Publications by authors named "Kang Min Park"

92 Publications

Existence and Significance of Internal Border Zone Infarcts with Accessory Lesions Located in the Anteromedial Temporal Lobe.

J Stroke Cerebrovasc Dis 2021 Jul 26;30(10):106004. Epub 2021 Jul 26.

Department of Neurology, UCLA Stroke Center, University of California, 635 Charles E. Young Drive South, Suite 225, Los Angeles, CA 90095, USA. Electronic address:

Objectives: To examine the existence and significance of internal border zone (IBZ) infarcts with accessory lesions in the anteromedial temporal lobe (ATL).

Materials And Methods: IBZ infarcts located at the corona radiata were selected based on diffusion-weighted imaging of 2535 consecutive patients with ischemic stroke and the presence of lesions in the ATL was identified. The Mann-Whitney U test, Student t-test, Pearson χ test, or Fisher exact test was used to analyze differences between the IBZ infarct groups with and without accessory lesions in the ATL.

Results: Thirty-six of 2535 patients (1.4%) had IBZ infarcts. The IBZ group with accessory lesions in the ATL (17 cases, 47.2%) showed a higher portion of occluded middle cerebral arteries than the IBZ group without accessory lesions in the ATL (p = 0.02). The initial National Institutes of Health Stroke Scale score (odds ratio, 2.03; 95% confidence interval, 1.04-3.99;   = 0.039) and progression after admission (odds ratio, 25.43; 95% confidence interval, 2.47-261.99; p = 0.007) were independently associated with poor prognosis in patients with IBZ infarcts. There were no differences in the progression rate and clinical outcomes, regardless of the presence of lesions in the ATL.

Conclusions: Our study suggests the existence of a distinct type of IBZ infarct characterized by accessory lesions in the ATL, which is associated with different arterial features but has a similar clinical course to IBZ infarcts without accessory lesions in the ATL.
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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2021.106004DOI Listing
July 2021

Network differences based on arterial spin labeling related to anti-seizure medication response in focal epilepsy.

Neuroradiology 2021 Jul 12. Epub 2021 Jul 12.

Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Haeundae-ro 875, Haeundae-gu, Busan, 48108, Korea.

Purpose: The aim of this study was to determine whether anti-seizure medication (ASM) response is associated with structural connectivity in diffusion tensor imaging (DTI) or functional co-variance network in arterial spin labeling (ASL) magnetic resonance imaging (MRI) in patients with focal epilepsy.

Methods: In this retrospective study conducted at a tertiary hospital, we enrolled 105 patients with focal epilepsy, of which 64 patients were good ASM responders, and 41 patients were poor ASM responders. All patients showed normal MRI findings on visual inspection and underwent DTI and ASL MRI from August 2018 to July 2020, with regular follow-up for at least 12 months after epilepsy diagnosis while taking ASMs. We calculated the structural connectivity based on DTI and functional co-variance network based on ASL MRI by using graph theory and analyzed their differences in relation to the ASM response.

Results: No differences were observed in structural connectivity between the good and poor ASM responders. However, significant differences were observed in functional co-variance network between the good and poor ASM responders. In comparison with good ASM responders, poor ASM responders showed a significantly greater characteristic path length (2.557 vs. 1.753, p = 0.034) and a lower local efficiency (2.311 vs. 3.927, p = 0.048).

Conclusion: Significant differences were observed in functional co-variance network based on ASL MRI between the good and poor ASM responders. These findings suggest that functional co-variance network could serve as a new biomarker of ASM response in focal epilepsy.
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http://dx.doi.org/10.1007/s00234-021-02741-8DOI Listing
July 2021

Application of machine learning analysis based on diffusion tensor imaging to identify REM sleep behavior disorder.

Sleep Breath 2021 Jul 8. Epub 2021 Jul 8.

Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Haeundae-ro 875, Haeundae-gu, Busan, 48108, Korea.

Purpose: We evaluated the feasibility of machine learning analysis using diffusion tensor imaging (DTI) parameters to identify patients with idiopathic rapid eye movement (REM) sleep behavior disorder (RBD). We hypothesized that patients with idiopathic RBD could be identified via machine learning analysis based on DTI.

Methods: We enrolled 20 patients with newly diagnosed idiopathic RBD at a tertiary hospital. We also included 20 healthy subjects as a control group. All of the subjects underwent DTI. We obtained the conventional DTI parameters and structural connectomic profiles from the DTI. We investigated the differences in conventional DTI measures and structural connectomic profiles between patients with idiopathic RBD and healthy controls. We then used machine learning analysis using a support vector machine (SVM) algorithm to identify patients with idiopathic RBD using conventional DTI and structural connectomic profiles.

Results: Several regions showed significant differences in conventional DTI measures and structural connectomic profiles between patients with idiopathic RBD and healthy controls. The SVM classifier based on conventional DTI measures revealed an accuracy of 87.5% and an area under the curve of 0.900 to identify patients with idiopathic RBD. Another SVM classifier based on structural connectomic profiles yielded an accuracy of 75.0% and an area under the curve of 0.833.

Conclusion: Our findings demonstrate the feasibility of machine learning analysis based on DTI to identify patients with idiopathic RBD. The conventional DTI parameters might be more important than the structural connectomic profiles in identifying patients with idiopathic RBD.
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http://dx.doi.org/10.1007/s11325-021-02434-9DOI Listing
July 2021

Alterations of the intrinsic amygdala-hippocampal network in juvenile myoclonic epilepsy.

Brain Behav 2021 Jul 5. Epub 2021 Jul 5.

Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.

Introduction: Several lines of evidence suggest that the amygdala-hippocampus is involved in the epileptogenic network of juvenile myoclonic epilepsy (JME). The aim of this study was to investigate the alterations in the individual nuclei of the amygdala and hippocampal subfields, and the intrinsic amygdala-hippocampal network of patients with JME compared to healthy controls.

Methods: This retrospective study conducted at a single tertiary hospital involved 35 patients with newly diagnosed JME, and 34 healthy subjects. We calculated the individual structural volumes of 18 nuclei in the amygdala, and 38 hippocampal subfields using three-dimensional volumetric T1-weighted imaging and FreeSurfer program. We also performed an analysis of the intrinsic amygdala-hippocampal global and local network based on these volumes using a graph theory and Brain Analysis using Graph Theory (BRAPH) program. We investigated the differences in these volumes and network measures between patients with JME and healthy controls.

