI) and conducted pairwise comparisons between the two groups. Results EEG power spectral analysis revealed significant interactions between the REM sleep state (phasic vs. tonic) and group at sigma (p = 0.009) and beta (p = 0.002) bands. Sigma- and beta-power decrease during phasic REM sleep was more pronounced and extensive in people with iRBD than in controls. Regarding functional connectivity, there were significant interactions between the REM sleep state and group at alpha (p = 0.029), sigma (p = 0.047), beta (p = 0.015), and gamma (p = 0.046) bands. The average wPLI was significantly higher during phasic REM sleep than during tonic REM sleep, which was observed in people with iRBD but not in controls. The altered functional connections mainly involved the frontal and parietal regions at beta and gamma bands. Conclusions Our findings provide neurophysiological evidence for pathological motor cortex activation during phasic REM sleep which may be associated with generation of dream-enacting behaviors in iRBD.
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Affiliation(s)
- Jun-Sang Sunwoo
- Department of Neurology, Soonchunhyang University College of Medicine, Seoul, South Korea
| | - Kwang Su Cha
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Jung-Ick Byun
- Department of Neurology, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
| | - Tae-Joon Kim
- Department of Neurology, National Center for Mental Health, Seoul, South Korea
| | - Jin-Sun Jun
- Department of Neurology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, South Korea
| | - Jung-Ah Lim
- Department of Neurology, Gangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Soon-Tae Lee
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| | - Keun-Hwa Jung
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| | - Kyung-Il Park
- Department of Neurology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, South Korea
| | - Kon Chu
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| | - Han-Joon Kim
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Manho Kim
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea.,Protein Metabolism Medical Research Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Sang Kun Lee
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea.,Neuroscience Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Kyung Hwan Kim
- Department of Biomedical Engineering, College of Health Science, Yonsei University, Wonju, South Korea
| | - Carlos H Schenck
- Minnesota Regional Sleep Disorders Center, and Department of Psychiatry, Hennepin County Medical Center and University of Minnesota Medical School, Minneapolis, MN
| | - Ki-Young Jung
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea.,Neuroscience Research Institute, Seoul National University College of Medicine, Seoul, South Korea
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11
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Her S, Cha KS, Choi JW, Kim H, Byun JI, Sunwoo JS, Kim TJ, Lim JA, Jung KY, Kim KH. Impaired visuospatial attention revealed by theta- and beta-band cortical activities in idiopathic REM sleep behavior disorder patients. Clin Neurophysiol 2019; 130:1962-1970. [PMID: 31476702 DOI: 10.1016/j.clinph.2019.07.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 07/04/2019] [Accepted: 07/26/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Idiopathic REM sleep behavior disorder (iRBD) patients are susceptible to cognitive deficits, especially attention dysfunction. The objective of this study is to elucidate the neural mechanism of the dysfunction in attention known as 'inhibition of return' (IOR) in iRBD patients based on an analysis of oscillatory cortical activity during a selective attention task. METHODS Event-related potentials (ERPs) were recorded from iRBD patients and normal control subjects while performing a Posner task. The differences in N1 ERP and theta- and beta-bands event-related spectral perturbations (ERSPs) between valid and invalid stimuli were compared between groups. RESULTS The N1 amplitude was significantly higher for the invalid stimuli in controls, while the valid-invalid difference was not significant in iRBD patients. The valid-invalid differences in ERSPs were prominent in controls at ∼100-400 ms for the theta-band and ∼200-400 ms for the beta-band, and the valid-invalid differences in ERSPs were not significant in the iRBD patients. CONCLUSION The results demonstrated that valid-invalid differences in neural activity were absent in iRBD patients, and these neural findings were in accord with the behavioral results. SIGNIFICANCE Our findings imply impairment in sensory-perceptual processing mediated by attentional control and response inhibition in early-stage iRBD before clinical neurodegeneration.
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Affiliation(s)
- Seongjin Her
- Department of Biomedical Engineering, College of Health Science, Yonsei University, Wonju, South Korea
| | - Kwang Su Cha
- Department of Biomedical Engineering, College of Health Science, Yonsei University, Wonju, South Korea; Department of Neurology, Seoul National University Hospital, Neuroscience Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Jeong Woo Choi
- Department of Biomedical Engineering, College of Health Science, Yonsei University, Wonju, South Korea; Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Hyun Kim
- Department of Biomedical Engineering, College of Health Science, Yonsei University, Wonju, South Korea
| | - Jung-Ick Byun
- Department of Neurology, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
| | - Jun-Sang Sunwoo
- Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea
| | - Tae-Joon Kim
- Department of Neurology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, South Korea
| | - Jung-Ah Lim
- Department of Neurology, Chamjoeun Hospital, Gwangju, South Korea
| | - Ki-Young Jung
- Department of Neurology, Seoul National University Hospital, Neuroscience Research Institute, Seoul National University College of Medicine, Seoul, South Korea.
| | - Kyung Hwan Kim
- Department of Biomedical Engineering, College of Health Science, Yonsei University, Wonju, South Korea.
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12
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Lim JA, Jun JS, Yang TW, Park B, Kim KT, Lee HE, Lee SK, Jung KY. Head jerks during sleep in a patient with obstructive sleep apnea. Sleep Med 2019; 57:141-143. [DOI: 10.1016/j.sleep.2019.02.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 02/08/2019] [Accepted: 02/12/2019] [Indexed: 11/30/2022]
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13
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Jun JS, Kim R, Byun JI, Kim TJ, Lim JA, Sunwoo JS, Lee ST, Jung KH, Park KI, Chu K, Kim M, Lee SK, Jung KY. Prolonged-release melatonin in patients with idiopathic REM sleep behavior disorder. Ann Clin Transl Neurol 2019; 6:716-722. [PMID: 31019996 PMCID: PMC6469244 DOI: 10.1002/acn3.753] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 01/30/2019] [Accepted: 02/07/2019] [Indexed: 11/10/2022] Open
Abstract
Objective We investigated the effects of prolonged-release melatonin (PRM) on idiopathic rapid eye movement (REM) sleep behavior disorder (iRBD). Methods In this 4-week, randomized, double-blind, placebo-controlled pilot study, 30 participants with polysomnography-confirmed iRBD were assigned to receive PRM 2 mg per day, PRM 6 mg per day, or placebo. Medication was administered orally 30 min before bedtime. Primary outcomes included scores from the Clinical Global Impression-Improvement (CGI-I) and the Korean version of the RBD questionnaire-Hong Kong (RBDQ-KR). The secondary outcomes included RBDQ-KR factor 1 and factor 2 subscores, the Pittsburgh Sleep Quality Index score, the Epworth Sleepiness Scale score, the Short Form Health Survey version 2 score, and the frequency of dream-enacting behaviors assessed using a sleep diary. Results After 4 weeks, there were no differences in the proportions of patients with a CGI-I score of much improved or very much improved among the study groups. In addition, RBDQ-KR scores and secondary outcomes were not improved in all groups at 4 weeks, and there were no differences between the groups. Conclusion Our findings suggest that PRM may not be effective in treating RBD-related symptoms within the dose range used in this study. Further studies using doses higher than 6 mg per day are warranted.
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Affiliation(s)
- Jin-Sun Jun
- Department of Neurology Seoul National University Hospital Seoul Republic of Korea.,Department of Neurosurgery Seoul National University Hospital Seoul Republic of Korea
| | - Ryul Kim
- Department of Neurology Seoul National University Hospital Seoul Republic of Korea
| | - Jung-Ick Byun
- Department of Neurology Kyung Hee University Hospital at Gangdong Seoul Republic of Korea
| | - Tae-Joon Kim
- Department of Neurology Ajou University School of Medicine Suwon Republic of Korea
| | - Jung-Ah Lim
- Department of Neurology Kangnam Sacred Heart Hospital Hallym University College of Medicine Seoul Republic of Korea
| | - Jun-Sang Sunwoo
- Department of Neurology Soonchunhyang University Seoul Hospital Seoul Republic of Korea
| | - Soon-Tae Lee
- Department of Neurology Seoul National University Hospital Seoul Republic of Korea
| | - Keun-Hwa Jung
- Department of Neurology Seoul National University Hospital Seoul Republic of Korea
| | - Kyung-Il Park
- Department of Neurology Seoul National University Healthcare System Gangnam Center Seoul Republic of Korea
| | - Kon Chu
- Department of Neurology Seoul National University Hospital Seoul Republic of Korea
| | - Manho Kim
- Department of Neurology Seoul National University Hospital Seoul Republic of Korea
| | - Sang Kun Lee
- Department of Neurology Seoul National University Hospital Seoul Republic of Korea
| | - Ki-Young Jung
- Department of Neurology Seoul National University Hospital Seoul Republic of Korea
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14
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Lim JA, Lee ST, Moon J, Jun JS, Kim TJ, Shin YW, Abdullah S, Byun JI, Sunwoo JS, Kim KT, Yang TW, Lee WJ, Moon HJ, Kim DW, Lim BC, Cho YW, Yang TH, Kim HJ, Kim YS, Koo YS, Park B, Jung KH, Kim M, Park KI, Jung KY, Chu K, Lee SK. Development of the clinical assessment scale in autoimmune encephalitis. Ann Neurol 2019; 85:352-358. [PMID: 30675918 DOI: 10.1002/ana.25421] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 01/21/2019] [Accepted: 01/21/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE There is no scale for rating the severity of autoimmune encephalitis (AE). In this study, we aimed to develop a novel scale for rating severity in patients with diverse AE syndromes and to verify the reliability and validity of the developed scale. METHODS The key items were generated by a panel of experts and selected according to content validity ratios. The developed scale was initially applied to 50 patients with AE (development cohort) to evaluate its acceptability, reproducibility, internal consistency, and construct validity. Then, the scale was applied to another independent cohort (validation cohort, n = 38). RESULTS A new scale consisting of 9 items (seizure, memory dysfunction, psychiatric symptoms, consciousness, language problems, dyskinesia/dystonia, gait instability and ataxia, brainstem dysfunction, and weakness) was developed. Each item was assigned a value of up to 3 points. The total score could therefore range from 0 to 27. We named the scale the Clinical Assessment Scale in Autoimmune Encephalitis (CASE). The new scale showed excellent interobserver (intraclass correlation coefficient [ICC] = 0.97) and intraobserver (ICC = 0.96) reliability for total scores, was highly correlated with modified Rankin scale (r = 0.86, p < 0.001), and had acceptable internal consistency (Cronbach α = 0.88). Additionally, in the validation cohort, the scale showed high interobserver reliability (ICC = 0.99) and internal consistency (Cronbach α = 0.92). INTERPRETATION CASE is a novel clinical scale for AE with a high level of clinimetric properties. It would be suitable for application in clinical practice and might help overcome the limitations of current outcome scales for AE. ANN NEUROL 2019;85:352-358.
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Affiliation(s)
- Jung-Ah Lim
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Department of Neurology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Soon-Tae Lee
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Jangsup Moon
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea
| | - Jin-Sun Jun
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Department of Neurology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, South Korea
| | - Tae-Joon Kim
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Department of Neurology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, South Korea
| | - Yong-Won Shin
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Suhailah Abdullah
- Division of Neurology, Department of Medicine, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Jung-Ick Byun
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Department of Neurology, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
| | - Jun-Sang Sunwoo
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Department of Neurology, Soonchunhyang University School of Medicine, Seoul, South Korea
| | - Keun Tae Kim
- Department of Neurology, Keimyung University Dongsan Medical Center, School of Medicine, Daegu, South Korea
| | - Tae-Won Yang
- Department of Neurology, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, South Korea
| | - Woo-Jin Lee
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Hye-Jin Moon
- Department of Neurology, Soonchunhyang University Bucheon Hospital, Bucheon, South Korea
| | - Dong Wook Kim
- Department of Neurology, Konkuk University School of Medicine, Seoul, South Korea
| | - Byung Chan Lim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea
| | - Yong Won Cho
- Department of Neurology, Keimyung University Dongsan Medical Center, School of Medicine, Daegu, South Korea
| | - Tae-Ho Yang
- Department of Neurology, Chonbuk National University Hospital, Jeonju, South Korea
| | - Hee Jin Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Neuroscience Center, Samsung Medical Center, Seoul, South Korea
| | - Young-Soo Kim
- Department of Neurology and Institute of Health Science, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Seoul, South Korea
| | - Yong Seo Koo
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Byeongsu Park
- Department of Neurology, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, South Korea
| | - Keun-Hwa Jung
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Manho Kim
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Center for Neuroscience and Protein Metabolism, Seoul National University College of Medicine, Seoul, South Korea
| | - Kyung-Il Park
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Department of Neurology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, South Korea
| | - Ki-Young Jung
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Kon Chu
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Sang Kun Lee
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
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15
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Kim TJ, Jun JS, Kim KT, MD TW, Park BS, Lim JA, Byun JI, Sunwoo JS, Shin JW, Jung KY. Clinical Characteristics and Efficacy of Iron Treatment for Restless Legs Syndrome Patients
with Very Low Ferritin Levels. Sleep Med Res 2018. [DOI: 10.17241/smr.2018.00171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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16
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Lim JA, Chong SE, Zainal Abidin H, Hassan MH. Cutaneous manifestation mimicking Stevens-Johnson syndrome in a critically ill patient: looks similar but totally different. Hong Kong Med J 2018; 23:653.e3-4. [PMID: 29226836 DOI: 10.12809/hkmj165051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- J A Lim
- Department of Internal Medicine, Hospital Sultan Abdul Halim, 08000 Sungai Petani, Kedah, Malaysia
| | - S E Chong
- Regenerative Medicine Cluster, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Bertam, 13200 Kepala Batas, Penang, Malaysia.,Department of Anesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kota Bharu, Kelantan, Malaysia
| | - H Zainal Abidin
- Department of Anesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kota Bharu, Kelantan, Malaysia
| | - M H Hassan
- Department of Anesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kota Bharu, Kelantan, Malaysia
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17
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Nam HW, Cho YJ, Lim JA, Kim SJ, Kim H, Sim SY, Lim DG. Functional status of immune cells in patients with long-lasting type 2 diabetes mellitus. Clin Exp Immunol 2018; 194:125-136. [PMID: 30022471 DOI: 10.1111/cei.13187] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2018] [Indexed: 12/13/2022] Open
Abstract
Although patients with diabetes contract infectious diseases at higher frequencies, and in more severe forms, compared to non-diabetics, the underlying defects of the immune function have not been defined clearly. To address this, we designed an immune monitoring protocol and analysed the functional status of various immune cells. Peripheral blood mononuclear cells (PBMCs) were stimulated with the proper ligands and the functional reactivity of each lineage of cells was subsequently measured. Patients with type 2 diabetes mellitus (T2DM) had PBMC composition ratios comparable to healthy controls, except for a higher frequency of B cell and effector T cell fractions. The capacity of myeloid cells to secrete proinflammatory cytokines was not diminished in terms of the sensitivity and magnitude of the response. Furthermore, cytolytic activity and interferon (IFN)-γ production of natural killer (NK) cells and CD8+ T cells were not decreased in T2DM patients. Phenotypical maturation of dendritic cells, indicated by the up-regulation of major histocompatibility complex (MHC) proteins and co-stimulatory molecules in response to lipopolysaccharide (LPS), was slightly enhanced in T2DM patients. Finally, the functional differentiation profiles of CD4+ T cells did not differ between T2DM patients and the control group. These data indicate that patients with long-lasting T2DM do not have any gross functional defects in immune cells, at least in circulating monocytes, dendritic cells, NK cells and T lymphocytes.
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Affiliation(s)
- H W Nam
- Division of Endocrinology, Department of Internal Medicine, Seoul, Korea
| | - Y J Cho
- Division of Endocrinology, Department of Internal Medicine, Seoul, Korea
| | - J A Lim
- Division of Endocrinology, Department of Internal Medicine, Seoul, Korea
| | - S J Kim
- Department of Family Medicine, National Medical Center, Seoul, Korea
| | - H Kim
- Center for Chronic Diseases, Seoul, Korea
| | - S Y Sim
- Research Institute, National Medical Center, Seoul, Korea
| | - D G Lim
- Center for Chronic Diseases, Seoul, Korea
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18
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Yang TW, Moon J, Kim TJ, Jun JS, Lim JA, Lee ST, Jung KH, Park KI, Jung KY, Chu K, Lee SK. HLA-A*11:01 is associated with levetiracetam-induced psychiatric adverse events. PLoS One 2018; 13:e0200812. [PMID: 30020991 PMCID: PMC6051654 DOI: 10.1371/journal.pone.0200812] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 07/03/2018] [Indexed: 11/19/2022] Open
Abstract
Levetiracetam (LEV) is effective for focal and generalized epilepsy and is used worldwide because of its relatively few drug interactions and favorable tolerability. However, some psychiatric adverse events (PAEs) have been reported, resulting in drug withdrawal. The pathophysiology of LEV-induced PAE has not yet been elucidated. In this study, we investigated the relationship between PAEs and human leukocyte antigen (HLA) genes. Eleven epilepsy patients, who developed PAEs after the administration of LEV and spontaneously improved after drug withdrawal, were enrolled retrospectively. Genomic DNA from the peripheral blood was extracted, and four-digit allele genotyping of HLA genes was performed. The genotype frequencies of HLA genes were compared to those of 80 patients in which LEV was well tolerated, as well as to 485 individuals from the general Korean population. The frequency of the HLA-A*1101 allele was significantly higher in the LEV-induced PAEs group compared to both the LEV-tolerant group (p = 0.021, OR 4.80, 95% CI 1.30-17.74) and the general Korean population (p = 0.015, OR 4.62, 95% CI 1.38-15.45). This study is the first attempt at investigating the relationship between the HLA system and LEV-induced PAE. The results of this study suggest that the HLA-A*1101 allele could be a risk factor for the development of PAEs.
