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ABSTRACT: Previous studies using voxel-based morphometry (VBM) provided emerging evidence of structural changes of the thalamus in idiopathic generalized epilepsy (IGE). However, the location of atrophy within the thalamus in IGE has been somewhat inconsistent across the studies. We, therefore, examined the location of thalamic atrophy and its relationship with clinical factors in IGE, using multiple analytic methods. Fifty IGE patients and 50 controls were scanned on a 3T MRI. Structural evaluation consisted of automated thalamic volumetry, VBM, and thalamic shape analysis. Group comparison between patients and controls was made to assess thalamic atrophy. Within-group correlations between thalamic atrophy and clinical variables were further performed in patients. Both thalamic volumes were reduced in IGE patients, and were negatively correlated with disease duration. The VBM showed a significant regional grey matter volume reduction in bilateral anterior-medial thalami in patients compared to controls. Voxel values extracted from the anterior-medial thalamic cluster were negatively correlated with disease duration. Vertex-based shape analysis revealed regional atrophy on the anterior-medial and posterior-dorsal aspects of thalamus bilaterally in patients compared to controls. Correlation analysis showed that anterior-medial and posterior-dorsal aspects of bilateral thalami were negatively correlated with disease duration. Combining multiple analyses, we demonstrated regional atrophy of anterior-medial and posterior-dorsal thalamus in patients with IGE. Given the anatomical connection of these thalamic regions with the frontal lobe, our finding of greater thalamic atrophy in relation to increasing disease duration further supports the pathophysiological concept of thalamo-frontal network abnormality underlying IGE, and may implicate frontal cognitive dysfunctions and disease progression.
Journal of Neurology 03/2013; · 3.47 Impact Factor
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ABSTRACT: Among the various visuospatial dysfunctions, deficits of stereopsis could be associated with Parkinson's disease. We examined differences in regional gray matter volume between Parkinson's disease patients with normal stereopsis and with abnormal stereopsis to delineate the possible anatomical correlate of stereopsis. Stereopsis was assessed using the Titmus test in 35 drug-naive patients with Parkinson's disease. Voxel-based morphometry was utilized to assess regionally specific differences in gray matter volume between 16 patients with normal stereopsis and 19 patients with abnormal stereopsis. Patients with abnormal stereopsis had a significant gray matter volume reduction in the right extrastriate visual cortex compared with patients with normal stereopsis (P<0.05, corrected for multiple comparisons). Voxel values extracted from the significant cluster in group comparison were negatively correlated with log seconds of arc of the Titmus test (Spearman correlation, P<0.001). Our results suggest that deficits of stereopsis are associated with nondominant extrastriate cortical atrophy and that abnormal stereopsis implicates the cortical visual dysfunction as part of the nonmotor symptoms in Parkinson's disease.
Neuroreport 01/2013; · 1.66 Impact Factor
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ABSTRACT: Background: Although long-term predictors of mortality and vascular events after ischemic stroke are well defined, the age-dependent differences in predicting outcomes are unknown, particularly for lipid parameters. Methods: We assessed recurrent stroke and other vascular events in patients with first-ever ischemic strokes who were registered in a prospectively collected hospital-based stroke registry. Patients were classified into a middle-age group (40-64 years old) and an old-age group (65 years and older). Results: A total of 551 patients comprising 235 middle-age and 316 old-age subjects were investigated. At the mean follow-up of 26.4 months, 49 (8.9%) patients had experienced recurrent stroke. Outcome events in the middle-age group (3.8%) were less frequent than in the old-age group (12.7%). The effects of vascular risk factors were different across age groups. In particular, the hazard ratio direction for triglycerides was significantly different between age groups for recurrent stroke or composite outcomes. Conclusions: Incidence and predictors of stroke and other vascular events following ischemic stroke are age-dependent. Differential effects of triglycerides on long-term outcomes following ischemic stroke were found to be hazardous at middle age but turned out to be non-significant at old age.