Results: There were no significant volume differences in the nuclei of the amygdala and hippocampal subfields between patients with JME and healthy controls. However, we found significant differences in the global network between patients with JME and healthy controls. The mean clustering coefficient was significantly decreased in patients with JME compared to healthy controls (0.473 vs. 0.653, p = .047). In addition, specific regions in the hippocampal subfields showed significant differences in the local network between the two groups. The betweenness centrality of the right CA1-head, right hippocampus-amygdala-transition area, left hippocampal fissure, left fimbria, and left CA3-head, was increased in patients with JME compared to healthy controls.

Conclusion: The intrinsic amygdala-hippocampal global and local networks differed in patients with JME compared to healthy controls, which may be related to the pathogenesis of JME, and memory dysfunction in patients with JME.
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http://dx.doi.org/10.1002/brb3.2274DOI Listing
July 2021

Brain networks in patients with isolated or recurrent transient global amnesia.

Acta Neurol Scand 2021 Jun 15. Epub 2021 Jun 15.

Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.

Objectives: The aim of this study was to investigate differences in cerebral blood flow (CBF) and functional networks between transient global amnesia (TGA) patients with a single event and those with recurrent events using arterial spin labeling (ASL) MRI.

Methods: We enrolled patients with TGA and classified them into two groups according to the number of TGA events: TGA patients with a single event and those with recurrent events. MRI scans were performed within 24 h after TGA ictal onset in all patients. We quantified CBF and analyzed the functional network based on CBF using graph theory, and determined the differences in CBF and functional networks between the groups.

Results: We enrolled 44 patients with TGA. Among them, 6 patients had recurrent TGA events, whereas 38 patients had a single TGA event. No regions had significantly different CBFs between TGA patients with recurrent events and those with a single event. The global functional network analysis found that the eccentricity was significantly higher in TGA patients with recurrent events than in those with a single event (5.829 vs. 4.657, p = .001). The local functional network analysis showed that several regions had significantly different betweenness centrality and eccentricity measures between TGA patients with recurrent events and those with a single event.

Conclusions: We demonstrated the differences in the functional network based on CBF using graph theory according to recurrence in patients with TGA. These findings suggest that TGA is a network disease, and functional network alterations in TGA are related to clinical symptoms.
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http://dx.doi.org/10.1111/ane.13490DOI Listing
June 2021

Significance of serum neuron-specific enolase in transient global amnesia.

J Clin Neurosci 2021 Jul 29;89:15-19. Epub 2021 Apr 29.

Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea. Electronic address:

Neuron-specific enolase (NSE) is a glycolytic enzyme, which is associated with neuronal cell dysfunction in the brain. This study evaluated the role of serum NSE levels of patients with transient global amnesia (TGA). In addition, the relationship between serum NSE levels and the clinical features of TGA was explored. Forty-eight patients with TGA were prospectively included, and their serum NSE levels were measured. We investigated serum NSE levels in patients with TGA. In addition, we analyzed the differences in clinical characteristics between patients with elevated and normal serum NSE levels. Of the 48 patients with TGA, 16 patients (33.3%) had elevated serum NSE levels (25.0 ± 11.5 ng/mL), whereas 32 patients (66.7%) showed normal serum NSE levels (12.8 ± 2.1 ng/mL). The patients with elevated serum NSE levels exhibited higher levels of cognitive impairment than those with normal serum NSE levels (4/16 vs. 1/32, p = 0.036). The serum NSE levels showed a relatively high discrimination (AUC 0.684) between patients with and without cognitive impairment, with 80.0% sensitivity and 74.4% specificity at a cut-off value 17.3 ng/mL. A third of all patients with TGA carry elevated serum NSE levels, which suggests that the neuronal cell dysfunction could be associated with TGA pathogenesis. In addition, it might be correlated with cognitive impairment.
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http://dx.doi.org/10.1016/j.jocn.2021.04.012DOI Listing
July 2021

Temporal lobe epilepsy with or without hippocampal sclerosis: Structural and functional connectivity using advanced MRI techniques.

J Neuroimaging 2021 Jun 10. Epub 2021 Jun 10.

Department of Neurology and Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.

Background And Purpose: The aim of this study was to investigate the differences in structural connectivity based on diffusion tensor imaging (DTI) and functional connectivity based on arterial spin labeling (ASL) MRI between temporal lobe epilepsy (TLE) patients with and without hippocampal sclerosis (HS).

Methods: We enrolled 50 patients with TLE, including 25 patients with HS and 25 patients without HS, who underwent brain MRI, including DTI and ASL. We calculated the network parameters of structural connectivity based on DTI and functional connectivity based on ASL using a graph theoretical analysis. The parameters included global network measures (radius, diameter, characteristic path length, global efficiency, local efficiency, mean clustering coefficient, transitivity, assortative coefficient, and small-worldness index) and a local network measure (betweenness centrality).

Results: The global and local network measures of structural connectivity were not different between TLE patients with and without HS. However, significant differences in functional connectivity existed between the two groups. The radius and diameter of the global network measures in the TLE patients with HS were significantly increased compared with those without HS (4.140 vs. 3.140, p = 0.045; 6.812 vs. 5.132, p = 0.049; respectively). No differences were detected between other global network measures of functional connectivity and local network measure.

Conclusions: Significant differences in global network measures of functional connectivity based on ASL existed between TLE patients with and without HS. These findings suggest that TLE patients with HS exhibit a more disconnected functional brain network than those without HS.
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http://dx.doi.org/10.1111/jon.12898DOI Listing
June 2021

Alterations of the structural covariance network in the hypothalamus of patients with cluster headache.

J Neurol 2021 May 30. Epub 2021 May 30.

Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Haeundae-ro 875, Haeundae-gu, Busan, 48108, Republic of Korea.

Objective: The hypothalamus is one of the key structures involved in the pathophysiology of cluster headaches. This study aimed to analyze the volume of hypothalamic subunits and structural covariance networks in the hypothalamus of patients with cluster headache.