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Affiliation(s)
- Tae-Won Yang
- Department of Neurology, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
| | - Jangsup Moon
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
- Program in Neuroscience, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Tae-Joon Kim
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
- Program in Neuroscience, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jin-Sun Jun
- Department of Neurology, Kyungpook National University Chilgok Hospital, Kyungpook National University School of Medicine, Daegu, Republic of Korea
| | - Jung-Ah Lim
- Department of Neurology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Soon-Tae Lee
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
- Program in Neuroscience, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Keun-Hwa Jung
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
- Program in Neuroscience, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyung-Il Park
- Department of Neurology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Republic of Korea
| | - Ki-Young Jung
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
- Program in Neuroscience, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kon Chu
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
- Program in Neuroscience, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sang Kun Lee
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
- Program in Neuroscience, Seoul National University College of Medicine, Seoul, Republic of Korea
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19
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Moon J, Kim DY, Lee WJ, Lee HS, Lim JA, Kim TJ, Jun JS, Park B, Byun JI, Sunwoo JS, Lee ST, Jung KH, Park KI, Jung KY, Kim M, Lee SK, Chu K. Efficacy of Propranolol, Bisoprolol, and Pyridostigmine for Postural Tachycardia Syndrome: a Randomized Clinical Trial. Neurotherapeutics 2018; 15:785-795. [PMID: 29500811 PMCID: PMC6095784 DOI: 10.1007/s13311-018-0612-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Postural tachycardia syndrome (POTS) is a form of dysautonomia which presents with complex symptoms including orthostatic intolerance. Several medications are prescribed for POTS; however, the efficacy of sustained medical treatment has not been well-investigated. Here, we conducted a 2 × 2 factorial design, randomized, clinical trial of a 3-month medical treatment regimen in POTS patients. Patients were randomly allocated to 4 treatment groups (Group 1: propranolol; Group 2: bisoprolol; Group 3: propranolol + pyridostigmine; Group 4: bisoprolol + pyridostigmine). The orthostatic intolerance questionnaire (OIQ), Beck depression inventory-II (BDI-II), and short-form health survey (SF-36) were conducted at baseline, 1 and 3 months after treatment. Seventy-seven patients who completed the 3-month follow-up were analyzed. In total, every clinical score improved significantly after medical treatment. The OIQ score was significantly lower than that at baseline (18.5 ± 6.7) after 1 month (12.5 ± 4.5, P < 0.01), which decreased further after 3 months (7.8 ± 5.7, P < 0.01). The OIQ score improvements were consistent across every treatment group. In the subgroup analysis of 59 patients who did not receive antidepressants, the BDI-II score significantly decreased after treatment, regardless of the regimen. Physical components of the SF-36 improved after 3 months in every group, while mental components improved only in Group 3. The amount of changes in each score was similar among groups throughout the comparisons. Sustained medical treatment is beneficial to POTS patients, not only for orthostatic intolerance symptoms but also for depression and diminished quality of life, even without prescriptions for antidepressants. The efficacy of each regimen in POTS patients was comparable. TRIAL REGISTRATION NCT02171988.
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Affiliation(s)
- Jangsup Moon
- Department of Neurology, Comprehensive Epilepsy Center, Laboratory for Neurotherapeutics, Biomedical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Do-Yong Kim
- Department of Neurology, Comprehensive Epilepsy Center, Laboratory for Neurotherapeutics, Biomedical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Woo-Jin Lee
- Department of Neurology, Comprehensive Epilepsy Center, Laboratory for Neurotherapeutics, Biomedical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Han Sang Lee
- Department of Neurology, Comprehensive Epilepsy Center, Laboratory for Neurotherapeutics, Biomedical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Jung-Ah Lim
- Department of Neurology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Tae-Joon Kim
- Department of Neurology, Comprehensive Epilepsy Center, Laboratory for Neurotherapeutics, Biomedical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Jin-Sun Jun
- Department of Neurology, Comprehensive Epilepsy Center, Laboratory for Neurotherapeutics, Biomedical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Byeongsu Park
- Department of Neurology, Ulsan University Hospital, Ulsan, South Korea
| | - Jung-Ick Byun
- Department of Neurology, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
| | - Jun-Sang Sunwoo
- Department of Neurology, Soonchunhyang University School of Medicine, Seoul, South Korea
| | - Soon-Tae Lee
- Department of Neurology, Comprehensive Epilepsy Center, Laboratory for Neurotherapeutics, Biomedical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Keun-Hwa Jung
- Department of Neurology, Comprehensive Epilepsy Center, Laboratory for Neurotherapeutics, Biomedical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Kyung-Il Park
- Department of Neurology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, South Korea
| | - Ki-Young Jung
- Department of Neurology, Comprehensive Epilepsy Center, Laboratory for Neurotherapeutics, Biomedical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Manho Kim
- Department of Neurology, Comprehensive Epilepsy Center, Laboratory for Neurotherapeutics, Biomedical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Sang Kun Lee
- Department of Neurology, Comprehensive Epilepsy Center, Laboratory for Neurotherapeutics, Biomedical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea.
| | - Kon Chu
- Department of Neurology, Comprehensive Epilepsy Center, Laboratory for Neurotherapeutics, Biomedical Research Institute, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea.
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Byun JI, Moon J, Kim DY, Shin H, Sunwoo JS, Lim JA, Kim TJ, Lee WJ, Lee HS, Jun JS, Park KI, Lee ST, Jung KH, Jung KY, Kim M, Lee SK, Chu K. Delayed orthostatic hypotension: Severity of clinical symptoms and response to medical treatment. Auton Neurosci 2018; 213:81-85. [PMID: 30005744 DOI: 10.1016/j.autneu.2018.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 05/17/2018] [Accepted: 06/26/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Severity of orthostatic intolerance and the benefit of medical treatment in patients with delayed OH have not been elucidated. This study aimed to compare the symptom severity between classic and delayed OH and evaluate the efficacy of midodrine or pyridostigmine in patients with delayed OH. METHODS This was an adjunctive study of previously reported randomized, open-label clinical trials evaluating the efficacy and safety of midodrine or pyridostigmine for classic OH. Seventeen patients with delayed OH were enrolled and also received midodrine (2.5 mg twice a day) or pyridostigmine (30 mg twice a day) alone or combined. Result of initial orthostatic vital sign and questionnaires were compared between the patients with delayed OH and previously reported 87 patients with classic OH. Delayed OH patients were followed up at 1 and 3 months post-treatment and the vital sign measurements and questionnaires were repeated during the follow-up period. RESULTS Questionnaire scores regarding OH-related symptoms, depression and health-related quality of life (HRQOL) were comparable between the classic and delayed OH patients at baseline. OH-related symptoms and depression were significantly improved after 3 months of medical treatment. CONCLUSION Patients with delayed OH exhibited orthostatic intolerance similar to that of classic OH. This study shows that these patients may benefit from medical treatment with either midodrine or pyridostigmine.
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Affiliation(s)
- Jung-Ick Byun
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Center for Medical Innovations, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea; Department of Neurology, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea; Program in Neuroscience, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jangsup Moon
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Center for Medical Innovations, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea; Program in Neuroscience, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Neurosurgery, Seoul National University Seoul Hospital, Seoul, Republic of Korea
| | - Do-Yong Kim
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Center for Medical Innovations, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyerim Shin
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Center for Medical Innovations, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea; Program in Neuroscience, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jun-Sang Sunwoo
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Center for Medical Innovations, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea; Department of Neurology, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Jung-Ah Lim
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Center for Medical Innovations, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea; Department of Neurology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Tae-Joon Kim
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Center for Medical Innovations, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea; Program in Neuroscience, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Woo-Jin Lee
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Center for Medical Innovations, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea; Program in Neuroscience, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Han Sang Lee
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Center for Medical Innovations, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea; Program in Neuroscience, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jin-Sun Jun
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Center for Medical Innovations, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea; Department of Neurology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Kyung-Il Park
- Department of Neurology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Republic of Korea
| | - Soon-Tae Lee
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Center for Medical Innovations, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea; Program in Neuroscience, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Keun-Hwa Jung
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Center for Medical Innovations, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea; Program in Neuroscience, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ki-Young Jung
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Center for Medical Innovations, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea; Program in Neuroscience, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Manho Kim
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Center for Medical Innovations, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea; Program in Neuroscience, Seoul National University College of Medicine, Seoul, Republic of Korea; Neuroscience and Protein Metabolism Research Center, College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sang Kun Lee
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Center for Medical Innovations, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea; Program in Neuroscience, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Kon Chu
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Center for Medical Innovations, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea; Program in Neuroscience, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Byun JI, Lee BU, Koo YS, Sunwoo JS, Lim JA, Moon J, Lee ST, Jung KH, Chu K, Kim M, Lim JM, Lee HJ, Lee E, Lee SK, Jung KY. Bright light exposure before bedtime impairs response inhibition the following morning: a non-randomized crossover study. Chronobiol Int 2018; 35:1035-1044. [PMID: 29580072 DOI: 10.1080/07420528.2018.1452030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
INTRODUCTION Bright light exposure in the late evening can affect cognitive function the following morning either by changing the biological clock and/or disturbing sleep, but the evidence for this effect is scarce, and the underlying mechanism remains unknown. In this study, we first aimed to evaluate the effect of bright light exposure before bedtime on frontal lobe activity the following morning using near-infrared spectroscopy (NIRS) during a Go/NoGo task. Second, we aimed to evaluate the effects of bright light exposure before bedtime on polysomnographic measures and on a frontal lobe function test the following morning. METHODS Twenty healthy, young males (mean age, 25.5 years) were recruited between September 2013 and August 2014. They were first exposed to control light (150 lux) before bedtime (from 20:00 h to 24:00 h) for 2 days and then to bright light (1,000 lux) before bedtime for an additional 5 days. We performed polysomnography (PSG) on the final night of each light exposure period (on nights 2 and night 7) and performed NIRS, which measures the concentrations of oxygenated and deoxygenated hemoglobin (OxyHb and DeoxyHb, respectively), coupled with a Go/NoGo task the following morning (between 09:30 h and 11:30 h). The participants also completed frontal lobe function tests the following morning. RESULTS NIRS showed decreased hemodynamic activity (lower OxyHb and a tendency toward higher DeoxyHb concentration) in the right frontal lobe during the NoGo block after 1000-lux light exposure compared with that during the NoGo block after 150-lux light exposure. The commission error rate (ER) during the Go/NoGo task was higher after 1000-lux light exposure than that during the Go/NoGo task after 150-lux light exposure (1.24 ± 1.09 vs. 0.6 ± 0.69, P = 0.002), suggesting a reduced inhibitory response. CONCLUSION This study shows that exposure to bright light before bedtime for 5 days impairs right frontal lobe activation and response inhibition the following morning.
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Affiliation(s)
- Jung-Ick Byun
- a Department of Neurology , Kyung Hee University Hospital at Gangdong , Seoul , Korea.,b Department of Neurology , Seoul National University Hospital, Seoul National University College of Medicine , Seoul , Korea
| | - Byeong Uk Lee
- g Department of Psychiatry , Korea University College of Medicine , Seoul , Korea
| | - Yong Seo Koo
- c Department of Neurology , Asan Medical Center , Seoul , Korea
| | - Jun-Sang Sunwoo
- b Department of Neurology , Seoul National University Hospital, Seoul National University College of Medicine , Seoul , Korea.,d Department of Neurology , Soonchunhyang University Hospital , Seoul , Korea
| | - Jung-Ah Lim
- b Department of Neurology , Seoul National University Hospital, Seoul National University College of Medicine , Seoul , Korea.,e Department of Neurology , National Center for Mental Health, An Affiliate of the Ministry for Health & Welfare , Seoul , Korea
| | - Jangsup Moon
- b Department of Neurology , Seoul National University Hospital, Seoul National University College of Medicine , Seoul , Korea
| | - Soon-Tae Lee
- b Department of Neurology , Seoul National University Hospital, Seoul National University College of Medicine , Seoul , Korea
| | - Keun-Hwa Jung
- b Department of Neurology , Seoul National University Hospital, Seoul National University College of Medicine , Seoul , Korea
| | - Kon Chu
- b Department of Neurology , Seoul National University Hospital, Seoul National University College of Medicine , Seoul , Korea
| | - Manho Kim
- b Department of Neurology , Seoul National University Hospital, Seoul National University College of Medicine , Seoul , Korea.,i Neuroscience and Protein metabolism research center , college of medicine , Seoul National University
| | - Jong-Min Lim
- f Department of Lighting Environment Research , Korea Institute of Lighting Technology , Seoul , South Korea
| | - Heon-Jeong Lee
- g Department of Psychiatry , Korea University College of Medicine , Seoul , Korea
| | - Eunil Lee
- h Department of Preventive Medicine , Korea University College of Medicine , Seoul , Korea
| | - Sang Kun Lee
- b Department of Neurology , Seoul National University Hospital, Seoul National University College of Medicine , Seoul , Korea
| | - Ki-Young Jung
- b Department of Neurology , Seoul National University Hospital, Seoul National University College of Medicine , Seoul , Korea
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Lim JA, Moon J, Kim TJ, Jun JS, Park B, Byun JI, Sunwoo JS, Park KI, Lee ST, Jung KH, Jung KY, Kim M, Jeon D, Chu K, Lee SK. Clustering of spontaneous recurrent seizures separated by long seizure-free periods: An extended video-EEG monitoring study of a pilocarpine mouse model. PLoS One 2018; 13:e0194552. [PMID: 29558523 PMCID: PMC5860752 DOI: 10.1371/journal.pone.0194552] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 03/06/2018] [Indexed: 02/07/2023] Open
Abstract
Seizure clustering is a common and significant phenomenon in patients with epilepsy. The clustering of spontaneous recurrent seizures (SRSs) in animal models of epilepsy, including mouse pilocarpine models, has been reported. However, most studies have analyzed seizures for a short duration after the induction of status epilepticus (SE). In this study, we investigated the detailed characteristics of seizure clustering in the chronic stage of a mouse pilocarpine-induced epilepsy model for an extended duration by continuous 24/7 video-EEG monitoring. A seizure cluster was defined as the occurrence of one or more seizures per day for at least three consecutive days and at least five seizures during the cluster period. We analyzed the cluster duration, seizure-free period, cluster interval, and numbers of seizures within and outside the seizure clusters. The video-EEG monitoring began 84.5±33.7 days after the induction of SE and continued for 53.7±20.4 days. Every mouse displayed seizure clusters, and 97.0% of the seizures occurred within a cluster period. The seizure clusters were followed by long seizure-free periods of 16.3±6.8 days, showing a cyclic pattern. The SRSs also occurred in a grouped pattern within a day. We demonstrate that almost all seizures occur in clusters with a cyclic pattern in the chronic stage of a mouse pilocarpine-induced epilepsy model. The seizure-free periods between clusters were long. These findings should be considered when performing in vivo studies using this animal model. Furthermore, this model might be appropriate for studying the unrevealed mechanism of ictogenesis.
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Affiliation(s)
- Jung-Ah Lim
- Department of Neurology, Comprehensive Epilepsy Center, Laboratory for Neurotherapeutics, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea.,Department of Neurology, Gangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Jangsup Moon
- Department of Neurology, Comprehensive Epilepsy Center, Laboratory for Neurotherapeutics, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Tae-Joon Kim
- Department of Neurology, Comprehensive Epilepsy Center, Laboratory for Neurotherapeutics, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Jin-Sun Jun
- Department of Neurology, Comprehensive Epilepsy Center, Laboratory for Neurotherapeutics, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Byeongsu Park
- Department of Neurology, Comprehensive Epilepsy Center, Laboratory for Neurotherapeutics, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea.,Department of Neurology, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, Korea
| | - Jung-Ick Byun
- Department of Neurology, Comprehensive Epilepsy Center, Laboratory for Neurotherapeutics, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea.,Department of Neurology, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
| | - Jun-Sang Sunwoo
- Department of Neurology, Comprehensive Epilepsy Center, Laboratory for Neurotherapeutics, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea.,Department of Neurology, Soonchunhyang University School of Medicine, Seoul, South Korea
| | - Kyung-Il Park
- Department of Neurology, Comprehensive Epilepsy Center, Laboratory for Neurotherapeutics, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea.,Department of Neurology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, South Korea
| | - Soon-Tae Lee
- Department of Neurology, Comprehensive Epilepsy Center, Laboratory for Neurotherapeutics, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Keun-Hwa Jung
- Department of Neurology, Comprehensive Epilepsy Center, Laboratory for Neurotherapeutics, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Ki-Young Jung
- Department of Neurology, Comprehensive Epilepsy Center, Laboratory for Neurotherapeutics, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Manho Kim
- Department of Neurology, Comprehensive Epilepsy Center, Laboratory for Neurotherapeutics, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Daejong Jeon
- Advanced Neural Technologies, Co., Seoul, South Korea
| | - Kon Chu
- Department of Neurology, Comprehensive Epilepsy Center, Laboratory for Neurotherapeutics, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Sang Kun Lee
- Department of Neurology, Comprehensive Epilepsy Center, Laboratory for Neurotherapeutics, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
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Sunwoo JS, Lee S, Kim JH, Lim JA, Kim TJ, Byun JI, Jeong MH, Cha KS, Choi JW, Kim KH, Lee ST, Jung KH, Park KI, Chu K, Kim M, Lee SK, Jung KY. Altered Functional Connectivity in Idiopathic Rapid Eye Movement Sleep Behavior Disorder: A Resting-State EEG Study. Sleep 2018; 40:3738526. [PMID: 28431177 DOI: 10.1093/sleep/zsx058] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2017] [Indexed: 11/13/2022] Open
Abstract
Study Objectives Idiopathic rapid eye movement sleep behavior disorder (iRBD) is considered as a prodromal stage of synucleinopathy. Although loss of functional connectivity is implicated in neurodegenerative diseases, network characteristics of electroencephalography (EEG) in iRBD are unknown. Therefore, we evaluated resting-state EEG functional connectivity to identify the brain network changes in patients with iRBD. Methods We prospectively enrolled 20 patients with polysomnography-confirmed iRBD and 16 controls. Four patients with mild cognitive impairment were excluded from the analysis after cognitive function tests. EEG was recorded during relaxed wakefulness. We computed the weighted phase lag index as a measure of functional connectivity from EEG recordings. Results All patients with iRBD (mean age 64.3 years; men, 68.8%) had no overt manifestations of neurodegenerative diseases such as Parkinsonism or dementia. The mean duration from symptom onset was 4.8 years. Overall connectivity strength did not differ between the two groups in all frequency bands. However, comparisons of each functional connection with the nonparametric permutation test demonstrated iRBD had decreased delta-band functional connectivity in the frontal regions. There were no significantly increased functional connections in all frequencies. The altered connections had a significant correlation with RBD questionnaire scores. Notably, delta-band weighted phase lag index between left frontal and central regions was correlated with verbal fluency performance (r = 0.486, p = .007). Conclusions Resting-state brain network of iRBD was characterized by a loss of delta-band functional connectivity. Therefore, functional networks in iRBD are altered at the early phase of disease.