European Neurology 12/2012; 69(3):171-178. · 1.81 Impact Factor
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ABSTRACT: Impulse control and repetitive behavior disorders (ICRBs) are a group of diseases including impulse control disorder (ICD), repetitive behavior disorder (RB), and dopamine dysregulation syndrome (DDS). This study determined the prevalence and associated characteristics of ICRBs in Parkinson's disease (PD) patients. Included were 297 patients, interviewed with the questionnaire for impulsive-compulsive disorders in PD for screening of various ICRBs. Questionnaire results and clinical characteristics were analyzed. The ICRB prevalence among PD patients was 15.5 % (46 of 297), with 35 patients with ICD, 20 with RB, and 7 with DDS. Patients with ICRB were predominantly male, younger, taking higher doses of dopaminergic drugs, and had longer disease duration, worse Unified Parkinson's Disease Rating Scale (UPDRS) motor score, and worse PD quality of life questionnaire score. However, each ICRB subtype had different risk factor profiles. ICD patients were predominantly male, younger, had longer disease duration, were affected by PD from young age, were taking higher total dopaminergic drug dosages, and had more RB. RB patients had higher UPDRS part III scores, were taking higher levodopa doses, and had higher comorbid ICD. DDS patients were taking higher dopamine agonist doses, and had more frequent ICD. In multivariate logistic regression for secondary analysis, only younger age and comorbid RB or DDS showed significant association with ICD and only poor UPDRS III score and comorbid ICD were significantly associated with RB. These findings suggested that different risk factors contribute to development of each ICRB subtype. ICRB could be a combination of heterogeneous disease entities that need to be treated separately.
Journal of Neurology 08/2012; · 3.47 Impact Factor
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ABSTRACT: Postural instability is one of the most disabling features of Parkinson's disease, usually occurring in late and advanced stages. The aim of this study was to investigate the postural performance of early-stage de novo Parkinson's disease patients with no clinical postural instability using computerized dynamic posturography. We sought to understand the relationship between postural sway and disease severity and the relationship between postural instability quantitatively measured by computerized dynamic posturography and cognitive impairment in early-stage Parkinson's disease patients.
Thirty-one subjects with Parkinson's disease and 20 healthy controls were assessed by the computerized dynamic posturography protocol using the sensory organization test and the motor control test. A neuropsychological assessment was also administered.
The mean equilibrium score for sensory organization test and the vestibular input ratio were significantly correlated with Hoehn-Yahr stage. No associations between motor latency for any motor control test condition and Hoehn-Yahr stage were found. The equilibrium score for sensory organization test correlated with the mini-mental status examination scores. There was a significant correlation between motor latency for large backward translation and mini-mental status examination scores. There were significant correlations between visual perception/construction/ memory of the neuropsychological battery test and the equilibrium score for sensory organization test and between verbal word learning test, controlled word association test and motor latency for large backward translation.
These findings showed the postural instability present in early-stage (Hoehn-Yahr stage 2-2.5) Parkinson's disease. We also found a close relationship between postural instability and cognitive function in Parkinson's disease patients.
The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques 07/2012; 39(4):473-82. · 0.97 Impact Factor
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ABSTRACT: Previous neuroimaging studies provide growing evidence that patients with juvenile myoclonic epilepsy (JME) have both structural and functional abnormalities of the thalamus and frontal lobe gray matter. However, limited data are available regarding the issue of white matter (WM) involvement, making the microstructural WM changes in JME largely unknown. In the present study we investigated changes of WM integrity in patients with JME, and their relationships with cognitive functions and epilepsy-specific clinical factors.
We performed diffusion tensor imaging (DTI) and neuropsychological assessment in 25 patients with JME and 30 control subjects matched for age, gender, and education level. Between-group comparisons of fractional anisotropy (FA) and mean diffusivity (MD) were carried out in a whole-brain voxel-wise manner by using tract-based spatial statistics (TBSS). In addition, both FA and MD were correlated with cognitive performance and epilepsy-specific clinical variables to investigate the influence of these clinical and cognitive factors on WM integrity changes.
Neuropsychological evaluation revealed that patients with JME had poorer performance than control subjects on most of the frontal function tests. TBSS demonstrated that, compared to controls, patients with JME had significantly reduced FA and increased MD in bilateral anterior and superior corona radiata, genu and body of corpus callosum, and multiple frontal WM tracts. Disease severity, as assessed by the number of generalized tonic-clonic seizures in given years, was negatively correlated with FA and positively correlated with MD extracted from regions of significant differences between patients and controls in TBSS.
