PubMed Health⌕ Search

Biomedical subjects

Kyoung Heo

Publications and source records attributed to Kyoung Heo.

13 recordsLinked to original sources

Minocycline inhibits caspase-dependent and -independent cell death pathways and is neuroprotective against hippocampal damage after treatment with kainic acid in mice.

Although minocycline has been generally thought to have neuroprotective properties, the neuroprotective role of minocycline has not been investigated in the animal model of epilepsy. In this study, we investigated whether minocycline is neuroprotective against kainic acid (KA)-induced cell death through the caspase-dependent or -independent mitochondrial apoptotic pathways. Adult male ICR mice were subjected to seizures by intrahippocampal KA injection with vehicle or with minocycline. For cell death analysis, TdT-mediated dUTP-biotin nick end labeling and cresyl-violet staining were performed. Western blot analysis and immunofluorescent staining for cytochrome c and apoptosis-inducing factor (AIF) were performed. Cell death was reduced in minocycline-treated mice. Cytosolic translocation of cytochrome c and subsequent activation of caspase-3 were diminished by minocycline treatment. AIF nuclear translocation and subsequent large-scale DNA fragmentation were also reduced in minocycline-treated mice. Thus, this study suggests that minocycline inhibits both caspase-dependent and -independent apoptotic pathways and may be neuroprotective against hippocampal damage after KA treatment.

Animals↗

Relationship between bilateral temporal hypometabolism and EEG findings for mesial temporal lobe epilepsy: analysis of 18F-FDG PET using SPM.

PURPOSE: To investigate the clinical significance of bilateral temporal hypometabolism (BTH) for patients with mesial temporal lobe epilepsy (MTLE) by using statistical parametric mapping (SPM). METHODS: Interictal 18F-FDG PET scans were performed for 29 patients with surgically treated MTLE. Clinical data, interictal epileptiform discharges (IEDs), ictal scalp EEG and intracarotid amobarbital test (IAT) were analyzed. To assess an 18F-FDG PET image, an SPM analysis as well as visual interpretation were applied. RESULTS: In 9 of 29 patients, the 18F-FDG PET scan revealed BTH by the SPM analysis, while only 3 patients showed BTH by the visual assessment. When the patients were classified into the unilateral temporal hypometabolism (UTH) and BTH groups based on the SPM results, bitemporal IEDs occurred significantly more frequently in the BTH group than in the UTH group (66.7% versus 22.2%). Bilateral independent seizure onset seen on the scalp EEG and bitemporal epilepsy were present only in the BTH group. Lateralized ictal onset was present less frequently in the BTH group than in the UTH group (44.4% versus 83.3%). There was no statistically significant difference in age at onset, duration of epilepsy, generalized seizure, history of febrile convulsion and CNS infection, lateralization throughout the whole tracing, lateralization on the IAT test, and surgical outcome between the UTH and BTH groups. CONCLUSION: Bilaterality of the EEG findings correlated with BTH on 18F-FDG PET by the SPM method. Our results suggest that analysis of 18F-FDG PET by using SPM may have a role in predicting those patients with bitemporal excitability or bitemporal independent epileptogenicity, and these patients should be monitored carefully.

Adolescent↗

Patient awareness of complex partial seizures.

PURPOSE: To assess self-awareness of complex partial seizures (CPSs) in unselected epilepsy patients through a thorough interview. METHODS: The study comprised 134 patients at our epilepsy clinic, whose CPSs had been documented by the patient's family members. We investigated the proportion and characteristics of patients unaware of their CPSs compared to those who were, and we monitored the evolution of unawareness of CPSs during the follow-up. RESULTS: Thirty-one (23%) patients were assigned to the unawareness group (complete, 23; incomplete, 8) and 103 (67%) patients to the awareness group. Patients in the unawareness group were older and had a later age of onset than patients in the awareness group. Interictal epileptiform discharges (IEDs) localized primarily to the temporal region and were more frequently detected in the unawareness group (94%) than the awareness group (55%). Bilateral independent IEDs were found more frequently in the unawareness group than in the awareness group (48% vs. 13%). The bilateral presence of lesions was also more frequent in the unawareness group than the awareness group (16.1% vs. 4.9%). Six (26%) of 23 patients with complete unawareness of their CPSs had experienced awareness of CPSs during the follow-up. Two of these patients even experienced the emergence of de novo aura. CONCLUSIONS: Our results indicate that a significant number of epilepsy patients are not aware of their CPSs. Unawareness of CPSs may be related to bitemporal dysfunction and a rapid and complete loss of consciousness caused by rapid spread of ictal discharges to the contralateral hemisphere in association with bilateral independent IEDs and bilateral presence of lesions.