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Affiliation(s)
- Jun-Sang Sunwoo
- Department of Neurology, Soonchunhyang University College of Medicine, Seoul, South Korea
| | - Sanghun Lee
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Department of Mathematical Sciences, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Jung-Hoon Kim
- Weldon School of Biomedical Engineering, College of Engineering, Purdue University, West Lafayette, IN
| | - Jung-Ah Lim
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea.,Department of Neurology, National Center for Mental Health, An affiliate of the Ministry for Health & Welfare, Seoul, South Korea
| | - Tae-Joon Kim
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| | - Jung-Ick Byun
- Department of Neurology, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
| | - Min Hee Jeong
- Department of Biomedical Engineering, College of Health Science, Yonsei University, Wonju, South Korea
| | - Kwang Su Cha
- Department of Biomedical Engineering, College of Health Science, Yonsei University, Wonju, South Korea
| | - Jeong Woo Choi
- Department of Biomedical Engineering, College of Health Science, Yonsei University, Wonju, South Korea
| | - Kyung Hwan Kim
- Department of Biomedical Engineering, College of Health Science, Yonsei University, Wonju, South Korea
| | - Soon-Tae Lee
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| | - Keun-Hwa Jung
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| | - Kyung-Il Park
- Department of Neurology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, South Korea
| | - Kon Chu
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| | - Manho Kim
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea.,Protein Metabolism Medical Research Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Sang Kun Lee
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea.,Neuroscience Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Ki-Young Jung
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea.,Neuroscience Research Institute, Seoul National University College of Medicine, Seoul, South Korea
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Shin JW, Koo YS, Kim YS, Kim DW, Kim KK, Lee SY, Kim HK, Moon HJ, Lim JA, Byun JI, Sunwoo JS, Moon J, Lee ST, Jung KH, Park KI, Chu K, Kim JM, Cho YW, Jung KY, Lee SK. Clinical characterization of unknown/cryptogenic status epilepticus suspected as encephalitis: A multicenter cohort study. J Neuroimmunol 2018; 315:1-8. [DOI: 10.1016/j.jneuroim.2017.12.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 12/11/2017] [Accepted: 12/11/2017] [Indexed: 01/12/2023]
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Youk J, Kim YS, Lim JA, Shin DY, Koh Y, Lee ST, Kim I. Depletion of nerve growth factor in chemotherapy-induced peripheral neuropathy associated with hematologic malignancies. PLoS One 2017; 12:e0183491. [PMID: 28827818 PMCID: PMC5565270 DOI: 10.1371/journal.pone.0183491] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 08/06/2017] [Indexed: 11/19/2022] Open
Abstract
Objective To investigate whether the depletion of nerve growth factor (NGF) is associated with the development of chemotherapy-induced peripheral neuropathy (CIPN) in patients with hematologic malignancy. Methods We prospectively enrolled hematologic cancer patients who had a plan to receive bortezomib, thalidomide, or vincristine. Baseline NGF levels were measured within one week before the start date of chemotherapy. Follow-up NGF levels were measured after four months from the start date of chemotherapy or the date when CIPN was initially diagnosed. Results Baseline and follow-up NGF pairs were measured in 45 patients (male/female = 27/18, median age = 63 years old). CIPN has developed in 28 patients. In the CIPN group, the level of NGF was significantly decreased after chemotherapy compared to the baseline (△NGF = −3.52 ±5.72; p-value = 0.003), while the NGF level of the no-CIPN group was not changed after chemotherapy. The differences in △NGF levels between the CIPN and no-CIPN group were more profound when analyzed in the subgroup of newly diagnosed multiple myeloma patients (△NGF = −4.14 ± 4.87 pg/ml for the CIPN group and +2.52 ± 8.39 pg/ml for the no-CIPN group; p-value = 0.043). Conclusions This study shows that the depletion of NGF occurs during the development of CIPN, suggesting pathogenesis based on the role of NGF and therapeutic implications.
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Affiliation(s)
- Jeonghwan Youk
- Division of Hematology/Oncology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Young-Sook Kim
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Jung-Ah Lim
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Dong-Yeop Shin
- Division of Hematology/Oncology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Youngil Koh
- Division of Hematology/Oncology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Soon-Tae Lee
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
- * E-mail: (IK); (SL)
| | - Inho Kim
- Division of Hematology/Oncology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
- * E-mail: (IK); (SL)
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Lee HS, Sunwoo JS, Ahn SJ, Moon J, Lim JA, Jun JS, Lee WJ, Lee ST, Jung KH, Park KI, Jung KY, Lee SK, Chu K. Central Nervous System Infection Associated with Orientia tsutsugamushi in South Korea. Am J Trop Med Hyg 2017; 97:1094-1098. [PMID: 28820719 DOI: 10.4269/ajtmh.17-0077] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Orientia tsutsugamushi is a major cause of vector-borne infection in Asia. Prompt recognition and appropriate treatment are crucial because of its potentially fatal complications and lack of response to beta-lactam antibiotics. The present study retrospectively evaluated the clinical characteristics and laboratory findings of 16 patients with scrub typhus-related central nervous system (CNS) infections. Single titers ≥ 1:40 of total serum antibodies against O. tsutsugamushi detected by an indirect immunofluorescent assay were considered as positive results. The median age was 35.5 (range, 14-72) years, and 10 (62.5%) patients were female. The most common symptoms were headache (81.3%) and fever (81.3%). Eschar formation was found in three (18.8%) patients. Among patients with encephalitis, seizures and altered consciousness occurred in five (83.3%) and four (66.7%) patients, respectively. An abnormal liver function was noted in seven (43.8%) patients. The median antibody titer was 1:120 (range, 1:40-1:2,560). Typical cerebrospinal fluid profiles were lymphocytic pleocytosis, mild protein elevations, and normal glucose levels. All patients received an empirical treatment with doxycycline and most (93.8%) of them recovered without neurological sequelae. None of the patients reported side effects of the doxycycline treatment. An empirical treatment with doxycycline is needed in patients with CNS infections in scrub typhus endemic areas.
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Affiliation(s)
- Han Sang Lee
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Jun-Sang Sunwoo
- Department of Neurology, Soonchunhyang University College of Medicine, Seoul, South Korea
| | - Seon-Jae Ahn
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Jangsup Moon
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Jung-Ah Lim
- Department of Neurology, National Center for Mental Health, An affiliate of the Ministry for Health & Welfare, Seoul, South Korea
| | - Jin-Sun Jun
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Woo-Jin Lee
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Soon-Tae Lee
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Keun-Hwa Jung
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Kyung-Il Park
- Department of Neurology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, South Korea
| | - Ki-Young Jung
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Sang Kun Lee
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Kon Chu
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
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Byun JI, Moon J, Kim DY, Shin H, Sunwoo JS, Lim JA, Kim TJ, Lee WJ, Lee HS, Jun JS, Park KI, Lee ST, Jung KH, Jung KY, Lee SK, Chu K. Efficacy of single or combined midodrine and pyridostigmine in orthostatic hypotension. Neurology 2017; 89:1078-1086. [PMID: 28794253 DOI: 10.1212/wnl.0000000000004340] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 06/08/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the long-term (for up to 3 months) efficacy and safety of single or combined therapy with midodrine and pyridostigmine for neurogenic orthostatic hypotension (OH). METHODS This was a randomized, open-label clinical trial. In total, 87 patients with symptomatic neurogenic OH were enrolled and randomized to receive 1 of 3 treatments: midodrine only, pyridostigmine only, or midodrine + pyridostigmine. The patients were followed up at 1 and 3 months after treatment. The primary outcome measures were improvement in orthostatic blood pressure (BP) drop at 3 months. Secondary endpoints were improvement of the orthostatic BP drop at 1 month and amelioration of the questionnaire score evaluating OH-associated symptoms. RESULTS Orthostatic systolic and diastolic BP drops improved significantly at 3 months after treatment in all treatment groups. Orthostatic symptoms were significantly ameliorated during the 3-month treatment, and the symptom severity was as follows: midodrine only < midodrine + pyridostigmine < pyridostigmine only group. Mild to moderate adverse events were reported by 11.5% of the patients. CONCLUSIONS Single or combination treatment with midodrine and pyridostigmine was effective and safe in patients with OH for up to 3 months. Midodrine was better than pyridostigmine at improving OH-related symptoms. CLINICALTRIALSGOV IDENTIFIER NCT02308124. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence that for patients with neurogenic OH, long-term treatment with midodrine alone, pyridostigmine alone, or both midodrine and pyridostigmine is safe and has similar effects in improving orthostatic BP drop up to 3 months.
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Affiliation(s)
- Jung-Ick Byun
- From the Department of Neurology (J.-I.B., J.M., D.-Y.K., H.S., J.-S.S., J.-A.L., T.-J.K., W.-J.L., H.S.L., J.-S.J. S.-T.L., K.-H.J., K.-Y.J., S.K.L., K.C.), Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Center for Medical Innovations, Biomedical Research Institute, Seoul National University Hospital; Department of Neurology (J.-I.B.), Kyung Hee University Hospital at Gangdong; Program in Neuroscience (J.-I.B., J.M., H.S., J.-A.L., T.-J.K., W.-J.L., H.S.L., J.-S.J., S.-T.L., K.-H.J., K.-Y.J., S.K.L., K.C.), Seoul National University College of Medicine; Department of Neurology (J.-S.S.), Soonchunhyang University Seoul Hospital; Department of Neurology (J.-A.L.), National Center for Mental Health, an affiliate of the Ministry for Health & Welfare; and Department of Neurology (K.-I.P.), Seoul National University Hospital Healthcare System Gangnam Center, Republic of Korea
| | - Jangsup Moon
- From the Department of Neurology (J.-I.B., J.M., D.-Y.K., H.S., J.-S.S., J.-A.L., T.-J.K., W.-J.L., H.S.L., J.-S.J. S.-T.L., K.-H.J., K.-Y.J., S.K.L., K.C.), Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Center for Medical Innovations, Biomedical Research Institute, Seoul National University Hospital; Department of Neurology (J.-I.B.), Kyung Hee University Hospital at Gangdong; Program in Neuroscience (J.-I.B., J.M., H.S., J.-A.L., T.-J.K., W.-J.L., H.S.L., J.-S.J., S.-T.L., K.-H.J., K.-Y.J., S.K.L., K.C.), Seoul National University College of Medicine; Department of Neurology (J.-S.S.), Soonchunhyang University Seoul Hospital; Department of Neurology (J.-A.L.), National Center for Mental Health, an affiliate of the Ministry for Health & Welfare; and Department of Neurology (K.-I.P.), Seoul National University Hospital Healthcare System Gangnam Center, Republic of Korea
| | - Do-Yong Kim
- From the Department of Neurology (J.-I.B., J.M., D.-Y.K., H.S., J.-S.S., J.-A.L., T.-J.K., W.-J.L., H.S.L., J.-S.J. S.-T.L., K.-H.J., K.-Y.J., S.K.L., K.C.), Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Center for Medical Innovations, Biomedical Research Institute, Seoul National University Hospital; Department of Neurology (J.-I.B.), Kyung Hee University Hospital at Gangdong; Program in Neuroscience (J.-I.B., J.M., H.S., J.-A.L., T.-J.K., W.-J.L., H.S.L., J.-S.J., S.-T.L., K.-H.J., K.-Y.J., S.K.L., K.C.), Seoul National University College of Medicine; Department of Neurology (J.-S.S.), Soonchunhyang University Seoul Hospital; Department of Neurology (J.-A.L.), National Center for Mental Health, an affiliate of the Ministry for Health & Welfare; and Department of Neurology (K.-I.P.), Seoul National University Hospital Healthcare System Gangnam Center, Republic of Korea
| | - Hyerim Shin
- From the Department of Neurology (J.-I.B., J.M., D.-Y.K., H.S., J.-S.S., J.-A.L., T.-J.K., W.-J.L., H.S.L., J.-S.J. S.-T.L., K.-H.J., K.-Y.J., S.K.L., K.C.), Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Center for Medical Innovations, Biomedical Research Institute, Seoul National University Hospital; Department of Neurology (J.-I.B.), Kyung Hee University Hospital at Gangdong; Program in Neuroscience (J.-I.B., J.M., H.S., J.-A.L., T.-J.K., W.-J.L., H.S.L., J.-S.J., S.-T.L., K.-H.J., K.-Y.J., S.K.L., K.C.), Seoul National University College of Medicine; Department of Neurology (J.-S.S.), Soonchunhyang University Seoul Hospital; Department of Neurology (J.-A.L.), National Center for Mental Health, an affiliate of the Ministry for Health & Welfare; and Department of Neurology (K.-I.P.), Seoul National University Hospital Healthcare System Gangnam Center, Republic of Korea
| | - Jun-Sang Sunwoo
- From the Department of Neurology (J.-I.B., J.M., D.-Y.K., H.S., J.-S.S., J.-A.L., T.-J.K., W.-J.L., H.S.L., J.-S.J. S.-T.L., K.-H.J., K.-Y.J., S.K.L., K.C.), Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Center for Medical Innovations, Biomedical Research Institute, Seoul National University Hospital; Department of Neurology (J.-I.B.), Kyung Hee University Hospital at Gangdong; Program in Neuroscience (J.-I.B., J.M., H.S., J.-A.L., T.-J.K., W.-J.L., H.S.L., J.-S.J., S.-T.L., K.-H.J., K.-Y.J., S.K.L., K.C.), Seoul National University College of Medicine; Department of Neurology (J.-S.S.), Soonchunhyang University Seoul Hospital; Department of Neurology (J.-A.L.), National Center for Mental Health, an affiliate of the Ministry for Health & Welfare; and Department of Neurology (K.-I.P.), Seoul National University Hospital Healthcare System Gangnam Center, Republic of Korea
| | - Jung-Ah Lim
- From the Department of Neurology (J.-I.B., J.M., D.-Y.K., H.S., J.-S.S., J.-A.L., T.-J.K., W.-J.L., H.S.L., J.-S.J. S.-T.L., K.-H.J., K.-Y.J., S.K.L., K.C.), Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Center for Medical Innovations, Biomedical Research Institute, Seoul National University Hospital; Department of Neurology (J.-I.B.), Kyung Hee University Hospital at Gangdong; Program in Neuroscience (J.-I.B., J.M., H.S., J.-A.L., T.-J.K., W.-J.L., H.S.L., J.-S.J., S.-T.L., K.-H.J., K.-Y.J., S.K.L., K.C.), Seoul National University College of Medicine; Department of Neurology (J.-S.S.), Soonchunhyang University Seoul Hospital; Department of Neurology (J.-A.L.), National Center for Mental Health, an affiliate of the Ministry for Health & Welfare; and Department of Neurology (K.-I.P.), Seoul National University Hospital Healthcare System Gangnam Center, Republic of Korea
| | - Tae-Joon Kim
- From the Department of Neurology (J.-I.B., J.M., D.-Y.K., H.S., J.-S.S., J.-A.L., T.-J.K., W.-J.L., H.S.L., J.-S.J. S.-T.L., K.-H.J., K.-Y.J., S.K.L., K.C.), Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Center for Medical Innovations, Biomedical Research Institute, Seoul National University Hospital; Department of Neurology (J.-I.B.), Kyung Hee University Hospital at Gangdong; Program in Neuroscience (J.-I.B., J.M., H.S., J.-A.L., T.-J.K., W.-J.L., H.S.L., J.-S.J., S.-T.L., K.-H.J., K.-Y.J., S.K.L., K.C.), Seoul National University College of Medicine; Department of Neurology (J.-S.S.), Soonchunhyang University Seoul Hospital; Department of Neurology (J.-A.L.), National Center for Mental Health, an affiliate of the Ministry for Health & Welfare; and Department of Neurology (K.-I.P.), Seoul National University Hospital Healthcare System Gangnam Center, Republic of Korea
| | - Woo-Jin Lee
- From the Department of Neurology (J.-I.B., J.M., D.-Y.K., H.S., J.-S.S., J.-A.L., T.-J.K., W.-J.L., H.S.L., J.-S.J. S.-T.L., K.-H.J., K.-Y.J., S.K.L., K.C.), Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Center for Medical Innovations, Biomedical Research Institute, Seoul National University Hospital; Department of Neurology (J.-I.B.), Kyung Hee University Hospital at Gangdong; Program in Neuroscience (J.-I.B., J.M., H.S., J.-A.L., T.-J.K., W.-J.L., H.S.L., J.-S.J., S.-T.L., K.-H.J., K.-Y.J., S.K.L., K.C.), Seoul National University College of Medicine; Department of Neurology (J.-S.S.), Soonchunhyang University Seoul Hospital; Department of Neurology (J.-A.L.), National Center for Mental Health, an affiliate of the Ministry for Health & Welfare; and Department of Neurology (K.-I.P.), Seoul National University Hospital Healthcare System Gangnam Center, Republic of Korea
| | - Han Sang Lee
- From the Department of Neurology (J.-I.B., J.M., D.-Y.K., H.S., J.-S.S., J.-A.L., T.-J.K., W.-J.L., H.S.L., J.-S.J. S.-T.L., K.-H.J., K.-Y.J., S.K.L., K.C.), Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Center for Medical Innovations, Biomedical Research Institute, Seoul National University Hospital; Department of Neurology (J.-I.B.), Kyung Hee University Hospital at Gangdong; Program in Neuroscience (J.-I.B., J.M., H.S., J.-A.L., T.-J.K., W.-J.L., H.S.L., J.-S.J., S.-T.L., K.-H.J., K.-Y.J., S.K.L., K.C.), Seoul National University College of Medicine; Department of Neurology (J.-S.S.), Soonchunhyang University Seoul Hospital; Department of Neurology (J.-A.L.), National Center for Mental Health, an affiliate of the Ministry for Health & Welfare; and Department of Neurology (K.-I.P.), Seoul National University Hospital Healthcare System Gangnam Center, Republic of Korea
| | - Jin-Sun Jun
- From the Department of Neurology (J.-I.B., J.M., D.-Y.K., H.S., J.-S.S., J.-A.L., T.-J.K., W.-J.L., H.S.L., J.-S.J. S.-T.L., K.-H.J., K.-Y.J., S.K.L., K.C.), Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Center for Medical Innovations, Biomedical Research Institute, Seoul National University Hospital; Department of Neurology (J.-I.B.), Kyung Hee University Hospital at Gangdong; Program in Neuroscience (J.-I.B., J.M., H.S., J.-A.L., T.-J.K., W.-J.L., H.S.L., J.-S.J., S.-T.L., K.-H.J., K.-Y.J., S.K.L., K.C.), Seoul National University College of Medicine; Department of Neurology (J.-S.S.), Soonchunhyang University Seoul Hospital; Department of Neurology (J.-A.L.), National Center for Mental Health, an affiliate of the Ministry for Health & Welfare; and Department of Neurology (K.-I.P.), Seoul National University Hospital Healthcare System Gangnam Center, Republic of Korea
| | - Kyung-Il Park
- From the Department of Neurology (J.-I.B., J.M., D.-Y.K., H.S., J.-S.S., J.-A.L., T.-J.K., W.-J.L., H.S.L., J.-S.J. S.-T.L., K.-H.J., K.-Y.J., S.K.L., K.C.), Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Center for Medical Innovations, Biomedical Research Institute, Seoul National University Hospital; Department of Neurology (J.-I.B.), Kyung Hee University Hospital at Gangdong; Program in Neuroscience (J.-I.B., J.M., H.S., J.-A.L., T.-J.K., W.-J.L., H.S.L., J.-S.J., S.-T.L., K.-H.J., K.-Y.J., S.K.L., K.C.), Seoul National University College of Medicine; Department of Neurology (J.-S.S.), Soonchunhyang University Seoul Hospital; Department of Neurology (J.-A.L.), National Center for Mental Health, an affiliate of the Ministry for Health & Welfare; and Department of Neurology (K.-I.P.), Seoul National University Hospital Healthcare System Gangnam Center, Republic of Korea
| | - Soon-Tae Lee
- From the Department of Neurology (J.-I.B., J.M., D.-Y.K., H.S., J.-S.S., J.-A.L., T.-J.K., W.-J.L., H.S.L., J.-S.J. S.-T.L., K.-H.J., K.-Y.J., S.K.L., K.C.), Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Center for Medical Innovations, Biomedical Research Institute, Seoul National University Hospital; Department of Neurology (J.-I.B.), Kyung Hee University Hospital at Gangdong; Program in Neuroscience (J.-I.B., J.M., H.S., J.-A.L., T.-J.K., W.-J.L., H.S.L., J.-S.J., S.-T.L., K.-H.J., K.-Y.J., S.K.L., K.C.), Seoul National University College of Medicine; Department of Neurology (J.-S.S.), Soonchunhyang University Seoul Hospital; Department of Neurology (J.-A.L.), National Center for Mental Health, an affiliate of the Ministry for Health & Welfare; and Department of Neurology (K.-I.P.), Seoul National University Hospital Healthcare System Gangnam Center, Republic of Korea.