Our findings of widespread disturbance of microstructural WM integrity in the frontal lobe and corpus callosum that interconnects frontal cortices could further support the pathophysiologic hypothesis of thalamofrontal network abnormality in JME. These WM abnormalities may implicate frontal cognitive dysfunctions and disease progression in JME.
Epilepsia 06/2012; 53(8):1371-8. · 3.96 Impact Factor
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ABSTRACT: Although the association between elevated C-reactive protein (CRP) level and long-term outcome after ischemic stroke is well known, the association between CRP and early neurologic deterioration (END) has not yet been thoroughly studied. We investigated the impact of CRP on END in patients with acute ischemic stroke. From a prospectively collected, multicenter stroke registry, 428 patients with acute ischemic stroke diagnosed within 24 hours of onset were enrolled in the study. Patients with hemorrhagic stroke, transient ischemic attack, and thrombolysis were excluded. END was defined as a >2-point increase in the National Institutes of Health Stroke Scale score within a 72-hour period. Data considered potentially associated with CRP level and the END were collected. END was observed in 47 patients. CRP level, time before arrival at the hospital, age, female sex, hematocrit, high-density lipoprotein (HDL) cholesterol level, hemoglobin A(1c) level, and internal carotid artery occlusion were significantly associated with END. On logistic regression analysis, CRP level, internal carotid artery occlusion, and HDL cholesterol proved to be independent variables. Our data suggest that CRP level at admission is significantly associated with END in acute ischemic stroke. HDL cholesterol and internal carotid artery occlusion are also associated with END.
Journal of stroke and cerebrovascular diseases: the official journal of National Stroke Association 01/2012; 21(3):181-6.
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ABSTRACT: Free fatty acids (FFAs), an important energy substrate, have an association with cardiovascular diseases, such as atherosclerosis, myocardial dysfunction and abnormal cardiac rhythm. However, limited reports are available on the association between FFAs and ischemic stroke. We hypothesized that plasma FFA concentration could be associated with an ischemic stroke, emphasizing the relationship between FFA and subtypes of ischemic stroke.
A cross-sectional study examined the association between FFA concentration and subtypes of stroke and cerebral atherosclerosis from a hospital-based acute stroke registry.
Data of 715 stroke patients were analyzed. The concentration of FFA was highest in the cardioembolic stroke subtype compared with the other stroke subtypes. Logistic regression analysis revealed that an increase in FFA concentration was significantly associated with the cardioembolic subtype after the adjustment of covariates. FFA concentration was also higher in patients with atrial fibrillation (AF) than those without AF. According to the presence of atherosclerotic stenosis, no significantly difference of FFA concentration was found for intracranial and extracranial cerebral arterial atherosclerosis.
Here we report a significant association between fasting FFA concentration and the cardioembolic stroke subtype. AF is suggested as the mediating factor between FFA and the cardioembolic stroke subtype.
The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques 11/2011; 38(6):874-9. · 0.97 Impact Factor
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ABSTRACT: Most cardinal motor signs in Parkinson's disease (PD) are more pronounced on one side than on the other. Unusually, one type of cardinal motor sign is found on one side while other motor signs are more pronounced on the contralateral side, the so-called dissociation of motor signs. The aims of this study were to determine the frequency of motor sign dissociation and to study the clinical characteristics of the dissociation group. To this end, clinical characteristics including the Unified Parkinson's Disease Rating Scale, Mini-Mental State Examination, Non-Motor Symptom Questionnaire and Frontal Lobe Assessment Battery were analyzed for 411 patients during consecutive follow-up visits. Dissociation was noted in 29 (7.06%) of the 411 patients. Dissociation of tremor and rigidity-bradykinesia was the most common type of dissociation pattern (17/29). There were no significant differences in demographic factors and clinical profiles between the dissociation and control groups. We suspect that each cardinal motor sign is pathogenetically different. The presence of dissociation did not affect the natural history of PD.
European Neurology 01/2010; 63(5):307-10. · 1.81 Impact Factor
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ABSTRACT: To investigate the difference in the spatial distribution of scalp initial ictal discharge (IID) patterns in mesial temporal lobe epilepsy with hippocampal sclerosis (HS-MTLE).
