Sun-Uk Lee

Predictors of surgical outcome and pathologic considerations in focal cortical dysplasia

Background: Although surgical resection has been an important alternative treatment for patients with intractable epilepsy related to focal cortical dysplasia (FCD), the prognostic relevance of the degree of pathologic severity is controversial and there has been only limited information regarding the prognostic factors involved in the surgical treatment of refractory epilepsy in patients with FCD. Methods: We undertook the present study to assess whether the pathologic subtypes of FCD affect surgical outcomes in patients with drug-resistant epilepsy. We also studied the prognostic roles of clinical factors and various diagnostic modalities in the surgical treatment. Results: A total of 166 consecutive patients were included. By univariate analysis, incomplete resection of epileptogenic area (p < 0.001), mild pathologic features (p = 0.01), and the presence of secondary tonic clonic seizures (2GTCS) (p = 0.05) were associated with poor surgical outcomes. There was a strong tendency for patients with severe pathologic features to have MRI abnormalities (p < 0.001). Incomplete resection of epileptogenic area (p < 0.001) and mild pathologic features (p = 0.02) were poor independent outcome predictors on multivariate analysis. The results of MRI, scalp EEG, fluorodeoxyglucose–PET, and ictal SPECT were not associated with surgical outcomes. Conclusions: Our study shows that there is a strong tendency for patients with severe pathologic features to have MRI abnormalities, and patients with incomplete resection, mild pathologic features, or the presence of secondary tonic clonic seizures have a high chance of a poorer surgical outcome.

Reduced circulating angiogenic cells in Alzheimer disease

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Specific immunoglobulin E and immunoglobulin G antibodies to toluene diisocyanate‐human serum albumin conjugate: useful markers for predicting long‐term prognosis in toluene diisocyanate‐induced asthma

Background Our previous study reported that more than 50% of toluene diisocyanate (TDI)‐induced asthma patients had persistent asthmatic symptoms even after complete avoidance. Although specific IgE (sIgE) has been detected in a portion of patients with TDI‐asthma, a recent investigation suggests that the presence of serum specific IgG (sIgG), not sIgE, is more closely associated with positive bronchoprovocation test (BPT) results.

Metalloproteinase‐9 is increased after toluene diisocyanate exposure in the induced sputum from patients with toluene diisocyanate‐induced asthma

Background and objective Persistent asthma symptoms are associated with airway inflammation and remodeling, which may be mediated through metalloproteinase (MMP) and tissue inhibitor of metalloproteinase (TIMP). The aim of this study was to evaluate MMPs and TIMP involvement in toluene diisocyanate (TDI)‐induced asthma.

Nitric oxide metabolites in induced sputum: a marker of airway inflammation in asthmatic subjects

The role of nitric oxide (NO) needs to be further clarified in allergic inflammation. This study was designed to investigate the relationships between NO metabolites and eosinophil count, eosinophil cationic protein (ECP), interleukin (IL)‐5 in induced sputum from asthmatics.

Dorsal Medullary Infarction: Distinct Syndrome of Isolated Central Vestibulopathy.

Background and Purpose— The characteristics of infarctions restricted to the dorsal medulla have received little attention. This study aimed to define the distinct clinical features of dorsal medullary infarction. Methods— Of the 172 patients with a diagnosis of medullary infarction at Seoul National University Bundang Hospital from 2003 to 2014, 18 patients with isolated dorsal medullary infarction were subjected to analyses of clinical and laboratory findings. Results— All patients presented acute isolated vestibular syndrome with dizziness/vertigo and imbalance. Almost all patients (17/18, 94%) showed the signs from involvements of the vestibular nuclei, nucleus prepositus hypoglossi, or inferior cerebellar peduncle, which included direction-changing gaze-evoked nystagmus (n=12), negative head-impulse tests (n=8), skew deviation (n=7), central patterns of head-shaking nystagmus (n=6), and spontaneous nystagmus (n=2). Initial magnetic resonance imagings including diffusion-weighted images were negative in 7 patients (39%). Twelve patients (67%) showed a progression and developed additional neurological abnormalities, but the neurological outcomes were favorable. Conclusions— The presence of central vestibular signs allows bedside differentiation of isolated vestibular syndrome because of dorsal medullary infarction from acute peripheral vestibular disorders. Because initially false-negative magnetic resonance imagings and subsequent progression are frequent in dorsal medullary infarction, early recognition through scrutinized evaluation is important for proper managements.