| | - Keun-Hwa Jung
- From the Department of Neurology (J.-I.B., J.M., D.-Y.K., H.S., J.-S.S., J.-A.L., T.-J.K., W.-J.L., H.S.L., J.-S.J. S.-T.L., K.-H.J., K.-Y.J., S.K.L., K.C.), Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Center for Medical Innovations, Biomedical Research Institute, Seoul National University Hospital; Department of Neurology (J.-I.B.), Kyung Hee University Hospital at Gangdong; Program in Neuroscience (J.-I.B., J.M., H.S., J.-A.L., T.-J.K., W.-J.L., H.S.L., J.-S.J., S.-T.L., K.-H.J., K.-Y.J., S.K.L., K.C.), Seoul National University College of Medicine; Department of Neurology (J.-S.S.), Soonchunhyang University Seoul Hospital; Department of Neurology (J.-A.L.), National Center for Mental Health, an affiliate of the Ministry for Health & Welfare; and Department of Neurology (K.-I.P.), Seoul National University Hospital Healthcare System Gangnam Center, Republic of Korea
| | - Ki-Young Jung
- From the Department of Neurology (J.-I.B., J.M., D.-Y.K., H.S., J.-S.S., J.-A.L., T.-J.K., W.-J.L., H.S.L., J.-S.J. S.-T.L., K.-H.J., K.-Y.J., S.K.L., K.C.), Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Center for Medical Innovations, Biomedical Research Institute, Seoul National University Hospital; Department of Neurology (J.-I.B.), Kyung Hee University Hospital at Gangdong; Program in Neuroscience (J.-I.B., J.M., H.S., J.-A.L., T.-J.K., W.-J.L., H.S.L., J.-S.J., S.-T.L., K.-H.J., K.-Y.J., S.K.L., K.C.), Seoul National University College of Medicine; Department of Neurology (J.-S.S.), Soonchunhyang University Seoul Hospital; Department of Neurology (J.-A.L.), National Center for Mental Health, an affiliate of the Ministry for Health & Welfare; and Department of Neurology (K.-I.P.), Seoul National University Hospital Healthcare System Gangnam Center, Republic of Korea
| | - Sang Kun Lee
- From the Department of Neurology (J.-I.B., J.M., D.-Y.K., H.S., J.-S.S., J.-A.L., T.-J.K., W.-J.L., H.S.L., J.-S.J. S.-T.L., K.-H.J., K.-Y.J., S.K.L., K.C.), Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Center for Medical Innovations, Biomedical Research Institute, Seoul National University Hospital; Department of Neurology (J.-I.B.), Kyung Hee University Hospital at Gangdong; Program in Neuroscience (J.-I.B., J.M., H.S., J.-A.L., T.-J.K., W.-J.L., H.S.L., J.-S.J., S.-T.L., K.-H.J., K.-Y.J., S.K.L., K.C.), Seoul National University College of Medicine; Department of Neurology (J.-S.S.), Soonchunhyang University Seoul Hospital; Department of Neurology (J.-A.L.), National Center for Mental Health, an affiliate of the Ministry for Health & Welfare; and Department of Neurology (K.-I.P.), Seoul National University Hospital Healthcare System Gangnam Center, Republic of Korea.
| | - Kon Chu
- From the Department of Neurology (J.-I.B., J.M., D.-Y.K., H.S., J.-S.S., J.-A.L., T.-J.K., W.-J.L., H.S.L., J.-S.J. S.-T.L., K.-H.J., K.-Y.J., S.K.L., K.C.), Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Center for Medical Innovations, Biomedical Research Institute, Seoul National University Hospital; Department of Neurology (J.-I.B.), Kyung Hee University Hospital at Gangdong; Program in Neuroscience (J.-I.B., J.M., H.S., J.-A.L., T.-J.K., W.-J.L., H.S.L., J.-S.J., S.-T.L., K.-H.J., K.-Y.J., S.K.L., K.C.), Seoul National University College of Medicine; Department of Neurology (J.-S.S.), Soonchunhyang University Seoul Hospital; Department of Neurology (J.-A.L.), National Center for Mental Health, an affiliate of the Ministry for Health & Welfare; and Department of Neurology (K.-I.P.), Seoul National University Hospital Healthcare System Gangnam Center, Republic of Korea
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Sunwoo JS, Yang TW, Kim DY, Lim JA, Kim TJ, Byun JI, Moon J, Lee ST, Jung KH, Park KI, Jung KY, Kim M, Lee SK, Chu K. Association of blood pressure variability with orthostatic intolerance symptoms. PLoS One 2017; 12:e0179132. [PMID: 28591231 PMCID: PMC5462414 DOI: 10.1371/journal.pone.0179132] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 05/24/2017] [Indexed: 11/18/2022] Open
Abstract
The short-term blood pressure variability (BPV) reflects autonomic regulatory mechanisms. However, the influence of BPV in orthostatic intolerance (OI) is unknown. Herein, we assessed BPV profiles in patients with OI and determined their association with orthostatic symptoms. In this cross-sectional study, we prospectively enrolled 126 patients presenting with OI at the Seoul National University Hospital from December 2014 to August 2016. Among them, those with other neurological diseases (n = 8) and insufficient BP measurements (n = 15) were excluded. The degree of OI symptoms were measured using the self-administered orthostatic intolerance questionnaire (OIQ). All patients underwent ambulatory BP monitoring and we calculated the standard deviation and coefficient of variation as a measure of BPV. The mean age was 48.6 years and the average of the total OIQ score was 11.6. The severe OI group had higher BPV values than the mild group, although mean BP profiles did not differ significantly. Correlation analysis demonstrated that the orthostatic symptoms were positively correlated with diastolic BPV for the total and awake periods. Multiple linear regression analysis revealed that diastolic BPV (B = 0.46, p = 0.031) and current smoking (B = 4.687, p = 0.018) were independent factors for higher OI symptom scores after adjusting for covariates. The results of the current study demonstrated that a positive correlation exists between BPV and OI symptoms. Further studies are required to confirm the present findings and understand the neural mechanisms contributing to the excessive BPV in patients with OI.
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Affiliation(s)
- Jun-Sang Sunwoo
- Department of Neurology, Soonchunhyang University College of Medicine, Seoul, South Korea
| | - Tae-Won Yang
- Department of Neurology, Gyeongsang National University Changwon Hospital, Changwon, South Korea
| | - Do-Yong Kim
- Department of Neurology, Comprehensive Epilepsy Center, Seoul National University Hospital, Seoul, South Korea
- Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| | - Jung-Ah Lim
- Department of Neurology, National Center for Mental Health, An affiliate of the Ministry for Health & Welfare, Seoul, South Korea
| | - Tae-Joon Kim
- Department of Neurology, Comprehensive Epilepsy Center, Seoul National University Hospital, Seoul, South Korea
- Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| | - Jung-Ick Byun
- Department of Neurology, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
| | - Jangsup Moon
- Department of Neurology, Comprehensive Epilepsy Center, Seoul National University Hospital, Seoul, South Korea
- Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| | - Soon-Tae Lee
- Department of Neurology, Comprehensive Epilepsy Center, Seoul National University Hospital, Seoul, South Korea
- Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| | - Keun-Hwa Jung
- Department of Neurology, Comprehensive Epilepsy Center, Seoul National University Hospital, Seoul, South Korea
- Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| | - Kyung-Il Park
- Department of Neurology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, South Korea
| | - Ki-Young Jung
- Department of Neurology, Comprehensive Epilepsy Center, Seoul National University Hospital, Seoul, South Korea
- Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| | - Manho Kim
- Department of Neurology, Comprehensive Epilepsy Center, Seoul National University Hospital, Seoul, South Korea
- Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
- Protein Metabolism Medical Research Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Sang Kun Lee
- Department of Neurology, Comprehensive Epilepsy Center, Seoul National University Hospital, Seoul, South Korea
- Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
- * E-mail: (SKL); (KC)
| | - Kon Chu
- Department of Neurology, Comprehensive Epilepsy Center, Seoul National University Hospital, Seoul, South Korea
- Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
- * E-mail: (SKL); (KC)
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Lee C, Im CH, Koo YS, Lim JA, Kim TJ, Byun JI, Sunwoo JS, Moon J, Kim DW, Lee ST, Jung KH, Chu K, Lee SK, Jung KY. Altered Network Characteristics of Spike-Wave Discharges in Juvenile Myoclonic Epilepsy. Clin EEG Neurosci 2017; 48:111-117. [PMID: 26697882 DOI: 10.1177/1550059415621831] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Epilepsy is a disease marked by hypersynchronous bursts of neuronal activity; therefore, identifying the network characteristics of the epileptic brain is important. Juvenile myoclonic epilepsy (JME) represents a common, idiopathic generalized epileptic syndrome, characterized by spike-and-wave discharge (SWD) electroencephalographic (EEG) waveforms. We compare herein the network properties of periods of SWD and baseline activity using graph theory. EEG data were obtained from 11 patients with JME. Functional cortical networks during SWD and baseline periods were estimated by calculating the coherence between all possible electrode pairs in the delta, theta, alpha, beta and gamma bands. Graph theoretical measures, including nodal degree, characteristic path length, clustering coefficient, and small-world index were then used to evaluate the characteristics of epileptic networks in JME. We also assessed short- and long-range connections between SWD and baseline networks. Compared to baseline, increased coherence was observed during SWD in all frequency bands. The nodal degree of the SWD network, particularly in the frontal region, was significantly higher compared to the baseline network. The clustering coefficient and small-world index were significantly lower in the theta and beta bands of the SWD versus baseline network, but the characteristic path length did not differ among networks. Long-range connections were increased during SWD, particularly between frontal and posterior brain regions. Our study suggests that SWD in JME is associated with increased local (particularly in frontal region) connectivity. Furthermore, the SWD network was associated with increased long-range connections, and reduced small-worldness, which may impair information processing during SWD.
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Affiliation(s)
- Chany Lee
- 1 Department of Biomedical Engineering, Hanyang University, Seoul, Korea
| | - Chang-Hwan Im
- 1 Department of Biomedical Engineering, Hanyang University, Seoul, Korea
| | - Yong Seo Koo
- 2 Department of Neurology, Korea University Medical Center, Korea University College of Medicine, Seoul, Korea
| | - Jung-Ah Lim
- 3 Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Tae-Joon Kim
- 3 Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Jung-Ick Byun
- 3 Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Jun-Sang Sunwoo
- 3 Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Jangsup Moon
- 3 Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Dong Wook Kim
- 4 Department of Neurology, Konkuk University School of Medicine, Seoul, Korea
| | - Soon-Tae Lee
- 3 Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Keun-Hwa Jung
- 3 Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Kon Chu
- 3 Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Sang-Kun Lee
- 3 Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Ki-Young Jung
- 3 Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.,5 Department of Neurology, Seoul National University Hospital, Neuroscience Research Institute, Seoul National University College of Medicine, Seoul, Korea
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30
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Kim TJ, Lee ST, Moon J, Sunwoo JS, Byun JI, Lim JA, Shin YW, Jun JS, Lee HS, Lee WJ, Yang AR, Choi Y, Park KI, Jung KH, Jung KY, Kim M, Lee SK, Chu K. Anti-LGI1 encephalitis is associated with unique HLA subtypes. Ann Neurol 2017; 81:183-192. [DOI: 10.1002/ana.24860] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 11/21/2016] [Accepted: 11/22/2016] [Indexed: 12/17/2022]
Affiliation(s)
- Tae-Joon Kim
- Department of Neurology; Seoul National University Hospital; Seoul South Korea
| | - Soon-Tae Lee
- Department of Neurology; Seoul National University Hospital; Seoul South Korea
| | - Jangsup Moon
- Department of Neurology; Seoul National University Hospital; Seoul South Korea
| | - Jun-Sang Sunwoo
- Department of Neurology; Soonchunhyang University Seoul Hospital; Seoul South Korea
| | - Jung-Ick Byun
- Department of Neurology; Kyung Hee University Hospital at Gangdong; Seoul South Korea
| | - Jung-Ah Lim
- Department of Neurology; Seoul National University Hospital; Seoul South Korea
| | - Yong-Won Shin
- Department of Neurology; Seoul National University Hospital; Seoul South Korea
| | - Jin-Sun Jun
- Department of Neurology; Seoul National University Hospital; Seoul South Korea
| | - Han Sang Lee
- Department of Neurology; Seoul National University Hospital; Seoul South Korea
| | - Woo-Jin Lee
- Department of Neurology; Seoul National University Hospital; Seoul South Korea
| | - Ah Reaum Yang
- Department of Neurology; Seoul National University Hospital; Seoul South Korea
| | - Yunhee Choi
- Medical Research Collaborating Center; Seoul National University Hospital; Seoul South Korea
| | - Kyung-Il Park
- Department of Neurology; Seoul National University Hospital Healthcare System Gangnam Center; Seoul South Korea
| | - Keun-Hwa Jung
- Department of Neurology; Seoul National University Hospital; Seoul South Korea
| | - Ki-Young Jung
- Department of Neurology; Seoul National University Hospital; Seoul South Korea
| | - Manho Kim
- Department of Neurology; Seoul National University Hospital; Seoul South Korea
- Protein Metabolism Medical Research Center; Seoul National University College of Medicine; Seoul South Korea
| | - Sang Kun Lee
- Department of Neurology; Seoul National University Hospital; Seoul South Korea
| | - Kon Chu
- Department of Neurology; Seoul National University Hospital; Seoul South Korea
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Lee WJ, Lee ST, Moon J, Sunwoo JS, Byun JI, Lim JA, Kim TJ, Shin YW, Lee KJ, Jun JS, Lee HS, Kim S, Park KI, Jung KH, Jung KY, Kim M, Lee SK, Chu K. Tocilizumab in Autoimmune Encephalitis Refractory to Rituximab: An Institutional Cohort Study. Neurotherapeutics 2016; 13:824-832. [PMID: 27215218 PMCID: PMC5081109 DOI: 10.1007/s13311-016-0442-6] [Citation(s) in RCA: 154] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
A considerable portion of autoimmune encephalitis (AE) does not respond to conventional immunotherapies and subsequently has poor outcomes. We aimed to determine the efficacy of tocilizumab, an anti-interleukin-6 antibody, in rituximab-refractory AE compared with other treatment options. From an institutional cohort of AE, 91 patients with inadequate clinical response to first-line immunotherapy and following rituximab were retrospectively reviewed. Patients were grouped according to their further immunotherapy strategies. Thirty (33.0 %) patients were included in the tocilizumab group, 31 (34.0 %) in the additional rituximab group, and 30 (33.0 %) in the observation group. Outcomes were defined as the favorable modified Rankin Scale scores (≤2) at 1 and 2 months from the initiation of each treatment strategy and at the last follow-up. Favorable clinical response (improvement of the modified Rankin Scale scores by ≥ 2 points or achievement of the mRS scores ≤ 2) at the last follow-up was also analyzed. The tocilizumab group showed more frequent favorable mRS scores at 2 months from treatment initiation and at the last follow-up compared with those at the relevant time points of the remaining groups. The majority (89.5 %) of the patients with clinical improvement at 1 month from tocilizumab treatment maintained a long-term favorable clinical response. No serious adverse effects of rituximab or tocilizumab were reported. Therefore, we suggest that tocilizumab might be a good treatment strategy for treating AE refractory to conventional immunotherapies and rituximab. The tocilizumab-mediated clinical improvement manifests as early at 1 month after treatment initiation.