Scalp ictal EEG data in 22 seizure-free patients after temporal lobectomy with amygdalo-hippocampectomy were classified as follows: a regular 5-9Hz rhythm with a restricted temporal/subtemporal distribution (type 1, 11 patients), or an irregular 2-5Hz rhythm with a widespread fronto-temporal distribution (type 2, 11 patients). EEG data were fragmented into segments of 1.28s, both at ictal onset and at baseline. The LORETA solution of three frequency bands was compared between ictal and baseline using statistical non-parametric mapping (p<0.01).
The LORETA solution of 5-9Hz in type 2 had wider cortical activity in the ipsilateral fronto-temporal area, compared to type 1 with activation of the ipsilateral focal mesial and lateral temporal regions. The LORETA solution of 10-13Hz in both types showed increased activity in the fronto-temporal area, which was wider in type 2 than type 1. Increased cortical activity of <5Hz was not observed in type 1, whereas increased cortical activity was observed in the bilateral anterior frontal area in type 2.
The cortical source distribution in HS-MTLE may depend on scalp IID frequency. The neural generators of 5-13Hz may be important for the formation of the ictal onset zone in both ictal patterns.
Spatial distributions in HS-MTLE patients differ with scalp IID frequency.
Clinical neurophysiology: official journal of the International Federation of Clinical Neurophysiology 09/2009; 120(10):1797-805. · 3.12 Impact Factor
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ABSTRACT: The aim of present study was to identify the common propagation pattern of ictal discharges in mesial temporal lobe epilepsy (TLE). Pre-surgical ictal scalp EEG recordings were collected from patients with TLE associated with hippocampal sclerosis. Two types of ictal onset patterns were identified based on spatial and spectral characteristics of initial ictal discharge waveforms: (a) a sustained regular 5- to 9-Hz rhythm with a restricted temporal or subtemporal distribution (type 1); and (b) an irregular 2- to 5-Hz rhythm with a widespread distribution (type 2). Scalp EEG data were decomposed into temporally independent, spatially fixed component by independent component analysis. The identified source activities corresponding to ictal discharges from each seizure were localized by dipole source localization, and dipole sources with similar spatial locations were clustered. To identify the sequence of propagation among component clusters during the progress of seizures, event-related spectral perturbation by wavelet transform was used. Fifty-five seizures (22 seizures in four Type 1 patients and 33 seizures in eight Type 2 patients) in 12 patients were analyzed. Ictal discharges associated with type 1 seizures arose from both the anterior temporal region and basal ganglia, and then spread into medial frontal region. The dominant frequency of ictal rhythm was in the theta range and remained relatively constant until the middle portion of seizures. Type 2 seizures developed bilaterally or predominantly in the ipsilateral medial temporal region, followed by the medial frontal region and basal ganglia. The dominant frequency of ictal activity at the onset of seizure was in the delta range. However, rhythmic theta activities with decreasing tendency ensued rapidly after seizure onset. These findings suggest that TLE associated with hippocampal sclerosis may have preferential propagating patterns according to the type of the ictal onset pattern.
Brain research 07/2009; 1287:206-19. · 2.46 Impact Factor
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ABSTRACT: This study was to explore the relationship between scalp ictal EEG patterns and interictal hypometabolic patterns in hippocampal sclerosis-associated mesial temporal lobe epilepsy (HS-MTLE) and determine the clinical significance of interictal hypometabolic patterns. Twenty-five patients were classified into 2 groups based on initial ictal discharge (IID) frequency on scalp EEG: (a) those with a sustained regular 5- to 9-Hz rhythm with a restricted temporal or subtemporal distribution (group 1, N=9); and (b) those with an irregular 2- to 5-Hz rhythm with a widespread distribution (group 2, N=16). Using statistical parametric mapping, the PET results of each group were compared with age- and sex-matched controls to identify regions of significant hypometabolism, and the clinical characteristics were compared. Group 1 showed focal hypometabolism confined to the ipsilateral temporal lobe, whereas group 2 showed widespread hypometabolism in the ipsilateral temporal lobe, insular cortex and anterior part of the putamen. The two groups showed no significant differences in clinical characteristics. Among semiologic features, dystonic limb posturing was more frequently observed in group 2 (p=0.03). In summary, scalp EEG IID patterns in HS-MTLE can be important in determining hypometabolic patterns on interictal PET. Differences in hypometabolic patterns may reflect preferential pathways of ictal propagation rather than intrinsic epileptogenic regions.