Methods: We retrospectively enrolled 18 patients with episodic cluster headache and 18 age- and sex-matched healthy controls. We calculated individual structural volumes in ten hypothalamic subunits using three-dimensional T1-weighted imaging and the FreeSurfer program, which conducted an automated segmentation based on deep convolutional neural networks. We also performed an analysis of the structural covariance network in the hypothalamus using graph theory and the BRAPH program. We compared the volumes of hypothalamic subunits and structural covariance networks in the hypothalamus of patients with cluster headache versus those of healthy controls.

Results: There were no significant differences in the structural volumes of the whole hypothalamus and hypothalamic subunits between patients with cluster headache and healthy controls. However, patients with cluster headache had significant alterations of the structural covariance network in the hypothalamus compared to that of healthy controls. The network measure of small-worldness index in patients with cluster headache was lower than that in healthy controls (0.844 vs. 0.955, p = 0.004).

Conclusion: We demonstrated a significant difference in the structural covariance network in the hypothalamus of patients with cluster headache versus those of healthy controls. These findings could be related to the pathogenesis of cluster headache.
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http://dx.doi.org/10.1007/s00415-021-10629-zDOI Listing
May 2021

Alteration of brain connectivity in neurologically asymptomatic patients with chronic kidney disease.

Medicine (Baltimore) 2021 Apr;100(16):e25633

Department of Internal Medicine.

Abstract: Our previous study demonstrated that patients with end-stage renal disease had decreased structural and functional brain connectivity, and there was a significant association between brain connectivity and cognitive function. The aim of this study was to evaluate the alterations of structural and functional connectivity using graph theoretical analysis in neurologically asymptomatic patients with relatively early-stage chronic kidney disease (CKD).We enrolled 18 neurologically asymptomatic patients with early CKD and 28 healthy controls. All the subjects underwent diffusion-tension imaging and resting functional magnetic resonance imaging. We calculated structural and functional connectivity based on diffusion-tension imaging and resting functional magnetic resonance imaging using a graph theoretical analysis. Then, we investigated differences of structural and functional connectivity between the CKD patients and the healthy controls.All the measures of structural connectivity were significantly different between the patients with CKD and healthy controls. The global efficiency, local efficiency, mean clustering coefficient, and small-worldness index were decreased, whereas the characteristic path length was increased in the patients with CKD compared with healthy controls. The structural betweenness centrality of the left calcarine and right posterior cingulum was also significantly different from that in healthy participants. However, all the measures of global functional connectivity in patients with CKD were not different from those in healthy controls. In patients with CKD, the functional betweenness centrality of the right insular cortex, right occipital pole, and right thalamus was significantly different from that in healthy participants.There are significant alterations of the global structural connectivity between the patients with CKD and the healthy subjects, whereas the global functional connectivity of the brain network is preserved. We find that the efficiency of the structural brain network is decreased in the patients with CKD.
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http://dx.doi.org/10.1097/MD.0000000000025633DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8078245PMC
April 2021

Artificial intelligence with kidney disease: A scoping review with bibliometric analysis, PRISMA-ScR.

Medicine (Baltimore) 2021 Apr;100(14):e25422

Department of Neurology, Inje University Haeundae Paik Hospital, Busan, Korea.

Background: Artificial intelligence (AI) has had a significant impact on our lives and plays many roles in various fields. By analyzing the past 30 years of AI trends in the field of nephrology, using a bibliography, we wanted to know the areas of interest and future direction of AI in research related to the kidney.

Methods: Using the Institute for Scientific Information Web of Knowledge database, we searched for articles published from 1990 to 2019 in January 2020 using the keywords AI; deep learning; machine learning; and kidney (or renal). The selected articles were reviewed manually at the points of citation analysis.

Results: From 218 related articles, we selected the top fifty with 1188 citations in total. The most-cited article was cited 84 times and the least-cited one was cited 12 times. These articles were published in 40 journals. Expert Systems with Applications (three articles) and Kidney International (three articles) were the most cited journals. Forty articles were published in the 2010s, and seven articles were published in the 2000s. The top-fifty most cited articles originated from 17 countries; the USA contributed 16 articles, followed by Turkey with four articles. The main topics in the top fifty consisted of tumors (11), acute kidney injury (10), dialysis-related (5), kidney-transplant related (4), nephrotoxicity (4), glomerular disease (4), chronic kidney disease (3), polycystic kidney disease (2), kidney stone (2), kidney image (2), renal pathology (2), and glomerular filtration rate measure (1).

Conclusions: After 2010, the interest in AI and its achievements increased enormously. To date, AIs have been investigated using data that are relatively easy to access, for example, radiologic images and laboratory results in the fields of tumor and acute kidney injury. In the near future, a deeper and wider range of information, such as genetic and personalized database, will help enrich nephrology fields with AI technology.
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http://dx.doi.org/10.1097/MD.0000000000025422DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8036048PMC
April 2021

Identification of focal epilepsy by diffusion tensor imaging using machine learning.

Acta Neurol Scand 2021 Jun 18;143(6):637-645. Epub 2021 Mar 18.

Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.

Objective: The aim of this study was to evaluate the feasibility of machine learning based on diffusion tensor imaging (DTI) measures to distinguish patients with focal epilepsy versus healthy controls and antiseizure medication (ASM) responsiveness.

Methods: This was a retrospective study performed at a tertiary hospital. We enrolled 456 patients with focal epilepsy, who underwent DTI and were taking ASMs. We enrolled 100 healthy subjects as a control. We obtained the conventional DTI measures and structural connectomic profiles from the DTI.

Results: The support vector machine (SVM) classifier based on the conventional DTI measures revealed an accuracy of 76.5% and an area under curve (AUC) of 0.604 (95% Confidence interval (CI), 0.506-0.695). Another SVM classifier combined with structural connectomic profiles demonstrated an accuracy of 82.8% and an AUC of 0.701 (95% CI, 0.606-0.784). Of the 456 patients with epilepsy, 242 patients were ASM good responders, whereas 214 patients were ASM poor responders. In the classification of the ASM responders, an SVM classifier based on the conventional DTI measures revealed an accuracy of 54.9% and an AUC of 0.551 (95% CI, 0.443-0.655). Another SVM classifier combined with structural connectomic profiles demonstrated an accuracy of 59.3% and an AUC of 0.594 (95% CI, 0.485-0.695).