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Affiliation(s)
- Woo-Jin Lee
- Department of Neurology, Comprehensive Epilepsy Center, Laboratory for Neurotherapeutics, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
- Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University, Seoul, South Korea
| | - Soon-Tae Lee
- Department of Neurology, Comprehensive Epilepsy Center, Laboratory for Neurotherapeutics, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
- Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University, Seoul, South Korea
| | - Jangsup Moon
- Department of Neurology, Comprehensive Epilepsy Center, Laboratory for Neurotherapeutics, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
- Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University, Seoul, South Korea
| | - Jun-Sang Sunwoo
- Department of Neurology, Comprehensive Epilepsy Center, Laboratory for Neurotherapeutics, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
- Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University, Seoul, South Korea
| | - Jung-Ick Byun
- Department of Neurology, Comprehensive Epilepsy Center, Laboratory for Neurotherapeutics, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
- Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University, Seoul, South Korea
| | - Jung-Ah Lim
- Department of Neurology, Comprehensive Epilepsy Center, Laboratory for Neurotherapeutics, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
- Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University, Seoul, South Korea
| | - Tae-Joon Kim
- Department of Neurology, Comprehensive Epilepsy Center, Laboratory for Neurotherapeutics, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
- Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University, Seoul, South Korea
| | - Yong-Won Shin
- Department of Neurology, Comprehensive Epilepsy Center, Laboratory for Neurotherapeutics, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
- Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University, Seoul, South Korea
| | - Keon-Joo Lee
- Department of Neurology, Comprehensive Epilepsy Center, Laboratory for Neurotherapeutics, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
- Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University, Seoul, South Korea
| | - Jin-Sun Jun
- Department of Neurology, Comprehensive Epilepsy Center, Laboratory for Neurotherapeutics, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
- Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University, Seoul, South Korea
| | - Han Sang Lee
- Department of Neurology, Comprehensive Epilepsy Center, Laboratory for Neurotherapeutics, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
- Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University, Seoul, South Korea
| | - Soyun Kim
- Department of Neurology, Comprehensive Epilepsy Center, Laboratory for Neurotherapeutics, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Kyung-Il Park
- Department of Neurology, Comprehensive Epilepsy Center, Laboratory for Neurotherapeutics, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
- Department of Neurology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, South Korea
| | - Keun-Hwa Jung
- Department of Neurology, Comprehensive Epilepsy Center, Laboratory for Neurotherapeutics, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
- Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University, Seoul, South Korea
| | - Ki-Young Jung
- Department of Neurology, Comprehensive Epilepsy Center, Laboratory for Neurotherapeutics, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
- Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University, Seoul, South Korea
| | - Manho Kim
- Department of Neurology, Comprehensive Epilepsy Center, Laboratory for Neurotherapeutics, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
- Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University, Seoul, South Korea
| | - Sang Kun Lee
- Department of Neurology, Comprehensive Epilepsy Center, Laboratory for Neurotherapeutics, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea.
- Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University, Seoul, South Korea.
| | - Kon Chu
- Department of Neurology, Comprehensive Epilepsy Center, Laboratory for Neurotherapeutics, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea.
- Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University, Seoul, South Korea.
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Moon J, Kim TJ, Lim JA, Sunwoo JS, Byun JI, Lee ST, Jung KH, Park KI, Jung KY, Jeon D, Yu KS, Jang IJ, Chu K, Lee SK. HLA-B*40:02 and DRB1*04:03 are risk factors for oxcarbazepine-induced maculopapular eruption. Epilepsia 2016; 57:1879-1886. [PMID: 27666425 DOI: 10.1111/epi.13566] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Oxcarbazepine (OXC) is a widely used antiepileptic drug for the treatment of partial seizures that was developed through structural variation of carbamazepine. Although OXC has a lower risk of cutaneous adverse drug reactions (cADRs) than carbamazepine, cADRs ranging from maculopapular eruption (MPE) to the more severe Stevens-Johnson syndrome and toxic epidermal necrolysis still limit the use of OXC in some patients. A few human leukocyte antigen (HLA)-related genetic risk factors for carbamazepine-induced cADRs have been identified. However, the HLA-related genetic risk factors associated with OXC-induced cADRs are unknown. METHODS A total of 40 patients who experienced OXC-induced MPE and 70 patients who were tolerant to OXC treatment were included in the study. Genomic DNA was extracted from the peripheral blood of these patients, and high-resolution HLA genotyping was performed. RESULTS The HLA-B*40:02 and HLA-DRB1*04:03 alleles were significantly associated with OXC-induced MPE compared with the OXC-tolerant group (odds ratio [OR] 4.33, p = 0.018 and OR 14.64, p = 0.003, respectively) and the general Korean population (OR 4.04, p = 0.001 and OR 3.11, p = 0.019, respectively). The HLA-B*15:01 genetic frequency was significantly lower in the OXC-MPE group compared to the OXC-tolerant group (OR 0.18, p = 0.016) and the Korean population (OR 0.22, p = 0.030). The allele frequencies of well-known HLA-related risk factors for carbamazepine-induced cADRs (HLA-B*15:02, A*31:01 and B*15:11) were not different among the three groups. SIGNIFICANCE This study is the first to demonstrate an association of HLA-B*40:02 and HLA-DRB1*04:03 with OXC hypersensitivity using a large cohort of patients with OXC-induced MPE. These findings should be confirmed in future studies in different ethnic groups.
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Affiliation(s)
- Jangsup Moon
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.,Program in Neuroscience, Seoul National University College of Medicine, Seoul, Korea
| | - Tae-Joon Kim
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.,Program in Neuroscience, Seoul National University College of Medicine, Seoul, Korea
| | - Jung-Ah Lim
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.,Program in Neuroscience, Seoul National University College of Medicine, Seoul, Korea
| | - Jun-Sang Sunwoo
- Department of Neurology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Jung-Ick Byun
- Department of Neurology, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Soon-Tae Lee
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.,Program in Neuroscience, Seoul National University College of Medicine, Seoul, Korea
| | - Keun-Hwa Jung
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.,Program in Neuroscience, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung-Il Park
- Department of Neurology, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Ki-Young Jung
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.,Program in Neuroscience, Seoul National University College of Medicine, Seoul, Korea
| | - Daejong Jeon
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.,Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, Korea
| | | | | | - Kon Chu
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.,Program in Neuroscience, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Kun Lee
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.,Program in Neuroscience, Seoul National University College of Medicine, Seoul, Korea
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Lim JA, Lee ST, Moon J, Jun JS, Park BS, Byun JI, Sunwoo JS, Park KI, Jung KH, Jung KY, Lee SK, Chu K. New feasible treatment for refractory autoimmune encephalitis: Low-dose interleukin-2. J Neuroimmunol 2016; 299:107-111. [PMID: 27725107 DOI: 10.1016/j.jneuroim.2016.09.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 08/29/2016] [Accepted: 09/02/2016] [Indexed: 12/20/2022]
Abstract
Low-dose interleukin-2 (IL-2) restores the balance of regulatory and effector T cells. We aimed to determine the feasibility of low-dose IL-2 as a treatment for refractory autoimmune encephalitis (AE). Ten patients who had received low-dose IL-2 were retrospectively identified. We observed an improvement in the modified Rankin Scale scores of six patients at the last follow-up compared with the scores at the initiation of low-dose IL-2 (p=0.014). One patient experienced treatment-related grade 3 neutropenia. Overall, low-dose IL-2 is a feasible and relatively safe treatment for AE patients who are refractory to the first- and second-line immunotherapies.
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Affiliation(s)
- Jung-Ah Lim
- Department of Neurology, Comprehensive Epilepsy Center, Laboratory for Neurotherapeutics, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Soon-Tae Lee
- Department of Neurology, Comprehensive Epilepsy Center, Laboratory for Neurotherapeutics, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Jangsup Moon
- Department of Neurology, Comprehensive Epilepsy Center, Laboratory for Neurotherapeutics, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Jin-Sun Jun
- Department of Neurology, Comprehensive Epilepsy Center, Laboratory for Neurotherapeutics, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Byeong-Su Park
- Department of Neurology, Comprehensive Epilepsy Center, Laboratory for Neurotherapeutics, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Jung-Ick Byun
- Department of Neurology, Comprehensive Epilepsy Center, Laboratory for Neurotherapeutics, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea; Department of Neurology, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
| | - Jun-Sang Sunwoo
- Department of Neurology, Comprehensive Epilepsy Center, Laboratory for Neurotherapeutics, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea; Department of Neurology, Soonchunhyang University School of Medicine, Seoul, South Korea
| | - Kyung-Il Park
- Department of Neurology, Comprehensive Epilepsy Center, Laboratory for Neurotherapeutics, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea; Department of Neurology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, South Korea
| | - Keun-Hwa Jung
- Department of Neurology, Comprehensive Epilepsy Center, Laboratory for Neurotherapeutics, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Ki-Young Jung
- Department of Neurology, Comprehensive Epilepsy Center, Laboratory for Neurotherapeutics, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Sang Kun Lee
- Department of Neurology, Comprehensive Epilepsy Center, Laboratory for Neurotherapeutics, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Kon Chu
- Department of Neurology, Comprehensive Epilepsy Center, Laboratory for Neurotherapeutics, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea.
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Lim JA, Lee ST, Kim TJ, Moon J, Sunwoo JS, Byun JI, Jung KH, Jung KY, Chu K, Lee SK. Frequent rhabdomyolysis in anti-NMDA receptor encephalitis. J Neuroimmunol 2016; 298:178-80. [PMID: 27609293 DOI: 10.1016/j.jneuroim.2016.08.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 07/26/2016] [Accepted: 08/01/2016] [Indexed: 01/18/2023]
Abstract
The aim of this study was to analyze the clinical presentation and provocation factors of rhabdomyolysis in anti-NMDAR encephalitis. Among the 16 patients with anti-NMDAR encephalitis in our institutional cohort, nine patients had elevated CK enzyme levels and clinical evidence of rhabdomyolysis. Rhabdomyolysis was more frequent after immunotherapy. The use of dopamine receptor blocker (DRB) increased the risk of rhabdomyolysis. None of the patients without rhabdomyolysis received DRBs. Rhabdomyolysis is a frequent complication in anti-NMDAR encephalitis and more common after immunotherapy and the use of DRBs increases the risk. Therefore, DRBs should be administered carefully in patients with anti-NMDAR encephalitis.
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Affiliation(s)
- Jung-Ah Lim
- Department of Neurology, Biomedical Research Institute, Seoul National University Hospital, College of Medicine, Seoul National University, Seoul, South Korea
| | - Soon-Tae Lee
- Department of Neurology, Biomedical Research Institute, Seoul National University Hospital, College of Medicine, Seoul National University, Seoul, South Korea
| | - Tae-Joon Kim
- Department of Neurology, Biomedical Research Institute, Seoul National University Hospital, College of Medicine, Seoul National University, Seoul, South Korea
| | - Jangsup Moon
- Department of Neurology, Biomedical Research Institute, Seoul National University Hospital, College of Medicine, Seoul National University, Seoul, South Korea
| | - Jun-Sang Sunwoo
- Department of Neurology, Biomedical Research Institute, Seoul National University Hospital, College of Medicine, Seoul National University, Seoul, South Korea; Department of Neurology, Soonchunhyang University School of Medicine, Seoul, South Korea
| | - Jung-Ick Byun
- Department of Neurology, Biomedical Research Institute, Seoul National University Hospital, College of Medicine, Seoul National University, Seoul, South Korea; Department of Neurology, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
| | - Keun-Hwa Jung
- Department of Neurology, Biomedical Research Institute, Seoul National University Hospital, College of Medicine, Seoul National University, Seoul, South Korea
| | - Ki-Young Jung
- Department of Neurology, Biomedical Research Institute, Seoul National University Hospital, College of Medicine, Seoul National University, Seoul, South Korea
| | - Kon Chu
- Department of Neurology, Biomedical Research Institute, Seoul National University Hospital, College of Medicine, Seoul National University, Seoul, South Korea.
| | - Sang Kun Lee
- Department of Neurology, Biomedical Research Institute, Seoul National University Hospital, College of Medicine, Seoul National University, Seoul, South Korea.
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Byun JI, Lee ST, Moon J, Jung KH, Sunwoo JS, Lim JA, Kim TJ, Shin YW, Lee KJ, Jun JS, Lee HS, Lee WJ, Kim YS, Kim S, Jeon D, Park KI, Jung KY, Kim M, Chu K, Lee SK. Distinct intrathecal interleukin-17/interleukin-6 activation in anti-N-methyl-d-aspartate receptor encephalitis. J Neuroimmunol 2016; 297:141-7. [DOI: 10.1016/j.jneuroim.2016.05.023] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 05/28/2016] [Accepted: 05/31/2016] [Indexed: 12/12/2022]
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Lee WJ, Lee ST, Byun JI, Sunwoo JS, Kim TJ, Lim JA, Moon J, Lee HS, Shin YW, Lee KJ, Kim S, Jung KH, Jung KY, Chu K, Lee SK. Rituximab treatment for autoimmune limbic encephalitis in an institutional cohort. Neurology 2016; 86:1683-91. [PMID: 27037228 DOI: 10.1212/wnl.0000000000002635] [Citation(s) in RCA: 122] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 01/04/2016] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE To determine efficacy and safety of rituximab treatment as a second-line immunotherapy treatment for autoimmune limbic encephalitis (ALE) and to determine factors associated with functional improvement and favorable outcome following rituximab treatment. METHODS We recruited 80 patients with ALE who were treated with rituximab as a second-line immunotherapy from the Korea Autoimmune Synaptic and Paraneoplastic Encephalitis Registry and reviewed 81 patients without rituximab as a control. We grouped patients according to the detection or type of antibodies; in addition, we evaluated clinical, laboratory, first-line immunotherapy, and rituximab treatment profiles and defined main outcomes as improvements on the modified Rankin Scale (mRS) score and a favorable mRS score (0-2) at the last follow-up. RESULTS Functional improvement occurred more frequently in the rituximab group compared to the control group. In the rituximab group, 30 (37.5%) patients had synaptic autoantibodies, 15 (18.8%) in the paraneoplastic autoantibodies, and 35 (43.8%) were antibody-negative. The effect of rituximab was the same regardless of autoantibody status. Additional monthly rituximab therapy and partial response to first-line immunotherapies were associated with mRS score improvements, as well as favorable mRS scores. mRS scores of 4-6 as the worst neurologic status predicted an unfavorable mRS score. There were no reported serious infusion-related or infectious adverse effects of rituximab. CONCLUSIONS Rituximab is effective and safe as a second-line immunotherapy for ALE, regardless of autoantibody status. Additional monthly rituximab therapy might potentiate the efficacy of rituximab. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence that rituximab improves mRS scores for patients with autoimmune limbic encephalitis who fail first-line therapy.
