Hyeon Mi Park

Sleep problems associated with behavioral and psychological symptoms as well as cognitive functions in Alzheimer's disease.

Background and Purpose It has been shown that sleep problems in Alzheimers disease (AD) are associated with cognitive impairment and behavioral problems. In fact, most of studies have founded that daytime sleepiness is significantly correlated with cognitive decline in AD. However, a few studies have also shown that nighttime sleep problems are associated with cognitive function and behavioral symptoms in AD. Accordingly, the aim of this study was to evaluate the effects of nighttime sleep on cognition and behavioral and psychological symptoms of dementia (BPSD) in AD. Methods The study population comprised 117 subjects: 63 AD patients and 54 age- and sex-matched non-demented elderly subjects. Detailed cognitive functions and behavioral symptoms were measured using the Seoul Neuropsychological Screening Battery (SNSB) and the Korean version of the Neuropsychiatric Inventory (NPI-K). Sleep characteristics were evaluated using the Korean version of the Pittsburgh Sleep Quality Index (PSQI-K). The correlations between PSQI-K and SNSB scores and between PSQI-K and NPI-K scores were analyzed. Results In AD patients, sleep latency was found to be negatively correlated with praxis (p=0.041), Rey-Osterrieth Complex Figure Test (RCFT) immediate recall (p=0.041), and RCFT recognition (p=0.008) after controlling for age and education, while sleep duration and sleep efficiency were positively correlated with praxis (p=0.034 and p=0.025, respectively). Although no significant correlation was found between PSQI-K and NPI-K scores, sleep disturbance and total PSQI-K scores were found to be significantly associated with apathy/indifference in AD. Conclusions Sleep problems such as prolonged sleep duration, sleep latency, and poor sleep efficiency in AD patients were correlated with cognitive dysfunction, and especially frontal executive and visuospatial functions, and BPSD. These findings suggest that treatment of nighttime sleep problems might improve cognition and behavioral symptoms in AD patients.

Factors contributing to Korean adolescents' perceptions of stigma with respect to epilepsy

We assessed knowledge and perceptions of epilepsy held by Korean adolescents in the general population, and investigated factors important in adolescents perceptions of stigma with respect to epilepsy. Surveys were distributed to students at 22 schools. A total of 1377 students participated. Fewer than half of all students (45.1%) reported hearing or reading about epilepsy. Overall, students showed a general lack of familiarity with and knowledge of epilepsy. Stigma perception scores were significantly higher in boys than in girls (P<0.05) and in middle school than in high school (P<0.05) students. We also found that stigma perception scores were significantly correlated with both younger age (r=-0.074, P=0.006) and lower knowledge scores (r=-0.404, P=0.000). Linear regression analysis showed that stigma-related perception was associated with lower knowledge scores (P<0.001) and middle school (P<0.05). These results indicate a need for public education of adolescents in the general population to decrease the stigma associated with epilepsy.

Factors contributing to Korean teachers' attitudes toward students with epilepsy

We investigated factors contributing to teachers attitudes toward students with epilepsy. Data were collected from 604 teachers in Korea. The questionnaire included the Scale of Attitudes Toward Persons with Epilepsy (ATPE) and a demographic and teaching experience survey. In stepwise linear regression analysis, ATPE Knowledge scores (P<0.001) and prior experience teaching a student with epilepsy (P=0.001) were identified as significant factors for ATPE Attitude scores. The ATPE Knowledge scores accounted for 50.1% of the variance in the Attitude scores, and experience teaching a student with epilepsy accounted only for 1.0%. Our finding that teachers knowledge is the most important factor influencing teachers attitudes toward epilepsy indicates that teachers should be provided with information about epilepsy universally, across geographic settings, educational levels, and experience levels.

A case of cluster headache accompanied by myoclonus and hemiparesis.