Adult↗

Antiepileptic drug withdrawal after successful surgery for intractable temporal lobe epilepsy.

PURPOSE: To investigate the prognosis related to antiepileptic drug (AED) discontinuation after successful surgery for intractable temporal lobe epilepsy. METHODS: The clinical courses after temporal lobectomies (TLs) were retrospectively analyzed in 88 consecutive patients. All the patients had TLs as the only surgical procedure, and they had been followed up for longer than 3 years. AED discontinuation was attempted if the patient had been seizure free without aura for >or=1 year during the follow-up period. RESULTS: Sixty-six (75%) patients achieved complete seizure freedom for >or=1 year; 28 patients were seizure free immediately after surgery (immediate success); and 38 patients became seizure free after some period of recurrent seizures (delayed success). AED discontinuation was attempted in 60 (91%) of 66 patients with a successful outcome. In 13 (22%) patients, seizure relapse developed during AED reduction (n=60), and in seven (12%) patients after discontinuation of AEDs (n=38). The seizure recurrence rate was not different between the immediate-and delayed-success groups. Among 20 patients with seizure relapse related to AED tapering, nine (45%) of them regained seizure freedom after reinstitution of AED treatment, and AEDs were eventually discontinued in six of them. Seizures that recurred after complete AED discontinuation had a better prognosis than did the seizures that recurred during AED reduction (seizure freedom in 86% vs. 23%). At the final assessment, 54 (61%) patients had been seizure free >or=1 year; 37 without AEDs and 17 with AEDs. The successful discontinuation of AEDs was more frequent for patients with a younger age at the time of surgery and for those patients with shorter disease duration. CONCLUSIONS: Our results suggest that seizure freedom without aura at >or=1 year is a reasonable indication for the attempt at AED discontinuation. The subsequent control of recurrent seizures was excellent, especially if seizures relapsed after the complete discontinuation of AEDs. Younger age at the time of surgery and a shorter disease duration seem to affect successful AED discontinuation for a long-term period.

Adolescent↗

Prominent cerebellar symptoms with unusual magnetic resonance imaging findings in acquired hepatocerebral degeneration.

BACKGROUND: Cerebellar lesions revealed by abnormal signals on magnetic resonance images are extremely rare in acquired hepatocerebral degeneration (AHCD). OBJECTIVE: To report a case of AHCD with prominent cerebellar findings both clinically and radiologically. DESIGN AND SETTING: Case report and tertiary-care hospital. PATIENT: A 46-year-old man complained of progressive speech difficulties of 5 months' duration. Two years earlier, he had been diagnosed as having cirrhosis of the liver caused by alcoholism and hepatitis B virus infection. RESULTS: The patient had progressive ataxic dysarthria and limb and gait ataxia as manifestations of AHCD. Magnetic resonance imaging of the brain revealed distinctive symmetrical T2 high-signal intensities in the bilateral cerebellar hemispheres and brachium pontis, which were consistent with his neurologic deficits. Simultaneously, high T1 signals in the bilateral pallidum and ventral midbrain were noted, which are typical manifestations of AHCD. Follow-up magnetic resonance imaging 3 months later showed the same cerebellar signs and abnormal signals. CONCLUSIONS: The cerebellar cortex and middle cerebellar peduncle are considered highly vulnerable structures to metabolic insults in liver disease. Findings from our patient suggest that dominant cerebellar deficits with compatible T2 high-signal lesions are another type of clinical manifestation in AHCD.

Alcoholism↗

Diffusion tensor MRI visualizes decreased subcortical fiber connectivity in focal cortical dysplasia.