Epilepsy research 04/2009; 84(2-3):187-93. · 2.48 Impact Factor
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ABSTRACT: The prevalence of a history of shoulder complaints is higher in patients with Parkinson's disease (PD) than in healthy individuals. The aims of this study were to evaluate shoulder disease in PD patients with ultrasonography (US) and to identify the relationship between the US findings of shoulder disease and the motor signs in patients with PD. Thirty-three PD patients completed a shoulder disability questionnaire, a musculoskeletal examination, and US of the shoulder. Twenty-two patients had abnormal US findings. Tendon tearing was the most common abnormal US finding (22/22), and the supraspinatus tendon was the most common site involved (15/22). Patients with tendon tearing had a significantly longer duration of disease than patients without tendon tearing (P = 0.027). Patients with adhesive capsulitis had a significantly higher rigidity score than patients without adhesive capsulitis (P = 0.035). Disease duration and rigidity were the contributing factors for the development of tendon tearing and adhesive capsulitis, respectively.
Movement Disorders 09/2008; 23(12):1772-6. · 4.51 Impact Factor
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ABSTRACT: Cortical laminar necrosis (CLN) is radiologically characterized by hyperintense cortical lesions on unenhanced T1-weighted images. Hypoxia is the representative cause of CLN; however, the rapid correction of hyponatremia has also been suggested as another possible cause. We present a patient who developed CLN and a permanent neurologic sequel following the rapid correction of hyponatremia without hypoxic insult, and discuss the characteristics of CLN lesions in view of osmotic demyelination syndrome based on magnetic resonance (MR) image findings.
Journal of neuroimaging: official journal of the American Society of Neuroimaging 06/2008; 19(2):185-7. · 1.72 Impact Factor
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ABSTRACT: Orthostatic headache is a key symptom of intracranial hypotension; however, not all orthostatic headaches are caused by cerebrospinal fluid leaks leading to intracranial hypotension. We report here the unusual case of a 68-year-old man presenting with orthostatic headache in which compression of the C3 spinal nerve root by metastatic tumor invasion may contribute to the development of his orthostatic headache.
Headache The Journal of Head and Face Pain 02/2008; 48(1):161-3. · 2.52 Impact Factor
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ABSTRACT: To investigate potential risk factors for hemodynamic depression (HD) in elective carotid angioplasty with stenting (CAS) by using multidetector computed tomography (MDCT) angiographic findings and clinical data.
A retrospective study was conducted for 32 patients that underwent MDCT angiography before CAS in our hospital. We reviewed the MDCT angiographic findings to evaluate parameters including total plaque volume, composition and the composition ratio of plaque, degree of stenosis, and distance of the most stenotic portion from carotid bifurcation. Clinical data such as patient age, presence of neurological symptoms, underlying medical disease, smoking history, and previous stroke history were noted. The MDCT angiographic parameters and clinical data were then analyzed to determine a prediction for periprocedural HD (systolic blood pressure, <90 mm Hg; or heart rate, <40 beats/min).
Periprocedural HD was observed in 9 patients (28.1%). Among the MDCT angiographic parameters, the hemodynamic unstable group of patients had a smaller total plaque volume than that of stable group of patients (P = 0.04). The other MDCT parameters and clinical data did not show statistically significant difference between 2 groups.
In this study, only the total volume of plaque was a positive factor for predicting HD during CAS. Multidetector computed tomography angiography can be helpful for predicting HD during CAS.