Conclusion: DTI using a machine learning is useful for differentiating patients with focal epilepsy from healthy controls, but it cannot classify ASM responsiveness. Combining structural connectomic profiles results in a better classification performance than the use of conventional DTI measures alone for identifying focal epilepsy and ASM responsiveness.
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http://dx.doi.org/10.1111/ane.13407DOI Listing
June 2021

Quantitative gait and postural analyses in patients with diabetic polyneuropathy.

J Diabetes Complications 2021 Apr 17;35(4):107857. Epub 2021 Jan 17.

Department of Neurology, Haeundae-Paik Hospital, Inje University, College of Medicine, Busan, Republic of Korea. Electronic address:

Background: Although gait disturbances are relatively common symptoms in diabetic polyneuropathy (DPN), few studies have quantitatively analyzed gait and posture in DPN patients. This study aimed to analyze gait and posture quantitatively in DPN patients and to determine the association between clinical and electrophysiological parameters and gait and posture parameters.

Methods: Sixty-four DPN patients were enrolled in this study. DPN was clinically assessed using the Toronto clinical neuropathy score (TCNS). All participants underwent nerve conduction study (NCS), three-dimensional motion analysis, and static posturography. We evaluate the correlation of gait and posture parameters with electrophysiological and clinical parameters.

Results: Foot height, step length, and stride length among gait parameters were inversely correlated with the TCNS. Anteroposterior range during eyes-closed and mediolateral distance and range during eyes-open and eyes-closed were inversely correlated with the sensory nerve action potential amplitude in the sural nerve. Mediolateral distance during eyes-open and eyes-closed was correlated with the compound muscle action potential amplitude in the peroneal nerve.

Conclusions: Gait parameters are associated with clinical parameters, and postural parameters are associated with electrophysiological parameters, particularly sensory NCS. Gait and postural analysis can be a useful tool for assessing the neurological status in DPN patients.
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http://dx.doi.org/10.1016/j.jdiacomp.2021.107857DOI Listing
April 2021

Effective connectivity alteration according to recurrence in transient global amnesia.

Neuroradiology 2021 Jan 23. Epub 2021 Jan 23.

Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Haeundae-ro 875, Haeundae-gu, Busan, Republic of Korea.

Purpose: This study aimed to evaluate alterations in structural covariance network and effective connectivity of the intrahippocampal circuit in patients with transient global amnesia (TGA). We also investigated whether there were differences of them according to recurrence.

Methods: We enrolled 88 patients with TGA and 50 healthy controls. We classified patients with TGA into two groups: the single event group (N = 77) and recurrent events group (N = 11). We performed volumetric analysis using the FreeSurfer program and structural covariance network analysis based on the structural volumes using a graph theoretical analysis in patients with TGA and healthy controls. The effective connectivity of the intrahippocampal circuit was also evaluated using structural equation modeling.

Results: There were no significant differences between patients with all TGA events/a single TGA event and healthy controls with regard to global structural covariance network. However, patients with recurrent events had significant alterations in global structural covariance network with a decrease in the small-worldness index (0.907 vs. 0.970, p = 0.032). In patients with all events/a single, there were alterations in effective connectivity from the entorhinal cortex to CA4, only. However, in patients with recurrent events, there were alterations in effective connectivity from the subiculum to the fimbria as well as from the entorhinal cortex to CA4 in bilateral hemispheres.

Conclusion: Our study revealed significant alterations in structural covariance network and disruption of the intrahippocampal circuit in patients with TGA compared to healthy controls, which is more prominent when amnestic events recurred. It could be related to the pathogenesis of TGA.
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http://dx.doi.org/10.1007/s00234-021-02645-7DOI Listing
January 2021

An investigation of thalamic nuclei volumes and the intrinsic thalamic structural network based on motor subtype in drug naïve patients with Parkinson's disease.

Parkinsonism Relat Disord 2020 12 4;81:165-172. Epub 2020 Nov 4.

Department of Neurosurgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea. Electronic address:

Introduction: This study aimed to investigate the alterations in thalamic nuclei volumes and the intrinsic thalamic structural network in patients with de novo Parkinson's disease (PD) based on their predominant symptoms.

Methods: We enrolled 65 patients with de novo PD (44 patients with tremor-dominant [TD] subtype and 21 patients with postural instability and gait disturbance [PIGD] subtype) and 20 healthy controls. All subjects underwent three-dimensional T1-weighted magnetic resonance imaging. The thalamic nuclei were segmented using the FreeSurfer program.

Results: We obtained volumetric differences in the thalamic nuclei of each subtype of PD in comparison of healthy control. Volumes of the right and left suprageniculate nuclei were significantly increased, whereas that of the left parafascicular nucleus was decreased in patients with the TD subtype. Volumes of the right and left suprageniculate nuclei and right ventromedial nucleus were significantly increased, whereas those of the right and left parafascicular nuclei volumes were decreased in patients with the PIGD subtype. The measures of the intrinsic thalamic global network were not different between patients with TD PD and healthy controls. However, in patients with the PIGD subtype, the global and local efficiencies were significantly increased compared to healthy controls. Moreover, although there were no differences in thalamic volume and intrinsic thalamic global network between patients with the TD and PIGD variants, we identified significant differences in the intrinsic thalamic local network between the two groups.

Conclusions: Alterations in thalamic nuclei volumes and the intrinsic thalamic network in patients with PD differed based on their predominant symptoms. These findings might be related to the underlying pathogenesis and suggest that PD is a heterogeneous syndrome.
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http://dx.doi.org/10.1016/j.parkreldis.2020.10.044DOI Listing
December 2020

Network characteristics of genetic generalized epilepsy: Are the syndromes distinct?

Seizure 2020 Nov 7;82:91-98. Epub 2020 Oct 7.

Departments of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea. Electronic address:

Objectives: This study evaluated the structural and functional connectivity of patients with genetic generalized epilepsy (GGE) compared to healthy subjects. We also investigated whether there are differences in structural and functional connectivity among different GGE syndromes.