Diffusion tensor imaging (DTI) was applied to 12 patients with focal cortical dysplasia (FCD) in frontal or occipital cortex. Fiber tractography was obtained from seeding points in superior longitudinal fasciculus or posterior corona radiata. Mean fractional anisotropy of fiber bundles around the affected cortex was decreased in comparison to the contralateral hemisphere with statistical significance (paired t test, P = 0.0274). On visual analysis, tractography depicted decreased volume of fiber bundles connected to the dysplastic cortex invariably even in those with a normal T2 signal intensity of underlying white matter adjacent to FCD. DTI has high potential to be applied to localize the FCD and to provide a better understanding of the pathological changes in the white matter.

Adolescent↗

Single-photon emission computed tomography in a patient with ictal metamorphopsia.

Metamorphopsia is a type of visual illusion, which has been reported as a rare ictal manifestation. The patient presented with a simple partial status epilepticus characterised by continuous facial metamorphopsia, intermittently accompanied by elementary visual hallucinations or other types of visual illusions. Subtraction single-photon emission computed tomography images showed an increased perfusion in the ventrolateral aspect of the right temporo-occipital junction (middle and inferior occipital, and inferior temporal gyri). The result suggests that the anatomical substrate involved in the generation of ictal facial metamorphopsia is located in the visual association areas at the right temporo-occipital junction.

Brain↗

Chronic activation of CREB and p90RSK in human epileptic hippocampus.

Mesial temporal lobe epilepsy (MTLE) is associated with severe neuronal death and reactive gliosis in hippocampus. However, the molecular mechanisms underlying these pathological changes remain unanswered. ERK has been reported chronically activated in reactive glia of human epileptic hippocampus. In the present study, we investigated which of the downstream signaling molecules of ERK would be involved in MTLE. Western blot analysis demonstrated that CREB and p90RSK were strongly activated in MTLE patients. Increase in the active forms of CREB and p90RSK resulted not only from the increase in their phosphorylation levels but also from the increase in the protein levels. Activation of CREB and p90RSK was noted in the whole subfields of hippocampus with Ammon's horn sclerosis (AHS) representing a distinctive cellular distribution. However, the common major change was present in proliferating reactive astrocytes. In contrast, their activation was not significant in adjacent temporal lobes despite the presence of a number of astrocytes expressing high levels of GFAP. Our results demonstrate that chronic activation CREB and p90RSK in the epileptic hippocampus may be closely associated with the histopathological changes of AHS.

Blotting, Western↗

Diffusion tensor MRI and fiber tractography of cerebellar atrophy in phenytoin users.

PURPOSE: The usefulness of diffusion tensor magnetic resonance imaging (DT-MRI) is still in debate, and the development of clinically feasible scan protocol is encouraged. The purpose of this study was to investigate the afferent fiber system to the cerebellum in patients with phenytoin (PHT)-induced cerebellar atrophy in comparison with cerebellar atrophy of other etiologies by using DT-MRI. METHODS: Thirteen patients (M/F ratio, 7:6; mean age, 42.5 years) and age-matched normal controls (n = 8) participated in this study. The patient group consisted of epilepsy patients who had received PHT therapy (n = 9) and clinically diagnosed as having olivopontocerebellar atrophy (OPCA; n = 4). DT-MRI was performed by using diffusion weighting of b = 600 s/mm2, and fractional anisotropy (FA) and color-coded vector maps were generated. FA of the middle cerebellar peduncle (MCP), the cerebellum, and transverse pontine fibers (TPF) was measured and compared between PHT and OPCA patients. RESULTS: Normal subjects showed FA values of 0.81 +/- 0.07 in MCP, 0.69 +/- 0.04 in TPF, and PHT users showed FA values of 0.84 +/- 0.09 in MCP, 0.72 +/- 0.08 in TPF, and 0.21 +/- 0.04 in cerebellum. OPCA patients showed FA values of 0.39 +/- 0.11 in MCP, 0.46 +/- 0.12 in TPF, and 0.22 +/- 0.07 in cerebellum. PHT users showed a statistically significant reduction of FA only in cerebellum, whereas OPCA demonstrated significant decrease of FA in MCP, TPF, and cerebellum (one-way analysis of variance, p < 0.01). Three-dimensional reconstruction of fiber tracts demonstrated decreased volume and altered fiber integrity within the peduncles and transverse pontine fibers in the OPCA group, whereas fiber course patterns in PHT users were similar to those in controls. CONCLUSIONS: PHT users showed normal orientation and anisotropy of MCP and TPF, whereas OPCA demonstrated impaired values, suggesting that PHT directly affects the cerebellum. DT-MRI can demonstrate detailed fiber configurations in degenerative diseases of brainstem and cerebellum and provides insight into the pathomechanisms of cerebellar atrophy.