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Affiliation(s)
- Woo-Jin Lee
- From the Department of Neurology (W.-J.L., S.-T.L., J.-I.B., J.-S.S., T.-J.K., J.-A.L., J.M., H.S.L., Y.-W.S., K.-J.L., S.K., K.-H.J., K.-Y.J., K.C., S.K.L.), Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital; and Program in Neuroscience (S.-T.L., J.-I.B., J.-S.S., T.-J.K., J.-A.L., J.M., H.S.L., Y.-W.S., K.-J.L., K.-H.J., K.-Y.J., K.C., S.K.L.), Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University; Department of Neurology (J.-I.B.), Kyung Hee University Hospital at Gangdong; Soonchunhyang University School of Medicine (J.-S.S.), Seoul, South Korea
| | - Soon-Tae Lee
- From the Department of Neurology (W.-J.L., S.-T.L., J.-I.B., J.-S.S., T.-J.K., J.-A.L., J.M., H.S.L., Y.-W.S., K.-J.L., S.K., K.-H.J., K.-Y.J., K.C., S.K.L.), Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital; and Program in Neuroscience (S.-T.L., J.-I.B., J.-S.S., T.-J.K., J.-A.L., J.M., H.S.L., Y.-W.S., K.-J.L., K.-H.J., K.-Y.J., K.C., S.K.L.), Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University; Department of Neurology (J.-I.B.), Kyung Hee University Hospital at Gangdong; Soonchunhyang University School of Medicine (J.-S.S.), Seoul, South Korea
| | - Jung-Ick Byun
- From the Department of Neurology (W.-J.L., S.-T.L., J.-I.B., J.-S.S., T.-J.K., J.-A.L., J.M., H.S.L., Y.-W.S., K.-J.L., S.K., K.-H.J., K.-Y.J., K.C., S.K.L.), Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital; and Program in Neuroscience (S.-T.L., J.-I.B., J.-S.S., T.-J.K., J.-A.L., J.M., H.S.L., Y.-W.S., K.-J.L., K.-H.J., K.-Y.J., K.C., S.K.L.), Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University; Department of Neurology (J.-I.B.), Kyung Hee University Hospital at Gangdong; Soonchunhyang University School of Medicine (J.-S.S.), Seoul, South Korea
| | - Jun-Sang Sunwoo
- From the Department of Neurology (W.-J.L., S.-T.L., J.-I.B., J.-S.S., T.-J.K., J.-A.L., J.M., H.S.L., Y.-W.S., K.-J.L., S.K., K.-H.J., K.-Y.J., K.C., S.K.L.), Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital; and Program in Neuroscience (S.-T.L., J.-I.B., J.-S.S., T.-J.K., J.-A.L., J.M., H.S.L., Y.-W.S., K.-J.L., K.-H.J., K.-Y.J., K.C., S.K.L.), Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University; Department of Neurology (J.-I.B.), Kyung Hee University Hospital at Gangdong; Soonchunhyang University School of Medicine (J.-S.S.), Seoul, South Korea
| | - Tae-Joon Kim
- From the Department of Neurology (W.-J.L., S.-T.L., J.-I.B., J.-S.S., T.-J.K., J.-A.L., J.M., H.S.L., Y.-W.S., K.-J.L., S.K., K.-H.J., K.-Y.J., K.C., S.K.L.), Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital; and Program in Neuroscience (S.-T.L., J.-I.B., J.-S.S., T.-J.K., J.-A.L., J.M., H.S.L., Y.-W.S., K.-J.L., K.-H.J., K.-Y.J., K.C., S.K.L.), Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University; Department of Neurology (J.-I.B.), Kyung Hee University Hospital at Gangdong; Soonchunhyang University School of Medicine (J.-S.S.), Seoul, South Korea
| | - Jung-Ah Lim
- From the Department of Neurology (W.-J.L., S.-T.L., J.-I.B., J.-S.S., T.-J.K., J.-A.L., J.M., H.S.L., Y.-W.S., K.-J.L., S.K., K.-H.J., K.-Y.J., K.C., S.K.L.), Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital; and Program in Neuroscience (S.-T.L., J.-I.B., J.-S.S., T.-J.K., J.-A.L., J.M., H.S.L., Y.-W.S., K.-J.L., K.-H.J., K.-Y.J., K.C., S.K.L.), Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University; Department of Neurology (J.-I.B.), Kyung Hee University Hospital at Gangdong; Soonchunhyang University School of Medicine (J.-S.S.), Seoul, South Korea
| | - Jangsup Moon
- From the Department of Neurology (W.-J.L., S.-T.L., J.-I.B., J.-S.S., T.-J.K., J.-A.L., J.M., H.S.L., Y.-W.S., K.-J.L., S.K., K.-H.J., K.-Y.J., K.C., S.K.L.), Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital; and Program in Neuroscience (S.-T.L., J.-I.B., J.-S.S., T.-J.K., J.-A.L., J.M., H.S.L., Y.-W.S., K.-J.L., K.-H.J., K.-Y.J., K.C., S.K.L.), Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University; Department of Neurology (J.-I.B.), Kyung Hee University Hospital at Gangdong; Soonchunhyang University School of Medicine (J.-S.S.), Seoul, South Korea
| | - Han Sang Lee
- From the Department of Neurology (W.-J.L., S.-T.L., J.-I.B., J.-S.S., T.-J.K., J.-A.L., J.M., H.S.L., Y.-W.S., K.-J.L., S.K., K.-H.J., K.-Y.J., K.C., S.K.L.), Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital; and Program in Neuroscience (S.-T.L., J.-I.B., J.-S.S., T.-J.K., J.-A.L., J.M., H.S.L., Y.-W.S., K.-J.L., K.-H.J., K.-Y.J., K.C., S.K.L.), Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University; Department of Neurology (J.-I.B.), Kyung Hee University Hospital at Gangdong; Soonchunhyang University School of Medicine (J.-S.S.), Seoul, South Korea
| | - Yong-Won Shin
- From the Department of Neurology (W.-J.L., S.-T.L., J.-I.B., J.-S.S., T.-J.K., J.-A.L., J.M., H.S.L., Y.-W.S., K.-J.L., S.K., K.-H.J., K.-Y.J., K.C., S.K.L.), Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital; and Program in Neuroscience (S.-T.L., J.-I.B., J.-S.S., T.-J.K., J.-A.L., J.M., H.S.L., Y.-W.S., K.-J.L., K.-H.J., K.-Y.J., K.C., S.K.L.), Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University; Department of Neurology (J.-I.B.), Kyung Hee University Hospital at Gangdong; Soonchunhyang University School of Medicine (J.-S.S.), Seoul, South Korea
| | - Keon-Joo Lee
- From the Department of Neurology (W.-J.L., S.-T.L., J.-I.B., J.-S.S., T.-J.K., J.-A.L., J.M., H.S.L., Y.-W.S., K.-J.L., S.K., K.-H.J., K.-Y.J., K.C., S.K.L.), Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital; and Program in Neuroscience (S.-T.L., J.-I.B., J.-S.S., T.-J.K., J.-A.L., J.M., H.S.L., Y.-W.S., K.-J.L., K.-H.J., K.-Y.J., K.C., S.K.L.), Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University; Department of Neurology (J.-I.B.), Kyung Hee University Hospital at Gangdong; Soonchunhyang University School of Medicine (J.-S.S.), Seoul, South Korea
| | - Soyun Kim
- From the Department of Neurology (W.-J.L., S.-T.L., J.-I.B., J.-S.S., T.-J.K., J.-A.L., J.M., H.S.L., Y.-W.S., K.-J.L., S.K., K.-H.J., K.-Y.J., K.C., S.K.L.), Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital; and Program in Neuroscience (S.-T.L., J.-I.B., J.-S.S., T.-J.K., J.-A.L., J.M., H.S.L., Y.-W.S., K.-J.L., K.-H.J., K.-Y.J., K.C., S.K.L.), Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University; Department of Neurology (J.-I.B.), Kyung Hee University Hospital at Gangdong; Soonchunhyang University School of Medicine (J.-S.S.), Seoul, South Korea
| | - Keun-Hwa Jung
- From the Department of Neurology (W.-J.L., S.-T.L., J.-I.B., J.-S.S., T.-J.K., J.-A.L., J.M., H.S.L., Y.-W.S., K.-J.L., S.K., K.-H.J., K.-Y.J., K.C., S.K.L.), Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital; and Program in Neuroscience (S.-T.L., J.-I.B., J.-S.S., T.-J.K., J.-A.L., J.M., H.S.L., Y.-W.S., K.-J.L., K.-H.J., K.-Y.J., K.C., S.K.L.), Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University; Department of Neurology (J.-I.B.), Kyung Hee University Hospital at Gangdong; Soonchunhyang University School of Medicine (J.-S.S.), Seoul, South Korea
| | - Ki-Young Jung
- From the Department of Neurology (W.-J.L., S.-T.L., J.-I.B., J.-S.S., T.-J.K., J.-A.L., J.M., H.S.L., Y.-W.S., K.-J.L., S.K., K.-H.J., K.-Y.J., K.C., S.K.L.), Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital; and Program in Neuroscience (S.-T.L., J.-I.B., J.-S.S., T.-J.K., J.-A.L., J.M., H.S.L., Y.-W.S., K.-J.L., K.-H.J., K.-Y.J., K.C., S.K.L.), Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University; Department of Neurology (J.-I.B.), Kyung Hee University Hospital at Gangdong; Soonchunhyang University School of Medicine (J.-S.S.), Seoul, South Korea
| | - Kon Chu
- From the Department of Neurology (W.-J.L., S.-T.L., J.-I.B., J.-S.S., T.-J.K., J.-A.L., J.M., H.S.L., Y.-W.S., K.-J.L., S.K., K.-H.J., K.-Y.J., K.C., S.K.L.), Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital; and Program in Neuroscience (S.-T.L., J.-I.B., J.-S.S., T.-J.K., J.-A.L., J.M., H.S.L., Y.-W.S., K.-J.L., K.-H.J., K.-Y.J., K.C., S.K.L.), Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University; Department of Neurology (J.-I.B.), Kyung Hee University Hospital at Gangdong; Soonchunhyang University School of Medicine (J.-S.S.), Seoul, South Korea.
| | - Sang Kun Lee
- From the Department of Neurology (W.-J.L., S.-T.L., J.-I.B., J.-S.S., T.-J.K., J.-A.L., J.M., H.S.L., Y.-W.S., K.-J.L., S.K., K.-H.J., K.-Y.J., K.C., S.K.L.), Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital; and Program in Neuroscience (S.-T.L., J.-I.B., J.-S.S., T.-J.K., J.-A.L., J.M., H.S.L., Y.-W.S., K.-J.L., K.-H.J., K.-Y.J., K.C., S.K.L.), Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University; Department of Neurology (J.-I.B.), Kyung Hee University Hospital at Gangdong; Soonchunhyang University School of Medicine (J.-S.S.), Seoul, South Korea.
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Byun JI, Lee ST, Jung KH, Sunwoo JS, Moon J, Kim TJ, Lim JA, Kim S, Kim DY, Han SH, Jang H, Suh HI, Cho AH, Kim DW, Shin JW, Koo YS, Choi WC, Lee WW, Choi N, Kim S, Nam H, Koo DL, Kim M, Lim BC, Chae JH, Kim KJ, Jeon D, Park KI, Jung KY, Kim M, Chu K, Lee SK. Prevalence of antineuronal antibodies in patients with encephalopathy of unknown etiology: Data from a nationwide registry in Korea. J Neuroimmunol 2016; 293:34-38. [PMID: 27049559 DOI: 10.1016/j.jneuroim.2016.02.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 02/01/2016] [Accepted: 02/05/2016] [Indexed: 12/31/2022]
Abstract
We aimed to evaluate the prevalence of antineuronal antibodies in a nationwide cohort of patients with encephalopathy of unknown etiology. We screened 1699 patients with idiopathic encephalopathy who were referred from 70 hospitals across Korea for autoimmune synaptic and classic paraneoplastic antibodies. Those with cerebellar degeneration, sensory polyneuropathy or other paraneoplastic syndromes without encephalopathy were not included in this study. One-hundred and four patients (6.12%) had antibody-associated autoimmune encephalopathy. Autoimmune synaptic antibodies were identified in 89 patients (5.24%) and classic paraneoplastic antibodies were identified in 16 patients (0.94%). The patients with antibody-associated autoimmune encephalopathy comprised a small but significant portion of the total number of patients with encephalopathy of unknown cause.
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Affiliation(s)
- Jung-Ick Byun
- Department of Neurology, Laboratory of Neurotherapeutics, Seoul National University Hospital, Seoul, South Korea; Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| | - Soon-Tae Lee
- Department of Neurology, Laboratory of Neurotherapeutics, Seoul National University Hospital, Seoul, South Korea; Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| | - Keun-Hwa Jung
- Department of Neurology, Laboratory of Neurotherapeutics, Seoul National University Hospital, Seoul, South Korea; Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| | - Jun-Sang Sunwoo
- Department of Neurology, Laboratory of Neurotherapeutics, Seoul National University Hospital, Seoul, South Korea; Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| | - Jangsup Moon
- Department of Neurology, Laboratory of Neurotherapeutics, Seoul National University Hospital, Seoul, South Korea; Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea; Departments of Neurology, Ewha Womans University School of Medicine and Ewha Medical Research Institute, Seoul, South Korea
| | - Tae-Joon Kim
- Department of Neurology, Laboratory of Neurotherapeutics, Seoul National University Hospital, Seoul, South Korea; Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| | - Jung-Ah Lim
- Department of Neurology, Laboratory of Neurotherapeutics, Seoul National University Hospital, Seoul, South Korea; Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| | - Soyun Kim
- Department of Neurology, Laboratory of Neurotherapeutics, Seoul National University Hospital, Seoul, South Korea
| | - Do-Yong Kim
- Department of Neurology, Laboratory of Neurotherapeutics, Seoul National University Hospital, Seoul, South Korea
| | - Su-Hyun Han
- Department of Neurology, Asan Medical Center, Seoul, South Korea
| | - Hyemin Jang
- Department of Neurology, Samsung Medical Center, Seoul, South Korea
| | - Hong Il Suh
- Department of Neurology, Ajou University Medical Center, Suwon, South Korea
| | - A-Hyun Cho
- Department of Neurology, Catholic University of Korea Yeouido St. Mary's Hospital, Seoul, South Korea
| | - Dong Wook Kim
- Department of Neurology, Konkuk University, Seoul, South Korea
| | - Jung-Won Shin
- Department of Neurology, CHA University, CHA Bundang Medical Center, Seongnam, South Korea
| | - Yong Seo Koo
- Department of Neurology, Korea University Anam Hospital, Seoul, South Korea
| | - Woo Chan Choi
- Kyungpook National University School of Medicine, Daegu, South Korea
| | - Woong-Woo Lee
- Department of Neurology, Eulji General Hospital, Seoul, South Korea
| | - Nari Choi
- Department of Neurology, Soonchun Hyang University Hospital Cheonan, Cheonan, South Korea
| | - Seongheon Kim
- Department of Neurology, Kangwon National University Hospital, Chuncheon, South Korea
| | - Hyunwoo Nam
- Department of Neurology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Dae Lim Koo
- Department of Neurology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Minah Kim
- Department of Psychiatry, Seoul National University Hospital, Seoul, South Korea
| | - Byung Chan Lim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea
| | - Jong-Hee Chae
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea
| | - Ki Joong Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea
| | - Daejong Jeon
- Department of Neurology, Laboratory of Neurotherapeutics, Seoul National University Hospital, Seoul, South Korea
| | - Kyung-Il Park
- Department of Neurology, Laboratory of Neurotherapeutics, Seoul National University Hospital, Seoul, South Korea; Department of Neurology, Seoul National University Hospital Healthcare System Gangnam Center, South Korea
| | - Ki-Young Jung
- Department of Neurology, Laboratory of Neurotherapeutics, Seoul National University Hospital, Seoul, South Korea; Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| | - Manho Kim
- Department of Neurology, Laboratory of Neurotherapeutics, Seoul National University Hospital, Seoul, South Korea; Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea; Protein Metabolism Research Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Kon Chu
- Department of Neurology, Laboratory of Neurotherapeutics, Seoul National University Hospital, Seoul, South Korea; Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea.
| | - Sang Kun Lee
- Department of Neurology, Laboratory of Neurotherapeutics, Seoul National University Hospital, Seoul, South Korea; Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea.
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Moon J, Lee HS, Byun JI, Sunwoo JS, Shin JW, Lim JA, Kim TJ, Shin YW, Lee KJ, Jeon D, Jung KH, Lee ST, Jung KY, Chu K, Lee SK. The complexity of diagnosing postural orthostatic tachycardia syndrome: influence of the diurnal variability. ACTA ACUST UNITED AC 2016; 10:263-70. [PMID: 26857333 DOI: 10.1016/j.jash.2016.01.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 12/28/2015] [Accepted: 01/09/2016] [Indexed: 12/31/2022]
Abstract
We investigated how the diagnosis of postural orthostatic tachycardia syndrome (POTS) would be changed due to diurnal variability in orthostatic tachycardia. The orthostatic vital sign test was administered to each patient twice, in the afternoon of the day of admission and the next morning (n = 113). Forty-six patients were diagnosed with POTS, and the remaining 67 patients were assigned to non-POTS group. Heart rate increments after standing were larger in the morning than in the afternoon in every group (all P < .001). Among the POTS patients, 82.6% fulfilled the diagnostic criteria for POTS in the morning and 52.2% in the afternoon. Most POTS group (65.2%) displayed normal result on single orthostatic vital sign test. Orthostatic intolerance symptoms were provoked in only 45.7% of the POTS patients, more frequently in the morning. In conclusion, diurnal variability in hemodynamic parameters and provoked symptoms significantly challenged the diagnosis of POTS.
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Affiliation(s)
- Jangsup Moon
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea; Program in Neuroscience, Neuroscience Research Institute of Seoul National University Medical Research Council, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Neurology, EwhaWomans University School of Medicine and Ewha Medical Research Institute, Seoul, Republic of Korea
| | - Han Sang Lee
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea; Program in Neuroscience, Neuroscience Research Institute of Seoul National University Medical Research Council, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jung-Ick Byun
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea; Program in Neuroscience, Neuroscience Research Institute of Seoul National University Medical Research Council, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jun-Sang Sunwoo
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea; Program in Neuroscience, Neuroscience Research Institute of Seoul National University Medical Research Council, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jung-Won Shin
- Department of Neurology, CHA Bundang Medical Center, CHA University, Seoungnam, Republic of Korea
| | - Jung-Ah Lim
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea; Program in Neuroscience, Neuroscience Research Institute of Seoul National University Medical Research Council, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Tae-Joon Kim
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea; Program in Neuroscience, Neuroscience Research Institute of Seoul National University Medical Research Council, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yong-Won Shin
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea; Program in Neuroscience, Neuroscience Research Institute of Seoul National University Medical Research Council, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Keon-Joo Lee
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea; Program in Neuroscience, Neuroscience Research Institute of Seoul National University Medical Research Council, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Daejong Jeon
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea; Program in Neuroscience, Neuroscience Research Institute of Seoul National University Medical Research Council, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Keun-Hwa Jung
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea; Program in Neuroscience, Neuroscience Research Institute of Seoul National University Medical Research Council, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Soon-Tae Lee
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea; Program in Neuroscience, Neuroscience Research Institute of Seoul National University Medical Research Council, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ki-Young Jung
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea; Program in Neuroscience, Neuroscience Research Institute of Seoul National University Medical Research Council, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kon Chu
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea; Program in Neuroscience, Neuroscience Research Institute of Seoul National University Medical Research Council, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Sang Kun Lee
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea; Program in Neuroscience, Neuroscience Research Institute of Seoul National University Medical Research Council, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Byun JI, Lee ST, Jung KH, Sunwoo JS, Moon J, Lim JA, Lee DY, Shin YW, Kim TJ, Lee KJ, Lee WJ, Lee HS, Jun J, Kim DY, Kim MY, Kim H, Kim HJ, Suh HI, Lee Y, Kim DW, Jeong JH, Choi WC, Bae DW, Shin JW, Jeon D, Park KI, Jung KY, Chu K, Lee SK. Effect of Immunotherapy on Seizure Outcome in Patients with Autoimmune Encephalitis: A Prospective Observational Registry Study. PLoS One 2016; 11:e0146455. [PMID: 26771547 PMCID: PMC4714908 DOI: 10.1371/journal.pone.0146455] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Accepted: 12/17/2015] [Indexed: 01/03/2023] Open
Abstract
Objective To evaluate the seizure characteristics and outcome after immunotherapy in adult patients with autoimmune encephalitis (AE) and new-onset seizure. Methods Adult (age ≥18 years) patients with AE and new-onset seizure who underwent immunotherapy and were followed-up for at least 6 months were included. Seizure frequency was evaluated at 2–4 weeks and 6 months after the onset of the initial immunotherapy and was categorized as “seizure remission”, “> 50% seizure reduction”, or “no change” based on the degree of its decrease. Results Forty-one AE patients who presented with new-onset seizure were analysed. At 2–4 weeks after the initial immunotherapy, 51.2% of the patients were seizure free, and 24.4% had significant seizure reduction. At 6 months, seizure remission was observed in 73.2% of the patients, although four patients died during hospitalization. Rituximab was used as a second-line immunotherapy in 12 patients who continued to have seizures despite the initial immunotherapy, and additional seizure remission was achieved in 66.6% of them. In particular, those who exhibited partial response to the initial immunotherapy had a better seizure outcome after rituximab, with low adverse events. Conclusion AE frequently presented as seizure, but only 18.9% of the living patients suffered from seizure at 6 months after immunotherapy. Aggressive immunotherapy can improve seizure outcome in patients with AE.