Methods: We enrolled 100 patients with a clinical diagnosis of GGE. The patients were classified into different syndrome groups(12 cases of childhood absence epilepsy, 13 cases of juvenile absence epilepsy, 56 cases of juvenile myoclonic epilepsy, and 19 cases of epilepsy with GTC alone). We applied graph theoretical analysis to structural brain volumes and EEG to evaluate structural and functional connectivity in the GGE patients.

Results: The global network measures showed significant differences in the structural and functional connectivity between the patients with GGE and the healthy controls, and the local network measures revealed hub reorganization in the GGE patients. The global efficiency, local efficiency, and clustering coefficients of the structural connectivity were significantly decreased, whereas the characteristic path length and small-worldness index were increased in the GGE patients. The global efficiency and local efficiency were increased and the small-worldness index decreased in the functional connectivity. The patients with juvenile myoclonic epilepsy had the most extensive changes in structural and functional connectivity compared to the healthy subjects.

Significance: This study's main finding is that structural and functional connectivity in patients with GGE is significantly different from that in healthy controls. We find that the different GGE syndromes show distinct structural and functional connectivity, which can lead further understanding of the pathogenesis of GGE syndromes.
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http://dx.doi.org/10.1016/j.seizure.2020.09.022DOI Listing
November 2020

Longitudinal analysis of structural connectivity in patients with newly diagnosed focal epilepsy of unknown origin.

Clin Neurol Neurosurg 2020 12 1;199:106264. Epub 2020 Oct 1.

Departments of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea. Electronic address:

Objectives: The aim of this longitudinal study was to clarify whether significant alterations in structural connectivity occur over time in patients with newly diagnosed focal epilepsy of unknown origin.

Methods: A total of 40 patients with newly diagnosed focal epilepsy of unknown origin and with normal brain magnetic resonance imaging (MRI) on visual inspection were enrolled. All subjects underwent MRI twice involving three-dimensional volumetric T1-weighted imaging, which were suitable for structural volume analysis. Gray matter volumes were obtained using the FreeSurfer image analysis suite, and structural connectivity analyses were performed using Matlab-based BRain Analysis using graPH theory software.

Results: The median interval between the two MRI scans was 18.5 months in patients with epilepsy. There was a general tendency toward decreased gray matter volumes on the second scan compared with the initial scan. However, the volumes of the right and left thalamus and brainstem on the second MRI scan had an increased tendency compared with those on the initial MRI scan. In measures of connectivity, there were significant differences between the two MRI scans. The mean clustering coefficient, global efficiency, local efficiency, and the small-worldness index were significantly increased, whereas the characteristic path length was decreased on the second MRI scan compared with the initial MRI scan.

Conclusions: The structural connectivity in patients with newly diagnosed focal epilepsy of unknown origin increases over time in the initial stage. These alterations and increases in structural connectivity may be related to underlying epileptogenicity in the initial stages of epilepsy.
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http://dx.doi.org/10.1016/j.clineuro.2020.106264DOI Listing
December 2020

Unilateral diffuse white matter involvement in a patient with atypical FMR1 mutation.

Clin Neurol Neurosurg 2020 10 25;197:106182. Epub 2020 Aug 25.

Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea. Electronic address:

A 62-year-old man without relevant medical history visited our emergency department with seizure. His brain MRI revealed diffuse high signal intensity in the white matter with some cortical involvement in the dorsolateral prefrontal area and middle frontal gyrus on FLAIR sequence, which were only confined to the left hemisphere. In his whole exome sequencing, a hemizygous variant, NM_001185081.1:c.1216C>T, was detected on FMR1 gene of Xq27.3, which creates a stop codon at codon 406 in exon 13. The variant is classified as pathogenic according to the recommendation of ACMG/AMP guideline. This is the first case report of the patient presenting with seizure, who had a pathogenic variant on FMR1 gene with diffuse cerebral white matter involvements in the unilateral hemisphere.
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http://dx.doi.org/10.1016/j.clineuro.2020.106182DOI Listing
October 2020

Can we predict drug response by functional connectivity in patients with juvenile myoclonic epilepsy?

Clin Neurol Neurosurg 2020 11 31;198:106119. Epub 2020 Jul 31.

Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea. Electronic address:

Objectives: We investigated functional connectivity based on EEG using graph theoretical analysis in patients with newly diagnosed juvenile myoclonic epilepsy (JME), and whether it could play a role as a biomarker predicting antiepileptic drug (AED) response.

Methods: We consecutively enrolled 38 patients with JME and 40 normal controls. The initial EEG was undertaken at the time of diagnosis of JME in a drug-naïve state. The second EEG was done after at least 12 months from the time of the initial EEG. We classified the patients with JME into two groups according to AED response at the time of taking the second EEG. We investigated functional connectivity based on graph theoretical analysis using connectivity measures of the coherence and phase locking value.

Results: In the analysis of functional connectivity using coherence as a connectivity measure, the global efficiency and local efficiency in the AED poor responders (N = 4) decreased, whereas the small-worldness index increased. In the analysis of functional connectivity using phase locking value as a connectivity measure, the global efficiency and local efficiency in the AED poor responders decreased. However, in the AED good responders (N = 34), none of the network measures were different from those in healthy controls.

Conclusions: We newly found that there were significant differences of functional connectivity based on initial EEG according to AED response in the patients with JME. This suggests that brain connectivity could play a role as a new biomarker predicting AED response in patients with JME.
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http://dx.doi.org/10.1016/j.clineuro.2020.106119DOI Listing
November 2020

Alterations in the metabolic networks of temporal lobe epilepsy patients: A graph theoretical analysis using FDG-PET.

Neuroimage Clin 2020 15;27:102349. Epub 2020 Jul 15.

Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea. Electronic address:

Objective: The aim of this study is to investigate changes in metabolic networks based on fluorodeoxyglucose positron emission tomography (FDG-PET) in patients with drug-resistant temporal lobe epilepsy (TLE) (with and without hippocampal sclerosis [HS]) when compared with healthy controls.