Journal of Computer Assisted Tomography 12/2007; 32(1):124-9. · 1.22 Impact Factor
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ABSTRACT: Visual assessment of structural MRI is, by definition, normal in patients with juvenile myoclonic epilepsy (JME), a major subsyndrome of idiopathic generalized epilepsy (IGE). However, recent quantitative MRI studies have shown structural abnormalities in cortical and thalamic grey matter (GM) in JME. Voxel-based morphometry (VBM) is a fully automated, unbiased, operator-independent MRI analysis technique that detects regionally specific differences in brain tissue composition on a voxel-wise comparison between groups of subjects. Using VBM, we examined structural differences in cortical and subcortical GM volume (GMV) between 25 JME patients (15 women, mean age=22.7+/-5.1 years) and age- and sex-matched 44 control subjects (27 women, mean age=23.1+/-4.3 years). We also performed a correlation analysis to delineate a possible relationship between the GMV increases or reductions and the increasing duration of epilepsy. Group comparison showed GMV increases in the superior mesiofrontal region bilaterally and GMV reductions in the thalamus bilaterally in JME patients (P<0.05, corrected for multiple comparisons using false discovery rate). Correlation analysis revealed that bilateral thalamic GMV had negative correlations with the duration of epilepsy (P<0.05, corrected for multiple comparisons after small volume corrections; P<0.05, Pearson correlation test). Our findings of GMV increases in the superior mesiofrontal regions and progressive thalamic atrophy could further support the pathophysiological concept of the functional abnormalities in thalamocortical circuit in JME.
NeuroImage 11/2007; 37(4):1132-7. · 5.89 Impact Factor
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Neurology 04/2007; 68(13):1074. · 8.31 Impact Factor
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ABSTRACT: Lesions involving the splenium of the corpus callosum (SCC) have been rarely reported in cases of hypoglycemic brain injury.
We identified signal abnormalities in the SCC in three adult patients with hypoglycemic encephalopathy by using diffusion-weighted imaging (DWI) on a 1.5-T MR scanner. Repeat DWI was performed in all patients following a marked clinical improvement, and MR angiography and routine MRI were also performed. We examined each patient's detailed medical history and blood laboratory tests in order to exclude other conditions causing similar SCC abnormalities.
Initial DWI was performed during which each patient showed altered mental status that was attributed to profound hypoglycemia. We observed an identical pattern of DWI abnormality characterized by high signals in the SCC with apparent diffusion coefficient reductions that were reversed completely within several days following appropriate correction of hypoglycemia. T2-weighted or FLAIR images also showed no residual lesion in the SCC and MR angiography was normal in all patients.
These case reports suggest that the SCC should be added to the list of selective vulnerability to hypoglycemia and that hypoglycemia, in turn, be included in the differential diagnosis of reversible SCC abnormalities.
Neuroradiology 04/2007; 49(3):217-22. · 2.82 Impact Factor
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ABSTRACT: The aims of the present study were to explore the relation between ictal scalp EEG patterns and ictal hyperperfusion patterns in patients with unilateral hippocampal sclerosis-associated mesial temporal lobe epilepsy (HS-MTLE) by using semiquantitative single-photon emission computed tomography (SPECT) analysis and to assess clinical significance of ictal hyperperfusion patterns.
We studied retrospectively 39 consecutive patients with surgically proven HS-MTLE. All had both interictal and ictal SPECTs with the tracer injection during a complex partial seizure (CPS) typical of MTLE semiology. According to initial ictal discharge (IID) frequency on scalp EEG, two lateralizing patterns were identified: (a) a sustained regular 5- to 9-Hz rhythm with a restricted temporal or subtemporal distribution (group 1); and (b) an irregular 2- to 5-Hz rhythm with a widespread distribution (group 2). We performed group analysis by using statistical parametric mapping (SPM) of paired ictal-interictal SPECTs to identify regions of significant ictal hyperperfusion and compared clinical characteristics, tracer-injection time, semiology, pathologic HS grade, and surgical outcome between two groups.
Of the 39 patients, 19 patients (10 males, nine right HS) were designated as group 1, and the remaining 20 patients (eight males, seven right HS), group 2. Group 1 showed hyperperfusion mainly confined to the ipsilateral temporal lobe, whereas group 2 showed widespread hyperperfusion in the extratemporal structures such as ipsilateral basal ganglia, brainstem, and bilateral thalamus, in addition to the ipsilateral temporal lobe. No significant difference was found between two groups in clinical characteristics, injection time, pathologic HS grade, and surgical outcome. Among semiologic features, dystonic limb posturing was more frequently observed in group 2 (p = 0.006).
Scalp EEG IID frequency in HS-MTLE can be an important determining factor of ictal hyperperfusion patterns. The lack of difference in surgical outcome between two groups implies that different hyperperfusion patterns, according to their IID frequencies, reflect only preferential pathways of ictal propagation rather than intrinsic epileptogenic region.
Epilepsia 03/2007; 48(2):270-7. · 3.96 Impact Factor