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Affiliation(s)
- Jung-Ick Byun
- Departments of Neurology, Seoul National University Hospital, Seoul, South Korea
- Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| | - Soon-Tae Lee
- Departments of Neurology, Seoul National University Hospital, Seoul, South Korea
- Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| | - Keun-Hwa Jung
- Departments of Neurology, Seoul National University Hospital, Seoul, South Korea
- Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| | - Jun-Sang Sunwoo
- Departments of Neurology, Seoul National University Hospital, Seoul, South Korea
- Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| | - Jangsup Moon
- Department of Neurology, Ewha Womans University School of Medicine and Ewha Medical Research Institute, Seoul, South Korea
| | - Jung-Ah Lim
- Departments of Neurology, Seoul National University Hospital, Seoul, South Korea
- Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| | - Doo Young Lee
- Departments of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Yong-Won Shin
- Departments of Neurology, Seoul National University Hospital, Seoul, South Korea
- Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| | - Tae-Joon Kim
- Departments of Neurology, Seoul National University Hospital, Seoul, South Korea
- Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| | - Keon-Joo Lee
- Departments of Neurology, Seoul National University Hospital, Seoul, South Korea
- Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| | - Woo-Jin Lee
- Departments of Neurology, Seoul National University Hospital, Seoul, South Korea
- Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| | - Han-Sang Lee
- Departments of Neurology, Seoul National University Hospital, Seoul, South Korea
- Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| | - Jinsun Jun
- Departments of Neurology, Seoul National University Hospital, Seoul, South Korea
- Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| | - Dong-Yub Kim
- Departments of Neurology, Samsung Medical Center, Seoul, South Korea
| | - Man-Young Kim
- Departments of Neurology, Chosun University Hospital, Gwangju, South Korea
| | - Hyunjin Kim
- Departments of Neurology, Asan medical center, Seoul, South Korea
| | - Hyeon Jin Kim
- Departments of Neurology, Ewha Woman’s University Hospital, Seoul, South Korea
| | - Hong Il Suh
- Departments of Neurology, Ajou University Medical Center, Suwon, South Korea
| | - Yoojin Lee
- Departments of Neurology, Asan medical center, Seoul, South Korea
| | - Dong Wook Kim
- Departments of Neurology, Konkuk University Medical Center, Seoul, South Korea
| | - Jin Ho Jeong
- Departments of Neurology, Inje University Busan Paik Hospital, Busan, South Korea
| | - Woo Chan Choi
- Departments of Neurology, Kyungpook National University Hospital, Daegu, South Korea
| | - Dae Woong Bae
- Departments of Neurology, St. Mary's Hospital, Seoul, South Korea
| | - Jung-Won Shin
- Departments of Neurology, Cha university, CHA Bundang Medical Center, Seongnam, South Korea
| | - Daejong Jeon
- Departments of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Kyung-Il Park
- Departments of Neurology, Seoul National University Hospital, Seoul, South Korea
- Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| | - Ki-Young Jung
- Departments of Neurology, Seoul National University Hospital, Seoul, South Korea
- Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| | - Kon Chu
- Departments of Neurology, Seoul National University Hospital, Seoul, South Korea
- Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
- * E-mail: (KC); (SKL)
| | - Sang Kun Lee
- Departments of Neurology, Seoul National University Hospital, Seoul, South Korea
- Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
- * E-mail: (KC); (SKL)
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Byun JI, Lee ST, Moon J, Jung KH, Shin JW, Sunwoo JS, Lim JA, Shin YW, Kim TJ, Lee KJ, Park KI, Jung KY, Lee SK, Chu K. Cardiac sympathetic dysfunction in anti-NMDA receptor encephalitis. Auton Neurosci 2015; 193:142-6. [DOI: 10.1016/j.autneu.2015.08.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 05/27/2015] [Accepted: 08/03/2015] [Indexed: 12/19/2022]
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Sunwoo JS, Chu K, Byun JI, Moon J, Lim JA, Kim TJ, Lee ST, Jung KH, Park KI, Jeon D, Jung KY, Kim M, Lee SK. Intrathecal-specific glutamic acid decarboxylase antibodies at low titers in autoimmune neurological disorders. J Neuroimmunol 2015; 290:15-21. [PMID: 26711563 DOI: 10.1016/j.jneuroim.2015.11.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Revised: 11/13/2015] [Accepted: 11/15/2015] [Indexed: 01/07/2023]
Abstract
Autoantibodies to glutamic acid decarboxylase (Gad-Abs) are implicated in various neurological syndromes. The present study aims to identify intrathecal-specific GAD-Abs and to determine clinical manifestations and treatment outcomes. Nineteen patients had GAD-Abs in cerebrospinal fluid but not in paired serum samples. Neurological syndromes included limbic encephalitis, temporal lobe epilepsy, cerebellar ataxia, autonomic dysfunction, and stiff-person syndrome. Immunotherapy had beneficial effects in 57.1% of patients, and the patients with limbic encephalitis responded especially well to immunotherapy. Intrathecal-specific antibodies to GAD at low titers may appear as nonspecific markers of immune activation within the central nervous system rather than pathogenic antibodies causing neuronal dysfunction.
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Affiliation(s)
- Jun-Sang Sunwoo
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea; Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| | - Kon Chu
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea; Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea.
| | - Jung-Ick Byun
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea; Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| | - Jangsup Moon
- Department of Neurology, Ewha Womans University School of Medicine and Ewha Medical Research Institute, Seoul, South Korea
| | - Jung-Ah Lim
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea; Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| | - Tae-Joon Kim
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea; Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| | - Soon-Tae Lee
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea; Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| | - Keun-Hwa Jung
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea; Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| | - Kyung-Il Park
- Department of Neurology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, South Korea
| | - Daejong Jeon
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea; Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| | - Ki-Young Jung
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea; Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| | - Manho Kim
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea; Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea; Protein Metabolism Medical Research Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Sang Kun Lee
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea; Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea.
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Moon J, Park HK, Chu K, Sunwoo JS, Byun JI, Lim JA, Kim TJ, Shin JW, Lee ST, Jung KH, Jung KY, Jeon D, Kim DW, Yu KS, Jang IJ, Kang HR, Park HW, Lee SK. The HLA-A*2402/Cw*0102 haplotype is associated with lamotrigine-induced maculopapular eruption in the Korean population. Epilepsia 2015; 56:e161-7. [PMID: 26282450 DOI: 10.1111/epi.13087] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2015] [Indexed: 11/29/2022]
Abstract
The use of lamotrigine (LTG) can be limited by the occurrence of cutaneous adverse drug reactions (cADRs) that range from maculopapular eruption (MPE) to the more severe Stevens-Johnson syndrome and toxic epidermal necrolysis. A few human leukocyte antigen (HLA)-related genetic risk factors for carbamazepine-induced cADR have been identified. However, the HLA-related genetic risk factors associated with LTG-induced cADR are not yet well known. We performed HLA genotyping in 50 Korean patients with epilepsy, including 21 patients presenting LTG-induced MPE and 29 LTG-tolerant patients. A significant association between the HLA-A*2402 allele and LTG-induced MPE was identified, in comparison with the LTG-tolerant group (odds ratio [OR] 4.09, p = 0.025) and the general Korean population (OR 3.949, p = 0.005). The frequencies of the Cw*0102 or Cw*0702 alleles were significantly higher in the LTG-MPE group than in the Korean population, whereas the frequency of the A*3303 allele was lower. The coexistence of the A*2402 and Cw*0102 alleles was significantly associated with the LTG-MPE group when compared to the LTG-tolerant group (OR 7.88, p = 0.007). In addition, the Cw*0701 allele was more frequent in the LTG-tolerant group than in the Korean population. These findings suggest the presence of HLA-related genetic risk factors for LTG-induced MPE in the Korean population.
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Affiliation(s)
- Jangsup Moon
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.,Program in Neuroscience, Seoul National University College of Medicine, Seoul, Korea
| | - Han-Ki Park
- Department of Internal Medicine, Institute of Allergy and Clinical Immunology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Kon Chu
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.,Program in Neuroscience, Seoul National University College of Medicine, Seoul, Korea
| | - Jun-Sang Sunwoo
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.,Program in Neuroscience, Seoul National University College of Medicine, Seoul, Korea
| | - Jung-Ick Byun
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.,Program in Neuroscience, Seoul National University College of Medicine, Seoul, Korea
| | - Jung-Ah Lim
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.,Program in Neuroscience, Seoul National University College of Medicine, Seoul, Korea
| | - Tae-Joon Kim
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.,Program in Neuroscience, Seoul National University College of Medicine, Seoul, Korea
| | - Jung-Won Shin
- Department of Neurology, CHA Bundang Medical Center, CHA University, Seoungnam, Korea
| | - Soon-Tae Lee
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.,Program in Neuroscience, Seoul National University College of Medicine, Seoul, Korea
| | - Keun-Hwa Jung
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.,Program in Neuroscience, Seoul National University College of Medicine, Seoul, Korea
| | - Ki-Young Jung
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.,Program in Neuroscience, Seoul National University College of Medicine, Seoul, Korea
| | - Daejong Jeon
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.,Program in Neuroscience, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Wook Kim
- Department of Neurology, Konkuk University College of Medicine, Seoul, Korea
| | - Kyung-Sang Yu
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, Korea
| | - In-Jin Jang
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, Korea
| | - Hye-Ryun Kang
- Department of Internal Medicine, Institute of Allergy and Clinical Immunology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Heung-Woo Park
- Department of Internal Medicine, Institute of Allergy and Clinical Immunology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Kun Lee
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.,Program in Neuroscience, Seoul National University College of Medicine, Seoul, Korea
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Lee DY, Moon J, Lee ST, Jung KH, Park DK, Yoo JS, Sunwoo JS, Byun JI, Lim JA, Kim TJ, Jung KY, Kim M, Jeon D, Chu K, Lee SK. Dysregulation of long non-coding RNAs in mouse models of localization-related epilepsy. Biochem Biophys Res Commun 2015; 462:433-40. [PMID: 25976677 DOI: 10.1016/j.bbrc.2015.04.149] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 04/26/2015] [Indexed: 10/23/2022]
Abstract
Genome-wide profiling has revealed that eukaryotic genomes are transcribed into numerous non-coding RNAs. In particular, long non-coding RNAs (lncRNAs) have been implicated in various human diseases due to their biochemical and functional diversity. Epileptic disorders have been characterized by dysregulation of epigenetic regulatory mechanisms, and recent studies have identified several lncRNAs involved in neural development and network function. However, comprehensive profiling of lncRNAs implicated in chronic epilepsy has been lacking. In this study, microarray analysis was performed to obtain the expression profile of lncRNAs dysregulated in pilocarpine and kainate models, two models of temporal lobe epilepsy commonly used for studying epileptic mechanisms. Total of 4622 lncRNAs were analyzed: 384 lncRNAs were significantly dysregulated in pilocarpine model, and 279 lncRNAs were significantly dysregulated in kainate model compared with control mice (≥3.0-fold, p < 0.05). Among these, 54 and 14 lncRNAs, respectively, had adjacent protein-coding genes whose expressions were also significantly dysregulated (≥2.0-fold, p < 0.05). Majority of these pairs of lncRNAs and adjacent genes shared the same direction of dysregulation. For the selected adjacent gene-lncRNA pairs, significant Gene Ontology terms were embryonic appendage morphogenesis and neuron differentiation. This was the first study to comprehensively identify dysregulated lncRNAs in two different models of chronic epilepsy and will likely provide a novel insight into developing lncRNA therapeutics.
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Affiliation(s)
- Doo Young Lee
- Department of Neurology, Laboratory for Neurotherapeutics, Biomedical Research Institute, Comprehensive Epilepsy Center, Seoul National University Hospital, Seoul, South Korea
| | - Jangsup Moon
- Department of Neurology, Laboratory for Neurotherapeutics, Biomedical Research Institute, Comprehensive Epilepsy Center, Seoul National University Hospital, Seoul, South Korea
| | - Soon-Tae Lee
- Department of Neurology, Laboratory for Neurotherapeutics, Biomedical Research Institute, Comprehensive Epilepsy Center, Seoul National University Hospital, Seoul, South Korea; Program in Neuroscience, Neuroscience Research Institute of Seoul National University Medical Research Council, College of Medicine, Seoul National University, Seoul, South Korea
| | - Keun-Hwa Jung
- Department of Neurology, Laboratory for Neurotherapeutics, Biomedical Research Institute, Comprehensive Epilepsy Center, Seoul National University Hospital, Seoul, South Korea; Program in Neuroscience, Neuroscience Research Institute of Seoul National University Medical Research Council, College of Medicine, Seoul National University, Seoul, South Korea
| | - Dong-Kyu Park
- Department of Neurology, Laboratory for Neurotherapeutics, Biomedical Research Institute, Comprehensive Epilepsy Center, Seoul National University Hospital, Seoul, South Korea
| | - Jung-Seok Yoo
- Department of Neurology, Laboratory for Neurotherapeutics, Biomedical Research Institute, Comprehensive Epilepsy Center, Seoul National University Hospital, Seoul, South Korea
| | - Jun-Sang Sunwoo
- Department of Neurology, Laboratory for Neurotherapeutics, Biomedical Research Institute, Comprehensive Epilepsy Center, Seoul National University Hospital, Seoul, South Korea; Program in Neuroscience, Neuroscience Research Institute of Seoul National University Medical Research Council, College of Medicine, Seoul National University, Seoul, South Korea
| | - Jung-Ick Byun
- Department of Neurology, Laboratory for Neurotherapeutics, Biomedical Research Institute, Comprehensive Epilepsy Center, Seoul National University Hospital, Seoul, South Korea; Program in Neuroscience, Neuroscience Research Institute of Seoul National University Medical Research Council, College of Medicine, Seoul National University, Seoul, South Korea
| | - Jung-Ah Lim
- Department of Neurology, Laboratory for Neurotherapeutics, Biomedical Research Institute, Comprehensive Epilepsy Center, Seoul National University Hospital, Seoul, South Korea; Program in Neuroscience, Neuroscience Research Institute of Seoul National University Medical Research Council, College of Medicine, Seoul National University, Seoul, South Korea
| | - Tae-Joon Kim
- Department of Neurology, Laboratory for Neurotherapeutics, Biomedical Research Institute, Comprehensive Epilepsy Center, Seoul National University Hospital, Seoul, South Korea
| | - Ki-Young Jung
- Department of Neurology, Laboratory for Neurotherapeutics, Biomedical Research Institute, Comprehensive Epilepsy Center, Seoul National University Hospital, Seoul, South Korea; Program in Neuroscience, Neuroscience Research Institute of Seoul National University Medical Research Council, College of Medicine, Seoul National University, Seoul, South Korea
| | - Manho Kim
- Department of Neurology, Laboratory for Neurotherapeutics, Biomedical Research Institute, Comprehensive Epilepsy Center, Seoul National University Hospital, Seoul, South Korea; Program in Neuroscience, Neuroscience Research Institute of Seoul National University Medical Research Council, College of Medicine, Seoul National University, Seoul, South Korea; Protein Metabolism Medical Research Center, College of Medicine, Seoul National University, Seoul, South Korea
| | - Daejong Jeon
- Department of Neurology, Laboratory for Neurotherapeutics, Biomedical Research Institute, Comprehensive Epilepsy Center, Seoul National University Hospital, Seoul, South Korea
| | - Kon Chu
- Department of Neurology, Laboratory for Neurotherapeutics, Biomedical Research Institute, Comprehensive Epilepsy Center, Seoul National University Hospital, Seoul, South Korea; Program in Neuroscience, Neuroscience Research Institute of Seoul National University Medical Research Council, College of Medicine, Seoul National University, Seoul, South Korea.
| | - Sang Kun Lee
- Department of Neurology, Laboratory for Neurotherapeutics, Biomedical Research Institute, Comprehensive Epilepsy Center, Seoul National University Hospital, Seoul, South Korea; Program in Neuroscience, Neuroscience Research Institute of Seoul National University Medical Research Council, College of Medicine, Seoul National University, Seoul, South Korea.
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Lee ST, Park CK, Kim JW, Park MJ, Lee H, Lim JA, Choi SH, Kim TM, Lee SH, Park SH, Kim IH, Lee KM. Early cognitive function tests predict early progression in glioblastoma. Neurooncol Pract 2015; 2:137-143. [PMID: 31386094 DOI: 10.1093/nop/npv007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Indexed: 11/15/2022] Open
Abstract
Background Early progression of glioblastoma prevents patients from completing the standard chemoradiation protocol. Given that cognitive function is associated with prognosis in glioblastoma, we investigated the usefulness of preoperative cognitive function tests for predicting the early progression of glioblastoma. Methods Consecutive patients who underwent glioma surgery were preoperatively evaluated with cognitive function tests including the Mini Mental State Examination, digit span tests, the Controlled Oral Word Association Test, the Trail Making Tests (TMT, parts A, B, and C), and the Stroop test. Glioblastomas were treated with a standard protocol using radiation and temozolomide, and 6-month progression-free survival (PFS-6) was analyzed retrospectively. Results Among 126 patients who underwent glioma surgery, 55 patients were diagnosed with glioblastoma, and 50 patients were eligible for the PFS-6 analysis. Thirty-four patients (68%) achieved PFS-6. No significant differences were observed in demographics or tumor characteristics between patients without progression (PFS-6) or patients with progression (no-PFS-6). In the cognitive function tests, the PFS-6 patients exhibited better performance in TMT-A and TMT-B. In a multivariate logistic regression, TMT-B was the only independent predictor for PFS-6, whereas age, years of education, gross total or near total resection, concomitant chemoradiation, and TMT-A were not predictors. Patients with good TMT-B performance exhibited better early prognosis in the Kaplan-Meier survival analysis and had better recursive partitioning analysis classes. Conclusions Our results indicated that preoperative TMTs can be useful for rapid evaluation of early prognosis in patients with glioblastoma.