Methods: We retrospectively enrolled 30 patients with drug-resistant temporal lobe epilepsy (17 patients with HS and 13 patients without HS) and 39 healthy controls. All subjects underwent interictal FDG-PET scans, which were analyzed to obtain metabolic connectivity using graph theoretical analysis. We investigated the differences in metabolic connectivity between patients with drug-resistant TLE (with and without HS) and healthy controls.

Results: When compared with healthy controls, TLE patients with HS showed alterations of global and local metabolic connectivity. When considering global connectivity, TLE patients with HS had a decreased average degree with increased modularity. When considering local connectivity, TLE patients with HS displayed alterations of betweeness centrality in widespread regions. However, there were no alterations of global metabolic connectivity in TLE patients without HS when compared with healthy controls. In addition, when compared to TLE patients without HS, TLE patients with HS had increased modularity.

Significance: Our study demonstrates more severe alterations in metabolic networks based on FDG-PET in TLE patients with HS than in those without HS and healthy controls. This may represent distinct epileptic networks in TLE patients with HS versus those without HS, although both are drug-resistant focal epilepsy.
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http://dx.doi.org/10.1016/j.nicl.2020.102349DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7374556PMC
June 2021

Alterations in Structural and Functional Connectivities in Patients with End-Stage Renal Disease.

J Clin Neurol 2020 Jul;16(3):390-400

Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.

Background And Purpose: The aim of this study was to evaluate the structural and functional connectivities of brain network using graph theoretical analysis in neurologically asymptomatic patients with end-stage renal disease (ESRD). We further investigated the prevalence of cognitive impairment (CI) in ESRD patients and analyzed the association between network measures of brain connectivity and cognitive function.

Methods: We prospectively enrolled 40 neurologically asymptomatic ESRD patients, 40 healthy controls, and 20 disease controls. All of the subjects underwent diffusion-tensor imaging (DTI) and resting-state functional magnetic resonance imaging (rs-fMRI). We calculated measures of structural and functional connectivities based on DTI and rs-fMRI, respectively, and investigated differences therein between the ESRD patients and the healthy controls. We assessed cognitive function in the ESRD patients using the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease neuropsychological battery.

Results: The ESRD patients exhibited decreased global structural and functional brain connectivities, as well as alterations of network hubs compared to the healthy controls and disease controls. About 70% of the ESRD patients had CI. Moreover, ESRD patients without CI exhibited decreased global connectivity and alterations of network hubs. Furthermore, there was a significant positive association between measures of brain connectivity and cognitive function.

Conclusions: We found that ESRD patients exhibited decreased structural and functional brain connectivities, and that there was a significant association between brain connectivity and cognitive function. These alterations in the brain network may contribute to the pathophysiological mechanism of CI in ESRD patients.
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http://dx.doi.org/10.3988/jcn.2020.16.3.390DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7354985PMC
July 2020

Differences of connectivity between ESRD patients with PD and HD.

Brain Behav 2020 08 24;10(8):e01708. Epub 2020 Jun 24.

Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.

Objectives: The aim of this study was to investigate alterations in structural and functional brain connectivity between patients with end-stage renal disease (ESRD) who were undergoing peritoneal dialysis (PD) and hemodialysis (HD).

Methods: We enrolled 40 patients with ESRD who were undergoing PD (20 patients) and HD (20 patients). We also enrolled healthy participants as a control group. All of the subjects underwent diffusion tensor imaging (DTI) and resting-state functional magnetic resonance imaging (rs-fMRI). Using data from the structural and functional connectivity matrix based on DTI and rs-fMRI, we calculated several network measures using graph theoretical analysis.

Results: The measures of global structural connectivity were significantly different between the patients with ESRD who were undergoing PD and healthy subjects. The global efficiency and local efficiency in the patients with PD were significantly decreased compared with those in healthy participants. However, all of the measures of global structural connectivity in the patients with HD were not different from those in healthy participants. Conversely, in the global functional connectivity, the characteristic path length was significantly increased and the small-worldness index was decreased in patients with HD. However, the measures of the global functional connectivity in the patients with PD were not different from those in healthy subjects.

Conclusion: This study revealed that alterations in structural and functional connectivity in patients who were undergoing PD and HD were different than those in healthy controls. These findings suggest that brain networks may be affected by different types of renal replacement therapy.
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http://dx.doi.org/10.1002/brb3.1708DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7428473PMC
August 2020

A case of a 'rude' but not to be missed manifestation of epilepsy: ictal swearing.

J R Coll Physicians Edinb 2020 Mar;50(1):46-48

Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Haeundae-ro 875, Haeundae-gu, Busan 612896, Republic of Korea, Email:

Swearing is described in various neurological conditions such as Tourette syndrome, Lesch-Nyhan syndrome and post stroke or encephalitis. However, swearing as an ictal manifestation or automatism has rarely been reported. We herein describe a case with swearing as a predominant manifestation in focal epilepsy.
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http://dx.doi.org/10.4997/JRCPE.2020.112DOI Listing
March 2020

Serum S100B represents a biomarker for cognitive impairment in patients with end-stage renal disease.

Clin Neurol Neurosurg 2020 08 12;195:105902. Epub 2020 May 12.

Neurology, Haeundae Paik Hospital, Inje University College of Medicine, 875, Haeundae-ro, Haeundae-gu, 48108 Busan, Republic of Korea. Electronic address:

Objectives: Cognitive impairment (CI) has been recognized as a complication of end-stage renal disease (ESRD) and its treatment. Neuron-specific enolase (NSE) and S100B protein are known neuro-biochemical markers of brain damage. The aim of this study was to investigate the potential role of serum NSE and S100B levels in predicting CI in patients with ESRD.

Patients And Methods: Thirty patients with ESRD were prospectively enrolled. All of them were receiving maintenance hemodialysis three times weekly for 180 days. We analyzed the potential value of serum NSE and S100B levels for distinguishing patients with CI from those without CI. The Mini-Mental State Examination was used for neuropsychological assessment. The differences between the groups were analyzed using demographic and laboratory profiles as independent variables.

