Su Jung Choi

Supratentorial cavernous angiomas presenting with seizures: Surgical outcomes in 60 consecutive patients

The aim of this study is to determine surgical outcomes and factors affecting seizure outcomes in patients who harbor supratentorial cavernous angiomas presenting with seizures. Sixty patients were classified into the intractable epilepsy group (n=22) and the sporadic seizure group (n=38) and then managed differently in accordance with our guidelines. Patients exhibiting sporadic seizures were treated by lesionectomy, except for patients harboring mesial temporal lesions. We performed lesionectomy, extended lesionectomy, standard temporal lobectomy and tailored resection on 33, 9, 9 and 9 patients, respectively. Finally, 72.7% (16/22) of patients with intractable epilepsy and 89.5% (34/38) of patients with sporadic seizures achieved Engel Class I outcomes. A long duration of illness was somewhat related to a poor outcome in patients with intractable epilepsy, yet this was not true of patients with sporadic seizures. Other factors which included age at onset, size of the lesions and locations were not related to seizure outcomes. The role of residual hemosiderin is yet to be discovered. A lesionectomy alone can be considered a reasonable approach for those patients who exhibit sporadic seizures and have an extra-temporal or neo-temporal lesion. In patients with intractable epilepsy and/or mesial temporal lesions, a more invasive approach could achieve the better seizure outcome.

Suicidal ideation and insomnia symptoms in subjects with obstructive sleep apnea syndrome

OBJECTIVEnInsomnia symptoms are prevalent in subjects with obstructive sleep apnea syndrome (OSA) and are important risk factors for suicidal ideation (SI). However, the significance of SI has not been clearly demonstrated in persons with both OSA and insomnia. We aimed to investigate the prevalence of SI and its relationship with insomnia symptoms, mood, and other relevant factors.nnnMETHODSnA total of 117 consecutive subjects with untreated OSA (apnea-hypopnea index ≥5/h) participated in the study. They completed questionnaires regarding SI ([BDI-II], item 9), insomnia symptoms (Insomnia Severity Index [ISI]), depressive mood (modified BDI-II [mBDI-II], which excluded items on SI and sleep disturbances), dysfunctional beliefs and attitudes about sleep (DBAS), social support, and quality of life.nnnRESULTSnThe overall prevalence of SI was 20.5% in subjects with OSA. A total of 32 subjects (27.4%) reported significant insomnia symptoms (ISIu2009≥u200915). Higher SI was associated with higher scores on ISI, DBAS, and mBDI-II and lower scores on social support and quality of life questionnaires. The severity of insomnia was positively correlated with depressive mood. The relationship between SI and insomnia severity was insignificant after adjusting for depressive symptom severity.nnnCONCLUSIONnPatients with OSA may have SI and insomnia symptoms. Collinearity was observed between sleep and mood disturbances. Yet, it is remarkable to find a significant association between OSA and SI, which are additional contributions to insomnia. This study suggests the necessity of integrated approaches to SI and related factors for the comprehensive treatment of OSA.

Sleep–wake pattern, chronotype and seizures in patients with epilepsy

PURPOSEnAlthough mounting evidence suggests that sleep and epilepsy are reciprocal and seizures influence circadian rhythms, sleep-wake pattern and seizure control have not been widely researched. This study aimed to investigate the association of sleep-wake pattern, sleep quality, and chronotype with seizures in patients with epilepsy (PWE).nnnMETHODSn160 consecutive PWE (aged 20-49 years, focal epilepsy, FE: generalized epilepsy, GE=127:33) and 130 age-gender matched healthy controls (HC) were enrolled. All subjects completed a sleep diary for more than 2 weeks, Pittsburgh Sleep Quality Index (PSQI), Epworth sleepiness scale (ESS), and the Morningness-Eveningness questionnaire (MEQ). Detailed seizure history was reviewed for the last 1 year.nnnKEY FINDINGSnSleep-wake patterns on workdays were different between PWE and HC (p<0.001), although PSQI, ESS, and MEQ did not differ. Social jetlag (difference of mid-sleep time between workdays and free days) was more evident in PWE (1.4h) than HC (0.7h, p<0.001). GE showed lower MEQ, later mid-sleep time on both workdays and free days, and larger social jetlag than FE. Higher seizure frequency was positively correlated with higher PSQI and ESS after adjusting for age, gender, and number of antiepileptic drugs (p<0.05). PWE with lower MEQ presented worse sleep quality.nnnSIGNIFICANCEnContrary to HC, PWE maintained sleep-wake patterns more regularly during workdays and free days. GE patients reported more eveningness-preference; however, their sleep quality was not worse than FE. Although sleep quality may affect seizure frequency, sleep-wake patterns and chronotype were not related to seizures in PWE.