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Affiliation(s)
- Soon-Tae Lee
- Department of Neurology, Seoul National University Hospital, Seoul, Korea (S.-T.L., H.L., J.-A.L., K.-M.L.); Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea (C.-K.P., J.W.K., M.-J.P.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (S.H.C.); Division of Medical Oncology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (T.M.K., S.-H.L.); Department of Pathology, Seoul National University Hospital, Seoul, Korea (S.-H.P.); Department of Radiation Oncology,Seoul National University Hospital, Seoul, Korea (I.H.K.)
| | - Chul-Kee Park
- Department of Neurology, Seoul National University Hospital, Seoul, Korea (S.-T.L., H.L., J.-A.L., K.-M.L.); Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea (C.-K.P., J.W.K., M.-J.P.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (S.H.C.); Division of Medical Oncology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (T.M.K., S.-H.L.); Department of Pathology, Seoul National University Hospital, Seoul, Korea (S.-H.P.); Department of Radiation Oncology,Seoul National University Hospital, Seoul, Korea (I.H.K.)
| | - Jin Wook Kim
- Department of Neurology, Seoul National University Hospital, Seoul, Korea (S.-T.L., H.L., J.-A.L., K.-M.L.); Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea (C.-K.P., J.W.K., M.-J.P.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (S.H.C.); Division of Medical Oncology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (T.M.K., S.-H.L.); Department of Pathology, Seoul National University Hospital, Seoul, Korea (S.-H.P.); Department of Radiation Oncology,Seoul National University Hospital, Seoul, Korea (I.H.K.)
| | - Min-Jung Park
- Department of Neurology, Seoul National University Hospital, Seoul, Korea (S.-T.L., H.L., J.-A.L., K.-M.L.); Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea (C.-K.P., J.W.K., M.-J.P.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (S.H.C.); Division of Medical Oncology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (T.M.K., S.-H.L.); Department of Pathology, Seoul National University Hospital, Seoul, Korea (S.-H.P.); Department of Radiation Oncology,Seoul National University Hospital, Seoul, Korea (I.H.K.)
| | - Hyon Lee
- Department of Neurology, Seoul National University Hospital, Seoul, Korea (S.-T.L., H.L., J.-A.L., K.-M.L.); Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea (C.-K.P., J.W.K., M.-J.P.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (S.H.C.); Division of Medical Oncology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (T.M.K., S.-H.L.); Department of Pathology, Seoul National University Hospital, Seoul, Korea (S.-H.P.); Department of Radiation Oncology,Seoul National University Hospital, Seoul, Korea (I.H.K.)
| | - Jung-Ah Lim
- Department of Neurology, Seoul National University Hospital, Seoul, Korea (S.-T.L., H.L., J.-A.L., K.-M.L.); Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea (C.-K.P., J.W.K., M.-J.P.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (S.H.C.); Division of Medical Oncology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (T.M.K., S.-H.L.); Department of Pathology, Seoul National University Hospital, Seoul, Korea (S.-H.P.); Department of Radiation Oncology,Seoul National University Hospital, Seoul, Korea (I.H.K.)
| | - Seung Hong Choi
- Department of Neurology, Seoul National University Hospital, Seoul, Korea (S.-T.L., H.L., J.-A.L., K.-M.L.); Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea (C.-K.P., J.W.K., M.-J.P.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (S.H.C.); Division of Medical Oncology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (T.M.K., S.-H.L.); Department of Pathology, Seoul National University Hospital, Seoul, Korea (S.-H.P.); Department of Radiation Oncology,Seoul National University Hospital, Seoul, Korea (I.H.K.)
| | - Tae Min Kim
- Department of Neurology, Seoul National University Hospital, Seoul, Korea (S.-T.L., H.L., J.-A.L., K.-M.L.); Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea (C.-K.P., J.W.K., M.-J.P.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (S.H.C.); Division of Medical Oncology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (T.M.K., S.-H.L.); Department of Pathology, Seoul National University Hospital, Seoul, Korea (S.-H.P.); Department of Radiation Oncology,Seoul National University Hospital, Seoul, Korea (I.H.K.)
| | - Se-Hoon Lee
- Department of Neurology, Seoul National University Hospital, Seoul, Korea (S.-T.L., H.L., J.-A.L., K.-M.L.); Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea (C.-K.P., J.W.K., M.-J.P.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (S.H.C.); Division of Medical Oncology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (T.M.K., S.-H.L.); Department of Pathology, Seoul National University Hospital, Seoul, Korea (S.-H.P.); Department of Radiation Oncology,Seoul National University Hospital, Seoul, Korea (I.H.K.)
| | - Sung-Hye Park
- Department of Neurology, Seoul National University Hospital, Seoul, Korea (S.-T.L., H.L., J.-A.L., K.-M.L.); Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea (C.-K.P., J.W.K., M.-J.P.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (S.H.C.); Division of Medical Oncology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (T.M.K., S.-H.L.); Department of Pathology, Seoul National University Hospital, Seoul, Korea (S.-H.P.); Department of Radiation Oncology,Seoul National University Hospital, Seoul, Korea (I.H.K.)
| | - Il Han Kim
- Department of Neurology, Seoul National University Hospital, Seoul, Korea (S.-T.L., H.L., J.-A.L., K.-M.L.); Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea (C.-K.P., J.W.K., M.-J.P.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (S.H.C.); Division of Medical Oncology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (T.M.K., S.-H.L.); Department of Pathology, Seoul National University Hospital, Seoul, Korea (S.-H.P.); Department of Radiation Oncology,Seoul National University Hospital, Seoul, Korea (I.H.K.)
| | - Kyoung-Min Lee
- Department of Neurology, Seoul National University Hospital, Seoul, Korea (S.-T.L., H.L., J.-A.L., K.-M.L.); Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea (C.-K.P., J.W.K., M.-J.P.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (S.H.C.); Division of Medical Oncology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (T.M.K., S.-H.L.); Department of Pathology, Seoul National University Hospital, Seoul, Korea (S.-H.P.); Department of Radiation Oncology,Seoul National University Hospital, Seoul, Korea (I.H.K.)
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Kang BS, Jung KH, Shin JW, Moon JS, Byun JI, Lim JA, Moon HJ, Kim YS, Lee ST, Chu K, Lee SK. Induction of burst suppression or coma using intravenous anesthetics in refractory status epilepticus. J Clin Neurosci 2015; 22:854-8. [PMID: 25744078 DOI: 10.1016/j.jocn.2014.11.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 11/05/2014] [Indexed: 10/23/2022]
Abstract
General anesthetic-induced coma therapy has been recommended for the treatment of refractory status epilepticus (RSE). However, the influence of electroencephalographic (EEG) burst suppression (BS) on outcomes still remains unclear. This study investigated the impact of intravenous anesthetic-induced BS on the prognosis of RSE using a retrospective analysis of all consecutive adult patients who received intravenous anesthetic treatment for RSE at the Seoul National University Hospital between January 2006 and June 2011. Twenty-two of the 111 episodes of RSE were enrolled in this study. Of the 22 RSE patients, 12 (54.5%) were women and 18 (81.4%) exhibited generalized convulsive status epilepticus. Sixteen patients (72.7%) were classified as having acute symptomatic etiology, including three patients with anoxic encephalopathy, and others with remote symptomatic etiology. Only two patients (9.1%) had a favorable Status Epilepticus Severity Score (0-2) at admission. All patients received midazolam (MDZ) as a primary intravenous anesthetic drug for RSE treatment; three (13.6%) received MDZ and propofol, and one (4.5%) received MDZ and pentobarbital. The rates of mortality and poor outcome at discharge were 13.6% (n=3) and 54.5% (n=12), respectively. While BS was achieved in six (27.5%) patients, it was not associated with mortality or poor outcome. Induced BS was associated with prolonged hospital stay in subgroup analysis when excluding anoxic encephalopathy. Our results suggest that induction of BS for treating RSE did not affect mortality or outcome at discharge and may lead to an increased length of hospital stay.
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Affiliation(s)
- Bong Su Kang
- Department of Neurology, Korea University Anam Hospital, Seoul, South Korea
| | - Keun-Hwa Jung
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, College of Medicine, Seoul National University, 101, Daehangno, Chongro-Gu, Seoul 110-744, South Korea
| | - Jeong-Won Shin
- Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Jang Sup Moon
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, College of Medicine, Seoul National University, 101, Daehangno, Chongro-Gu, Seoul 110-744, South Korea
| | - Jung-Ick Byun
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, College of Medicine, Seoul National University, 101, Daehangno, Chongro-Gu, Seoul 110-744, South Korea
| | - Jung-Ah Lim
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, College of Medicine, Seoul National University, 101, Daehangno, Chongro-Gu, Seoul 110-744, South Korea
| | - Hye Jin Moon
- Department of Neurology, Dongsan Medical Center, Keimyung University, Daegu, South Korea
| | - Young-Soo Kim
- Department of Neurology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea
| | - Soon-Tae Lee
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, College of Medicine, Seoul National University, 101, Daehangno, Chongro-Gu, Seoul 110-744, South Korea
| | - Kon Chu
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, College of Medicine, Seoul National University, 101, Daehangno, Chongro-Gu, Seoul 110-744, South Korea
| | - Sang Kun Lee
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, College of Medicine, Seoul National University, 101, Daehangno, Chongro-Gu, Seoul 110-744, South Korea.
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Lee KJ, Shin JW, Moon J, Lim JA, Byun JI, Kim TJ, Shin YW, Lee ST, Jung KH, Lee SK, Chu K. An illustrative case of mixed pesticide poisoning with remarkable improvement: a case report. J Neurol Sci 2014; 344:232-3. [PMID: 24993470 DOI: 10.1016/j.jns.2014.06.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 06/11/2014] [Accepted: 06/13/2014] [Indexed: 01/08/2023]
Affiliation(s)
- Keon-Joo Lee
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea; Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| | - Jung-Won Shin
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea; Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| | - Jangsup Moon
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea; Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| | - Jung-Ah Lim
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea; Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| | - Jung-Ick Byun
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea; Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| | - Tae-Joon Kim
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea; Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| | - Yong-Won Shin
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea; Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| | - Soon-Tae Lee
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea; Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| | - Keun-Hwa Jung
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea; Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| | - Sang Kun Lee
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea; Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| | - Kon Chu
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea; Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea.
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Moon J, Jung KH, Shin JW, Lim JA, Byun JI, Lee ST, Chu K, Lee SK. Safety of tianeptine use in patients with epilepsy. Epilepsy Behav 2014; 34:116-9. [PMID: 24739449 DOI: 10.1016/j.yebeh.2014.03.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 02/15/2014] [Accepted: 03/23/2014] [Indexed: 10/25/2022]
Abstract
Depression is a frequent comorbidity in patients with epilepsy (PWE). However, it is often undertreated because of concerns of seizure exacerbation by antidepressant treatment. The effect of tianeptine on seizure frequency is not known as yet. Thus, we aimed to evaluate the influence of tianeptine on the seizure frequency in PWE. We retrospectively reviewed the medical records of PWE who received tianeptine between January 2006 and June 2013 at the Epilepsy Center of Seoul National University Hospital. Patients were excluded if the dose or type of antiepileptic drugs (AEDs) they took was altered at the start of tianeptine treatment or if the treatment period of tianeptine was <3 months. A total of 74 PWE were enrolled in our study (male: 32, mean age: 41.9±14.5). Sixty-nine patients had localization-related epilepsy, and 5 had idiopathic generalized epilepsy (IGE). Mean seizure frequency during the 3-month period just after tianeptine exposure was compared with the baseline seizure frequency, which showed no change in 69 (93.2%) patients, decrease in 2 (2.7%) patients, and increase in 3 patients (4.1%). The type of epileptic syndrome, the baseline seizure frequency, and the number of coadministered AEDs did not influence the change in seizure frequency after tianeptine prescription. Change in seizure frequency did not differ between the patients given tianeptine as an additive antidepressant and those given tianeptine as a replacement antidepressant. Our data suggest that tianeptine can be prescribed safely to PWE with depression without increasing the seizure frequency regardless of the baseline severity of epilepsy. Tianeptine may be actively considered as a first-choice antidepressant or as an alternative antidepressant in PWE with depression.
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Affiliation(s)
- Jangsup Moon
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 110-744, Republic of Korea
| | - Keun-Hwa Jung
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 110-744, Republic of Korea
| | - Jung-Won Shin
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 110-744, Republic of Korea
| | - Jung-Ah Lim
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 110-744, Republic of Korea
| | - Jung-Ick Byun
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 110-744, Republic of Korea
| | - Soon-Tae Lee
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 110-744, Republic of Korea
| | - Kon Chu
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 110-744, Republic of Korea
| | - Sang Kun Lee
- Laboratory for Neurotherapeutics, Department of Neurology, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 110-744, Republic of Korea.
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Lim JA, Lee ST, Jung KH, Kim S, Shin JW, Moon J, Byun JI, Kim TJ, Shin YW, Lee KJ, Kim YS, Park KI, Lee SK, Chu K. Anti-N-methyl-d-aspartate receptor encephalitis in Korea: clinical features, treatment, and outcome. J Clin Neurol 2014; 10:157-61. [PMID: 24829602 PMCID: PMC4017019 DOI: 10.3988/jcn.2014.10.2.157] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 12/10/2013] [Accepted: 12/12/2013] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND AND PURPOSE Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is the most common type of autoimmune synaptic encephalitis and it often responds to treatment. We analyzed the clinical characteristics of anti-NMDAR encephalitis in Korea. METHODS Serum and/or cerebrospinal fluid (CSF) of adult patients (aged ≥18 years) with encephalitis of undetermined cause were screened for anti-NMDAR antibodies using a cell-based indirect immunofluorescence assay. The patients came from 41 university hospitals. RESULTS Of the 721 patients screened, 40 were identified with anti-NMDAR antibodies and clinical details of 32 patients were obtained (median age, 41.5 years; 15 females). Twenty-two patients (68.8%) presented with psychiatric symptoms, 16 (50%) with seizures, 13 (40.6%) with movement disorders, 15 (46.9%) with dysautonomia, 11 (34.4%) with memory disturbance, and 11 (34.4%) with speech disturbance. Magnetic resonance imaging, electroencephalography, and CSF examinations yielded nonspecific findings. Tumor information was only available for 22 patients: 5 patients had tumors, and 2 of these patients had ovarian teratomas. Twenty-two patients received immunotherapy and/or surgery, and therapeutic responses were analyzed in 21 patients, of which 14 (66.7%) achieved favorable functional outcomes (score on the modified Rankin Scale of 0-2). CONCLUSIONS This study investigated the clinical characteristics of adult anti-NMDAR encephalitis in Korea. Currently, elderly patients who do not have tumors are commonly diagnosed with this condition. Understanding the detailed clinical characteristics of this disease will improve the early detection of anti-NMDAR encephalitis in patients both young and old.
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Affiliation(s)
- Jung-Ah Lim
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital; Program in Neuroscience, Seoul National University College of Medicine, Seoul, Korea
| | - Soon-Tae Lee
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital; Program in Neuroscience, Seoul National University College of Medicine, Seoul, Korea
| | - Keun-Hwa Jung
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital; Program in Neuroscience, Seoul National University College of Medicine, Seoul, Korea
| | - Soyun Kim
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital; Program in Neuroscience, Seoul National University College of Medicine, Seoul, Korea
| | - Jung-Won Shin
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital; Program in Neuroscience, Seoul National University College of Medicine, Seoul, Korea
| | - Jangsup Moon
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital; Program in Neuroscience, Seoul National University College of Medicine, Seoul, Korea
| | - Jung-Ick Byun
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital; Program in Neuroscience, Seoul National University College of Medicine, Seoul, Korea
| | - Tae-Joon Kim
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital; Program in Neuroscience, Seoul National University College of Medicine, Seoul, Korea
| | - Yong-Won Shin
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital; Program in Neuroscience, Seoul National University College of Medicine, Seoul, Korea
| | - Keon-Joo Lee
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital; Program in Neuroscience, Seoul National University College of Medicine, Seoul, Korea
| | - Young-Su Kim
- Department of Neurology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Kyung-Il Park
- Department of Neurology, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Sang Kun Lee
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital; Program in Neuroscience, Seoul National University College of Medicine, Seoul, Korea
| | - Kon Chu
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital; Program in Neuroscience, Seoul National University College of Medicine, Seoul, Korea
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Kim TJ, Lee ST, Shin JW, Moon J, Lim JA, Byun JI, Shin YW, Lee KJ, Jung KH, Kim YS, Park KI, Chu K, Lee SK. Clinical manifestations and outcomes of the treatment of patients with GABAB encephalitis. J Neuroimmunol 2014; 270:45-50. [PMID: 24662003 DOI: 10.1016/j.jneuroim.2014.02.011] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 02/20/2014] [Accepted: 02/24/2014] [Indexed: 12/22/2022]
Abstract
Encephalitis associated with anti-γ-aminobutyric acid-B (GABAB) receptor antibodies has been identified recently. However, only a few cases have been reported to date and its clinical manifestations and prognosis have not been investigated systematically. We identified five cases of GABAB encephalitis in Korea. Here we present the clinical features, treatment responses, and brain positron emission tomography findings of the cases. The patients had a clinical triad of memory changes, seizure, and association with small-cell lung cancer. Early diagnosis and comprehensive immune modulation may provide a good outcome.
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Affiliation(s)
- Tae-Joon Kim
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea; Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| | - Soon-Tae Lee
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea; Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea.
| | - Jung-Won Shin
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea; Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| | - Jangsup Moon
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea; Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| | - Jung-Ah Lim
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea; Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| | - Jung-Ick Byun
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea; Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| | - Yong-Won Shin
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea; Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| | - Keon-Joo Lee
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea; Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| | - Keun-Hwa Jung
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea; Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| | - Young-Soo Kim
- Department of Neurology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea
| | - Kyung-Il Park
- Department of Neurology, Seoul Paik Hospital, Inje University College of Medicine, Seoul, South Korea
| | - Kon Chu
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea; Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| | - Sang Kun Lee
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea; Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
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50
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Shin YW, Lee ST, Shin JW, Moon J, Lim JA, Byun JI, Kim TJ, Lee KJ, Kim YS, Park KI, Jung KH, Lee SK, Chu K. VGKC-complex/LGI1-antibody encephalitis: clinical manifestations and response to immunotherapy. J Neuroimmunol 2013; 265:75-81. [PMID: 24176648 DOI: 10.1016/j.jneuroim.2013.10.005] [Citation(s) in RCA: 149] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Revised: 10/07/2013] [Accepted: 10/11/2013] [Indexed: 01/17/2023]
Abstract
Leucine-rich glioma inactivated 1 (LGI1) was recently identified as a target protein in autoimmune synaptic encephalitis, a rare condition associated with autoantibodies against structures in the neuronal synapse. Studies dealing with LGI1 are small in number and the various outcomes of different therapeutic regimens are not well studied. Here, we analyzed clinical characteristics of 14 patients with LGI1 antibodies, and outcomes according to therapeutic strategies. Most patients exhibited abnormal brain positron emission tomography and that patients treated with steroids alone were more likely to relapse and had less favorable outcomes than those treated with steroids and intravenous immunoglobulins.
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Affiliation(s)
- Yong-Won Shin
- Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea; Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
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