Results: Of the 30 patients with ESRD, 13 had CI, whereas the other 17 did not. The demographic profiles, including age, and laboratory profiles, including S100B level, were significantly different between the patients with and without CI. The patients with CI were older than those without CI. Additionally, serum S100B levels in patients with CI were significantly higher than those in patients without CI. However, serum NSE levels did not differ between the groups. The best cut-off values for predicting CI were 17.7 mg/mL for NSE and 36.1 pg/mL for S100B, respectively, based on receiver operating characteristic analysis. Multiple logistic regression analyses showed that serum S100B level was a statistically significant independent predictor of CI.

Conclusions: We found that approximately 40% of patients with ESRD had CI. Serum S100B levels but not serum NSE levels are significantly increased in patients with ESRD. These findings suggest that CI in patients with ESRD is associated with glial cell dysfunction in the brain.
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http://dx.doi.org/10.1016/j.clineuro.2020.105902DOI Listing
August 2020

Top 100 Cited Articles on Sleep Medicine: A Bibliometric Analysis.

Eur Neurol 2020 28;83(1):111-120. Epub 2020 Apr 28.

Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea,

Background: The purpose of this study was to identify the top 100 cited articles dedicated to sleep medicine published in journals that have made key contributions to the field.

Methods: We performed a search of journals and selected 100 top-cited articles by utilizing the Institute for Scientific Information database available under the banner of the Web of Science. Next, we manually reviewed the contents of the top 100 cited articles. We examined the characteristics of the articles, such as the number of citations, ranking, authorship, article title, year of publication, publishing journal, publication type, and topic categories.

Results: The top-cited articles were published in 49 journals, and the most frequently cited journal was Sleep (23 articles). The top 100 cited articles originated from institutions in 9 countries, with the USA contributing 67 articles. The institution associated with the largest numbers of sleep medicine citation classics was Stanford University (11 articles). Morin CM, who was the first author for 6 articles, was listed most frequently in the sleep medicine citation classics. The publication years were concentrated in the 2000s, when 42 articles were published. The topics included 35 insomnia studies, 25 sleep physiology studies, 22 obstructive sleep apnea studies, and 19 other studies.

Conclusions: The present study provides a detailed list of the most-cited articles on sleep medicine. This currently relevant approach provides an opportunity to recognize the classic articles on sleep, to provide useful insights into international leaders, and to describe research trends in the field of sleep medicine.
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http://dx.doi.org/10.1159/000507393DOI Listing
November 2020

Characteristics of Perfusion Computed Tomography Imaging in Patients with Seizures Mimicking Acute Stroke.

Eur Neurol 2020 22;83(1):56-64. Epub 2020 Apr 22.

Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea,

Introduction: Seizures as acute stroke mimics are a diagnostic challenge.

Objective: The aim of the study was to characterize the perfusion patterns on perfusion computed tomography (PCT) in patients with seizures masquerading as acute stroke.

Methods: We conducted a study on patients with acute seizures as stroke mimics. The inclusion criteria for this study were patients (1) initially presenting with stroke-like symptoms but finally diagnosed to have seizures and (2) with PCT performed within 72 h of seizures. The PCT of seizure patients (n = 27) was compared with that of revascularized stroke patients (n = 20) as the control group.

Results: Among the 27 patients with seizures as stroke mimics, 70.4% (n = 19) showed characteristic PCT findings compared with the revascularized stroke patients, which were as follows: (1) multi-territorial cortical hyperperfusion {(73.7% [14/19] vs. 0% [0/20], p = 0.002), sensitivity of 73.7%, negative predictive value (NPV) of 80%}, (2) involvement of the ipsilateral thalamus {(57.9% [11/19] vs. 0% [0/20], p = 0.007), sensitivity of 57.9%, NPV of 71.4%}, and (3) reduced perfusion time {(84.2% [16/19] vs. 0% [0/20], p = 0.001), sensitivity of 84.2%, NPV of 87%}. These 3 findings had 100% specificity and positive predictive value in predicting patients with acute seizures in comparison with reperfused stroke patients. Older age was strongly associated with abnormal perfusion changes (p = 0.038), with a mean age of 66.8 ± 14.5 years versus 49.2 ± 27.4 years (in seizure patients with normal perfusion scan).

Conclusions: PCT is a reliable tool to differentiate acute seizures from acute stroke in the emergency setting.
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http://dx.doi.org/10.1159/000506591DOI Listing
November 2020

Development of a predictive scale for cardioembolic stroke using extracted thrombi and angiographic findings.

J Clin Neurosci 2020 Mar 19;73:224-230. Epub 2020 Feb 19.

Department of Neurology, Inje University Haeundae Paik Hospital, Busan, Republic of Korea. Electronic address:

We analyzed the histopathological findings of the clots obtained from patients with acute ischemic stroke by mechanical thrombectomy. We then developed a clinical scoring system for predicting pathogenic causes in patients with undetermined ischemic stroke using these histopathological and the angiographic findings during endovascular treatment. Only cases with the occlusion of the intracranial internal carotid artery or the proximal part of the middle cerebral artery were included in this study. Histopathologic findings of clots were compared and analyzed using the Trial of Org 10,172 in Acute Stroke Treatment (TOAST; large artery atherosclerosis, cardioembolic, and undetermined groups) and angiographic occlusion type (AOT; branching-site occlusion and truncal-type occlusion groups) classification systems. Fifty-two patients had enough clots extracted by mechanical thrombectomy for full histopathologic examination. There was no significant within-group difference in the fraction of components in the thrombi for either the TOAST or AOT system; however, the platelet distribution patterns were different. The large artery atherosclerotic group and truncal-type occlusion group had mostly peripheral patterns, whereas the cardioembolic group, undetermined group and branching-site occlusion group had mostly clustering patterns (p = 0.02 in TOAST classification; p = 0.007 in AOT classification). Patients with scores of 3 or 4 on our new scale had a sensitivity of 93.5% and a specificity of 100% for cardioembolic stroke. The BOCS scale, developed using a combination of the TOAST and AOT classification systems, may be helpful as an adjunctive diagnostic tool for identifying cases caused by cardiogenic embolism in patients with undetermined ischemic stroke.
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http://dx.doi.org/10.1016/j.jocn.2020.01.089DOI Listing
March 2020

Intrinsic hippocampal and thalamic networks in temporal lobe epilepsy with hippocampal sclerosis according to drug response.