Long-Term Outcome of Vagus Nerve Stimulation for Refractory Epilepsy: A Longitudinal 4 year Follow-up Study in Korea.

Background and Purpose: We evaluated the long-term outcome of patients with refractory epilepsy who were treated with vagus nerve stimulation (VNS). Methods: This investigation is designed as an uncontrolled, open-label, retrospective and long-term study. From June 1999 to October 2009, 20 patients were suitable for inclusion criteria: 4-year follow-up and documented seizure frequency before and after implantation. Seizure frequency was collected by clinical recording and interview. Primary outcome measures were the reduction in mean seizure frequency and responder rate (seizure frequency reduction of >50%). Results: In 20 patients (M:F=16:4), mean age at the time of implantation was 22.3 years (range 8–44) and mean disease duration was 13.9 years (range 1–37). Mean maximum stimulation output current was 1.90 mA (range 0.25–3.5). Overall mean seizure frequency reduction rate was 61.8% at 4 year follow-up comparison with baseline (p<0.001). Proposition of responder (> 50% seizure frequency reduction) of yearly follow-up were 40 % at 1 yr, 50% at 2 yrs, 45% at 3 yrs, and 60% at 4 yrs. There was no difference of stimulation parameter between the responders and non-responders. Conclusions: Long-term outcome of VNS suggests that VNS is an effective treatment option that can be alternative to surgery in patients with refractory epilepsy.

Validation of the Korean Munich Chronotype Questionnaire

PurposeThe Munich Chronotype Questionnaire (MCTQ) assesses actual sleep-wake timing and has advantages compared to prior chronotype questionnaires in that it differentiates sleep-wake patterns between work days and free days and uses corrected mid-sleep time on free days after correcting for accumulated sleep debt over the week to categorize chronotype. The current study, we validated the Korean version of the MCTQ.MethodsIn this study, 310 participants (mean ageu2009=u200927.09u2009±u20095.64; 78.1% females) completed the Korean version of the MCTQ.ResultsMCTQ parameters were significantly correlated with MEQ (Morningness-Eveningness Questionnaire) scores (│r│u2009≥u20090.48), and test-retest reliability was ≥u20090.72. Cutoff scores of 2.5%, which correlated to 2.36 and 8.57 mid-sleep times in our sample, showed the best convergence with MEQ when categorizing chronotype.ConclusionsOur study suggests that the MCTQ is a useful questionnaire in assessing chronotype in young adults.

Validation of the Munich ChronoType Questionnaire in Korean Older Adults

Objective This study aimed to evaluate psychometric properties of the Munich ChronoType Questionnaire (MCTQ) in a sample of Korean older adults. Methods One-hundred ninety two participants aged 65 and over completed interview-based questionnaires about chronotype, insomnia, depression, and anxiety. Additionally, a small subset of subjects completed a 7-day sleep diary and actigraphy measurements. Results Morningness-Eveningness Questionnaire (MEQ) scores were significantly negatively correlated with Midpoint of sleep on free days corrected for sleep debt accumulated through weekdays (MSFsc) (r=-0.45, p<0.01) assessed by the MCTQ. MSFsc using the MCTQ was significantly positively correlated with MSFsc assessed by both the sleep diary (r=0.74, p<0.05) and actigraphy (r=0.76, p<0.05). Additionally, MSFsc assessed by the MCTQ was significantly positively correlated with insomnia (r=0.26, p<0.01), depression (r=0.25, p<0.01), and anxiety (r=0.18, p<0.05). Finally, based on MEQ scores, we derived a cut-off score for the MCTQ that distinguishes morning type and other types (intermediate/evening types) in older adults. Conclusion The results of these studies supported the validity of the MCTQ in Korean older adults. Additionally, while sleep rhythms in elder adults may be more advanced, eveningness tendency may be still important and indicative of sleep and psychological disturbance.