Pharmacogenetic study of the effects of NK2R G231E G>A and TBX21 H33Q C>G polymorphisms on asthma control with inhaled corticosteroid treatment

Background and Objective:  Inhaled corticosteroids (ICS) are widely used as maintenance regimens for asthma patients. However, response to ICS shows marked inter‐individual variability. Genetic factors have been shown to be potential predictors of responsiveness to ICS. We aimed to evaluate those pharmacogenetic effects on asthma control in further detail.

Association of TNF-α promoter polymorphisms with aspirin-induced urticaria

Objective:  Although the pathogenesis of aspirin‐induced urticaria (AIU) is not fully understood, mast cell activation has been noted in patients with AIU. Tumour necrosis factor (TNF)‐α, a potent pro‐inflammatory cytokine, is released by human skin mast cells and other inflammatory cells in patients with urticaria. To investigate the role of TNF‐α promoter polymorphisms in the development of AIU, we performed an association study of TNF‐α promoter polymorphisms with AIU phenotype.

Surgical treatment of delayed epilepsy in hemiconvulsion-hemiplegia-epilepsy syndrome

Objective: Hemiconvulsion-hemiplegia-epilepsy (HHE) syndrome is an uncommon consequence of prolonged febrile convulsive seizures in infancy and early childhood. Delayed epilepsy in HHE syndrome is frequently intractable to medical treatment. The present study evaluated the role and prognosis of surgical treatment in patients with delayed epilepsy of HHE syndrome. Methods: We included 26 consecutive patients who were diagnosed with HHE syndrome and underwent surgical treatment for delayed epilepsy at Seoul National University Hospital. The multidisciplinary presurgical evaluations included brain MRI, video-EEG monitoring, FDG-PET, and ictal SPECT. Anterior temporal lobectomy (ATL), cortical resection, functional hemispherectomy, and callosotomy were performed according to the results of presurgical evaluations. Results: Patients were grouped into either the temporal lobe epilepsy (TLE) group (n = 12) or the neocortical/multifocal epilepsy group (n = 14) according to the results of presurgical evaluations. Patients were included in the TLE group if there was strong evidence that the mesial temporal lobe was the only ictal-onset area. The other patients were included in the neocortical/multifocal group. There were no significant differences in demographic characteristics between the two groups. All patients in the TLE group became seizure-free after ATL, but only four patients became seizure-free, and additional two patients showed improvement after various surgical procedures in the neocortical/multifocal group (p = 0.002). Conclusion: Surgical intervention may be helpful in patients with delayed epilepsy in hemiconvulsion-hemiplegia-epilepsy (HHE) syndrome, especially if the mesial temporal lobe appears to be the only epileptogenic area, regardless of the presence of additional abnormalities seen with neuroimaging. Therefore, surgical treatment should be considered for selected patients with delayed epilepsy in HHE syndrome.

Head-shaking and Vibration-induced Nystagmus During and Between the Attacks of Unilateral Ménière's Disease.

Objective To aid in defining each phase of Ménière’s disease (MD) and underlying vestibular pathophysiology by analyzing the evolving patterns of spontaneous, head-shaking (HSN), and vibration-induced nystagmus (VIN) during and between the attacks of MD. Study Design Retrospective case series review. Methods We analyzed the patterns of HSN and VIN during 123 attacks from 87 patients who had definite unilateral MD and underwent recording of eye movements both during and between the attacks using video-oculography. Results HSN tended to beat toward the lesion side during the irritative phase (80.0%) and toward the healthy side during the paretic phase (82.9%). In contrast, VIN was more commonly induced during the irritative phase (63.7%) and more likely beat toward the healthy side irrespective of the phases evaluated (84.3%). Directional dissociation may occur between HSN and VIN, especially during the irritative phase when HSN mostly beat to the lesion side, but VIN is toward the healthy side. Conclusion The characteristic patterns of HSN and VIN during each phase of MD would aid in defining the acute phases of MD and understanding the underlying vestibular pathophysiology.