Background Cluster headache is a primary headache disorder characterized by periodic episodes of intense headache accompanied by autonomic symptoms. We report an unusual clinical presentation of cluster headache that was preceded by myoclonus and accompanied by hemiparesis. Case Report A 26-year-old man visited hospital due to recurrent jerky movements on the left side of his face and neck area lasting 3 days. These jerky movements had disappeared spontaneously without specific treatment. On the 10th day after onset of the jerky movements, the patient developed a series of unilateral severe headaches that were accompanied by autonomic symptoms lasting 1-2 hours. According to the second edition of The International Classification of Headache Disorders, he was diagnosed as having cluster headache. Two of the 16 severe headache attacks this patient suffered were accompanied by dysarthria and hemiparesis. Electroencephalography performed during hemiparesis revealed diffuse lateralized slow activity on the ipsilateral hemisphere of the headache side. The headache and accompanying hemiparesis disappeared after medical treatment for cluster headache. Conclusions We describe a case of cluster headache accompanied by hemiparesis, which was preceded by myoclonus. We also outline the possible mechanisms underlying this case.

Atypical Acute Motor Axonal Neuropathy with Cerebrospinal Pleocytosis Mimicking Myelitis

Dear Editor, Acute motor axonal neuropathy (AMAN) is an axonal variant of Guillain-Barré syndrome (GBS) that is distinguished from acute inflammatory demyelinating polyradiculoneuropathy (AIDP) by both the electrophysiological pattern and clinical presentation. Because AMAN selectively involves motor nerves, sensory and autonomic disturbances are generally not observed. Here we report an atypical case of AMAN that presented with sudden-onset quadriparesis that was worse in the lower extremities, severe acroparesthesia, abrupt-onset bladder dysfunction, and cerebrospinal fluid (CSF) pleocytosis. A 53-year-old woman experienced severe diarrhea for 10 days that was followed by muscle weakness (grade 3 or 4 in the upper extremities and grade 1 or 2 in the lower extremities according to Medical Research Council criteria) and pain and numbness in all limbs. Difficulty with urination appeared suddenly and almost simultaneously. Cranial nerve function was intact. Deep tendon reflexes were normal in the arm but reduced in the legs. Pathological reflexes and sensory level could not be clearly observed. Blood laboratory findings were within normal ranges. CSF analysis revealed a red blood cell count of 5/mm3, a white blood cell count of 101/mm3 (comprising 86% lymphocytes and 14% monocytes), 67.1 mg/dL total protein, and 51 mg/dL glucose. Brain and spine MRI findings were unremarkable (Supplementary Fig. 1 in the online-only Data Supplement). Somatosensory-evoked potentials at the median and tibial nerves were also normal. Nerve conduction studies performed on days 5 and 12 after the onset of weakness revealed reduced amplitudes in the distal nerves, with partial conduction block as well as mild slowing of the motor conduction velocity and prolonged distal latencies, which confirmed the diagnosis of AMAN (Table 1) (Supplementary Fig. 2 in the online-only Data Supplement). Furthermore, the finding of an enzyme-linked immunosorbent assay test for serum IgG autoantibodies to ganglioside GM1 was strongly positive (219.93%). The findings of extensive CSF and serological analyses for infectious diseases (syphilis, HIV, fungus, bacterium, and mycobacterium) and viral agents (herpes simplex, varicella zoster, cytomegalovirus, and Epstein-Barr virus) as well as CSF oligoclonal band and CSF malignant cell tests were all negative. The patient was treated with intravenous immunoglobulin, but her clinical improvement was slow. AMAN is a motor-nerve-selective and axonal variant of GBS. The characteristic electrophysiological pattern is low-amplitude or absent compound muscle action potentials with normal sensory nerve action potentials and reversible conduction block. Unlike AIDP, AMAN rarely manifests with sensory loss, pain, paresthesia, or autonomic disturbance.1 The presence of certain symptoms such as bladder/bowel disturbance at symptom onset, the presence of a sensory level and CSF pleocytosis, and marked asymmetry of weakness cast doubt on a GBS diagnosis and may indicate a spinal cord lesion.2 This list of symptoms, which has been provided to clinicians to avoid misdiagnosis of GBS, should Jiwon Yang Yeong-Bae Lee Kwang-Woo Lee Hyeon-Mi Park