Seizure 2020 Jan 21;76:32-38. Epub 2020 Jan 21.

Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea. Electronic address:

Purpose: The aim of this study was to investigate whether intrinsic hippocampal or thalamic networks in patients with temporal lobe epilepsy (TLE) with hippocampal sclerosis (HS) were different according to antiepileptic drug (AED) response.

Methods: We enrolled 80 patients with TLE with HS and 40 healthy controls. Of the patients with TLE with HS, 43 were classified as a drug-resistant epilepsy (DRE) group, whereas 37 patients were enrolled as a drug-controlled epilepsy (DCE) group. We investigated the structural connectivity of the global brain, intrinsic hippocampal, and intrinsic thalamic networks based on structural volumes in the patients with DRE and DCE, and analyzed the differences between them.

Results: There were significant alterations of the intrinsic hippocampal network compared with healthy controls. The average degree and the global efficiency were decreased, whereas the characteristic path length was increased in the patients with DRE compared with those in healthy controls. In the patients with DCE, only the small-worldness index was decreased compared with healthy controls. Compared to the patients with DCE, the mean clustering coefficient was increased in the patients with DRE.

Conclusion: We found that the intrinsic hippocampal network in patients with TLE with HS was different according to AED response. The patients with DRE had more severe disruptions of the intrinsic hippocampal network than those with DCE compared with healthy controls. These findings suggested that the hippocampal network might be related to AED response and could be a new biomarker of medical outcome in patients with TLE with HS.
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http://dx.doi.org/10.1016/j.seizure.2020.01.010DOI Listing
January 2020

Predicting the antiepileptic drug response by brain connectivity in newly diagnosed focal epilepsy.

J Neurol 2020 Apr 10;267(4):1179-1187. Epub 2020 Jan 10.

Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Haeundae-ro 875, Haeundae-gu, Busan, 48108, South Korea.

Objective: Growing evidence has suggested that epilepsy is a disease with alterations in brain connectivity. The aim of this study was to investigate whether the changes in brain connectivity can predict the response to an antiepileptic drug (AED) in patients with a newly diagnosed focal epilepsy of unknown etiology.

Methods: This observational study was independently performed at two tertiary hospitals (Group A and B). Thirty-eight patients with newly diagnosed focal epilepsy of unknown etiology were enrolled in Group A and 46 patients in Group B. We divided these patients into two groups according to their seizure control after AED treatment: AED good and poor responders. We defined the AED good responders as those in whom had seizure free for at least the last 6 months while AED poor responders who were not. All of the subjects underwent diffusion tensor imaging, and graph theoretical analysis was applied to reveal the brain connectivity. We investigated the difference in the clinical characteristics and network measurements between the two groups.

Results: Of the network measures, the assortativity coefficient in the AED good responders was significantly higher than that in the AED poor responders in both Groups A and B (- 0.0239 vs. - 0.0473, p = 0.0110 in Group A; 0.0173 vs. - 0.0180, p = 0.0024 in Group B). The Kaplan-Meier survival analysis revealed that the time to failure to retain the first AED was significantly longer in the patients with assortative networks (assortativity coefficient > 0) than in those with disassortative networks (assortativity coefficient < 0) in Group B.

Conclusion: We demonstrated that the assortativity coefficient differed between patients with newly diagnosed focal epilepsy of unknown etiology according to their AED responses, which suggests that the changes in brain connectivity could be a biomarker for predicting the responses to AED.
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http://dx.doi.org/10.1007/s00415-020-09697-4DOI Listing
April 2020

Alterations of gray matter volumes and connectivity in patients with tuberous sclerosis complex.

J Clin Neurosci 2020 Feb 28;72:360-364. Epub 2019 Dec 28.

Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea. Electronic address:

Tuberous sclerosis complex (TSC) is an inherited genetic disorder caused by mutations in the TSC1 or TSC2 genes, encoding hamartin and tuberin. We aimed to evaluate structural volumes and connectivity of patients with TSC compared to those of healthy subjects. We consecutively enrolled 13 patients with a diagnosis of TSC and 15 age- and sex-matched healthy control subjects. Subjects underwent three-dimensional volumetric T1-weighted imaging, suitable for a quantitative analysis. Structural volumes were investigated using FreeSurfer image analysis software, and structural connectivity was calculated from a connectivity matrix, which was estimated from the correlation analysis of structural volumes using the Brain Analysis using Graph Theory software package. Differences in structural volumes and connectivity were analyzed between patients with TSC and healthy subjects. There were no differences of cortical volumes between the patients with TSC and healthy controls. However, we found decreased gray matter volumes in several subcortical regions in the patients with TSC compared to those in healthy controls, specifically in the putamen (0.3212 vs. 0.3841%, p = 0.001), even after multiple corrections. Regarding global structural connectivity, the small-worldness index was significantly decreased in patients with TSC compared to that in healthy controls (0.907 vs. 0.977, p = 0.049). This study revealed structural volumes and connectivity in patients with TSC that are significantly different from those in healthy controls. These alterations have implications for the pathogenesis of TSC.
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http://dx.doi.org/10.1016/j.jocn.2019.12.046DOI Listing
February 2020

A rare but treatable cause of recurrent chest pain - Ictal chest pain.

BMC Neurol 2019 Dec 30;19(1):348. Epub 2019 Dec 30.

Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Haeundae-ro 875, Haeundae-gu, Busan, 612896, Republic of Korea.

Background: Chest pain as the primary manifestation of epilepsy is extremely rare and has only been reported once to date.

Case Presentation: We herein describe a 47-year-old woman with recurrent chest pain for 3 years. The cause of her chest pain remained elusive despite extensive investigations including comprehensive cardiac work-up. She was referred to the neurology clinic for one episode of confusion. Video-electroencephalographic monitoring detected unequivocal ictal changes during her habitual chest pain events. She has remained chest pain (seizure) free with a single antiseizure drug.

Conclusions: This case underlines the importance of epilepsy as a rare yet treatable cause of recurrent chest pain. Further studies are required to determine the pathophysiology of ictal chest pain.
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http://dx.doi.org/10.1186/s12883-019-1575-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6936059PMC
December 2019
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