Adult↗

Interictal epileptiform discharges relate to 1H-MRS-detected metabolic abnormalities in mesial temporal lobe epilepsy.

PURPOSE: To examine whether the distribution of interictal epileptiform discharges (IEDs) recorded from foramen ovale electrodes (FOEs) correlates with metabolite levels in medial structures of the temporal lobes in patients with mesial temporal lobe epilepsy (MTLE). METHODS: We studied 34 patients with MTLE. The lateralization ratio of IEDs was calculated after counting IEDs recorded from FOEs during prolonged video-EEG monitoring. Metabolite ratio between N-acetylaspartate (NAA) and creatine (Cr) was calculated in each medial temporal structure. The correlation between the lateralization ratio of IEDs and metabolic ratio was evaluated. RESULTS: The asymmetry indexes of IEDs correlated with the asymmetry index of NAA/Cr ratio in the medial temporal structure (rho = -0.380; p = 0.027). Analysis of IEDs and metabolite ratio revealed a significant inverse relation in the contralateral side to the major epileptogenic focus (rho = -0.360; p = 0.037); however, this significance was not present in the ipsilateral side (rho = -0.018; p = 0.921). CONCLUSIONS: There is a correlation between the neuronal dysfunction or damage detected by MRS and the epileptic activity in the contralateral medial temporal structure. Our results suggest that the pathomechanism underlying the contralateral reduction of NAA/Cr ratio, frequently observed in patients with MTLE, might be related to the process of epileptogenesis generating the independent contralateral IEDs.

Adult↗

Syndromic diagnosis at the epilepsy clinic: role of MRI in lobar epilepsies.

PURPOSE: Magnetic resonance imaging (MRI) is an essential diagnostic tool for the management of epilepsy at modern epilepsy clinics. This study was conducted to incorporate MRI features into the international classification of epilepsies and epilepsy syndromes (ICEES) proposed by the International League Against Epilepsy (ILAE). METHODS: Three hundred consecutive patients newly registered in the Yonsei Epilepsy Clinic underwent stepwise classifications based on clinical features, clinical EEG, and clinical EEG-MRI correlations. The patients were required to have epilepsy and have undergone both EEG and MRI for inclusion in the study. Interictal epileptiform discharges (IEDs) in the EEG were divided into lobar, multilobar, and generalized. MRI lesions were divided into lobar and multilobar lesions. Lobar epilepsies (LEs) were divided into temporal, frontal, parietal, occipital, rolandic, temporoparietooccipital junctional, multilobar, and nonlocalized LEs. RESULTS: Two hundred forty-nine patients satisfied the inclusion criteria. In the first-step diagnosis, 190 patients were classified as having localization-related epilepsy; 24 patients, generalized epilepsy; 34 patients, undetermined epilepsy; and one patient, a special syndrome. EEG revealed IEDs in 124 (50%) patients, and the second-step diagnosis changed the diagnostic categories of 79 (32%) patients. MRI detected lesions in 106 (43%) patients, and the third-step diagnosis changed the diagnostic categories of 30 (12%) patients. The nonspecific diagnostic categories of ICEES decreased from 49% to 37% and then to 29%, as diagnosis progressed from steps one to three. In cases of LE, MRI was superior to EEG in its clinical correlation. Additionally, the diagnostic precision in temporal lobe epilepsy was far better than that for other LEs. CONCLUSIONS: The impact of MRI on ICEES was only modest in terms of changing diagnostic categories, although MRI provided a structural substrate for epilepsy in 38% of patients with negative EEGs. In LE, MRI was as sensitive as EEG, and its clinical correlation was superior to that of EEG, which strongly supports the rationale of incorporating MRI into ICEES.

Adult↗

Coma probably induced by lorazepam-valproate interaction.

Both valproate (VPA) and lorazepam (LZP) are primarily cleared from the body by glucuronidation. Concomitant administration of VPA has been reported to reduce the elimination of LZP. However, it remains unknown whether this drug interaction is clinically significant. We report a patient with epilepsy who showed that VPA-LZP interaction could result in severe encephalopathy such as coma.

Adult↗