Factors Associated with Care-giver Burden of Pediatric Epilepsy Patients

BACKGROUND: Pediatric epilepsy can result in a heavy burden of illness for the family and the role of family caregivers is becoming more important for the management of the disease. However, there are only few studies about care-giver burden of pediatric epilepsy. This study examined the factors which may influence care-giver burden of pediatric epilepsy patients METHODS: We surveyed 87 care-givers of pediatric epilepsy patients. The demographic and social data of the care-givers, along with the social and clinical data of the patients were obtained. The Korean version of the Burden Interview (KBI) and the Korean version of the Beck Depression Inventory (KBDI) were used. The relationship between the demographic and social data of care-givers, the clinical factors of the patients and KBI score were evaluated. RESULTS: Of the 87 participants, sixty-nine (79.3%) were the mothers. The mean age of caregivers was 41.3 years and the mean score on the KBI was 20.2 (+/-16.8) points. The mean age of the patients was 11.1 years and 48 patients (55.8%) were male. The number of antiepileptic drugs prescribed, severity of the disease and school record had a significant correlation with KBI in a multivariate linear regression analysis. CONCLUSIONS: We suggest that in addition to the strict control of the seizure, that the consideration for the academic functions of pediatric patients is also important for reducing care-giver burden in the treatment of pediatric epilepsy.

Clinical Feature and Outcome in Spontaneous Cerebellar Hemorrhage: Determination of Treatment Strategies

BACKGROUND: Cerebellar hemorrhage may present with a wide spectrum of clinical manifestations, from a benign course with little to no neurological deficit to a rapidly fatal course with hydrocephalus and brainstem compression. However, controversy remains concerning the management of patients with cerebellar hemorrhage. The aim of this study was to set the criteria for conservative or surgical treatment and predictive factors of poor outcomes. METHODS: During the 5-year period from July 1997 through July 2002, a series of 64 consecutive patients with spontaneous cerebellar hemorrhage was evaluated. On admission, all patients underwent a standard neurological examination, and a computed tomography (CT) scan. The location and size of hematoma, hypertension, hydrocephalus, intraventricular hemorrhage and compression of quadrigeminal cistern on a CT scan were compared with the Glasgow coma scale (GCS) and Glasgow Outcome Scale (GOS). RESULTS: Patients with GCS scores of 13 or more at admission and with a hematoma of less than 15 mL showed good outcomes. Patients with GCS scores of 10 or less at admission or with a hematoma measuring 15 mL or more had poor outcomes. Patients with intraventricular hemorrhage (p<0.05), compression of quadrigeminal cistern (p<0.05), and hydrocephalus (p<0.05) in the brain CT had poor outcomes. CONCLUSIONS: In treating patients with spontaneous cerebellar hemorrhage, an initial GCS and CT scan were quite helpful in determining treatment strategies. For patients whose CT scan show intraventricular hemorrhages, compression of the quadrigeminal cistern, and hydrocephalus, intensive therapy should be deemed necessary.

Analysis of Risk Factors for Recurrent Ischemic Stroke: Based on Data of Outpatient Clinic in an University Hospital

BACKGROUND: Risk factors for recurrent stroke have been evaluated in a few community-based epidemiologic studies. This study aims to estimate the risk factors of recurrent ischemic stroke. METHODS: All patients enrolled as acute ischemic stroke patients from Jan. 1998 to Dec. 2000, and who had visited out-patient clinics at regular intervals with a good compliance were included as subjects. Subjects with poor compliance and those expired were excluded. Subjects with recurrent ischemic stroke were selected according to the diagnostic criteria for recurrent ischemic stroke. Their demographic characterisics (age, sex), risk factors of stroke (hypertension, diabetes mellitus, hyperlipidemia, cardiac disease, transient ischemic attack, smoking, alcohol), and types of stroke (TOAST classification) were analyzed to identify the factors responsible for recurrent ischemic stroke. RESULTS: Among 599 patients with ischemic stroke, 43 patients (7.2%) were identified as having recurrent stroke (27 men and 16 women; mean age=66.3 years). Hypertension and hyperlipidemia were the risk factors which were statistically significant in inducing recurrent ischemic stroke. According to the TOAST classification, cardioembolism was more prevalent in recurrent ischemic stroke. CONCLUSIONS: Hypertension, hyperlipidemia, cardioembolism plays a significant role in recurrent ischemic stroke. Therefore, the control of these risk factors appears to be important for reducing further recurrent ischemic stroke.

Cerebral CO2 Vasoreactivity by Transcranial Doppler with Rebreathing Method: Comparison between Ischemic Stroke and Normal Control

BACKGROUND: Cerebral vasoreactivity is an index of the autoregulation of cerebral perfusion, and can be measured by functional imaging such as Xe CT, SPECT, PET in reponse to a hypercapneic stimulus. Recently, a transcranial Doppler (TCD) study helped in the evaluation of cerebral CO2 vasoreactivity by a breath holding method and CO2 inhalation. However, the breath holding method had some constrictions in reliability and the CO2 inhalation method is not as feasible to apply to routine study. In order to measure cerebral CO2 vasoreactivity in a routine TCD study conveniently and reliably, we devised a method of rebreathing into a closed volume of a reservoir bag as a hypercapneic stimulus, and applied it to normal volunteers and patients with ischemic stroke. METHODS: We performed a cerebral CO2 vasoreactivity study by the rebreathing method in 22 normal volunteers and 61 ischemic stroke patients. As a hypercapneic stimulus, we applied a fitted mask connected with a closed reservoir bag for about 90 seconds, and the mean flow velocity (MFV) and pulsatility index (PI) were evaluated at the proximal middle cerebral arteries of 50-55 mm depth, before and after the hypercapneic stimulus. Cerebral vasoreactivities as percent increments of MFV in MCA were compared between the two groups. RESULTS: MFV of both the normal control and patient groups increased continuously during the hypercapneic stimulus, but the rate of the increments of MFV markedly diminished after about 60 seconds of rebreathing. The mean cerebral vasoreactivity of 61 MCA's in the ischemic stroke patient group (47.0 +/- 22.0%) was significantly lower than that of 22 MCA's in the normal control group (60.2 +/- 16.0%). But, the percent decrement of PI showed no significant difference between both groups. CONCLUSIONS: We suppose that the rebreathing method is a relatively reliable and convenient technique as a hypercapneic stimulus in determining cerebral CO2 vasoreactivity by TCD. Cerebral vasoreactivity measured by the rebreathing method is significantly lower in the ischemic stroke patient group than in the normal control group, which may reflect that the atherosclerosis itself could cause reduced distensibility of the small arteriole as well as the structural narrowing of the cerebral arteries.