Effect of Korean Red Ginseng on Sleep: A Randomized, Placebo-Controlled Trial / 수면정신생리

OBJECTIVES: Ginseng has a long history of being used in insomnia treatment and there is some evidence from animal studies of its sleep-enhancing property. From this, it can be assumed that ginseng has sleep-promoting effect in humans. The purpose of this study was to investigate the effect of Korean red ginseng on change of sleep architecture in humans. METHODS: A total of 20 healthy young males with regular sleep and wake habits and without any psychiatric nor cognitive problems were selected based on review of sleep questionnaires and sleep diaries they completed followed by an interview with a board-certified psychiatrist. The subjects were randomly assigned to red ginseng or placebo for 2 weeks of trial. The total daily dose of ginseng was 4,500 mg. The polysomnographic recordings were made at baseline and at 2 weeks after. The effects of red ginseng and placebo on sleep were assessed by comparing the changes in polysomnographic variables between the two groups. RESULTS: A total of 15 subjects, 8 from red ginseng group and 7 from placebo group, were included to undergo polysomnographic procedures. The red ginseng group showed tendencies to increase stage 3 sleep (p=0.087) and to decrease stage 2 sleep (p=0.071) from the baseline compared with the placebo group. CONCLUSION: Korean red ginseng tends to increase deep sleep and decrease shallow sleep. Our result is in line, at least in part, with previous findings that Korean red ginseng increased total and NREM sleep in rats. Further studies with higher ginseng dosage, larger sample size and longer trial duration should be conducted to confirm the sleep stabilizing and balancing effects of Korean red ginseng.

A Case of Adult Mumps Meningoencephalitis with a Past Measles-Mumps-Rubella (MMR) Vaccination

When dealing with a mumps infection, the complication of meningoencephalitis is quite rare. A 24-year-old soldier with a past MMR vaccination was admitted because of aseptic meningitis. His cognitive functioning was rapidly deteriorating with the swelling of both parotid glands. MR findings revealed discrete lesions in the brainstem and thalamus. He barely recovered within 2 months. Among adults with a failure to get the immunity despite vaccination, institutional crowding can lead to a fatal CNS complication such as mumps meningoencephalitis.

Ictal Hyperperfusion of Brain Structures Related to Ictal Dystonic Posturing in Temporal Lobe Seizures

BACKGROUND: Although dystonic posturing (DP) during temporal lobe seizures is known to be related to basal ganglia activation, the mechanism of the dystonic posturing has not been investigated in greater details . METHODS: Thirty-two patients with mesial temporal lobe epilepsy (TLE) underwent ictal and interictal SPECTs. They were classified into two groups: 1) DP with ictal dystonia during ictal SPECT (N=15) and 2) Non-DP without dystonia (N=17). Ictal-interictal SPECT subtraction was performed as follows: co-registration, intensity normalization, subtraction, thresholding and then an overlay to SPGR MRI. The presence and intensity of ictal hyperperfusion were determined in frontal lobe, basal ganglia, temporal lobe and insular cortex. RESULTS: The incidences of ictal hyperperfusion in DP vs. Non-DP were caudate nucleus [80.0%(12/15 patients) vs. 0% (0/17), p=0.001], putamen [93.3% (14/15) vs. 48.2% (8/17), p=0.005], globus pallidus [53.3% (8/15) vs. 23.5% (4/17), p=0.082], thalamus [80.0% (12/15) vs. 41.2% (7/17), p=0.026], insular cortex [46.7% (7/15) vs.23.5% (4/17), p=0.051], orbitofrontal [46.7% (6/15) vs. 35.3% (7/17), p=0.053], medial frontal [6.7% (1/15) vs. 18.7% (2/17), p=0.621], dorsolateral frontal [13.3% (2/15) vs. 18.7%(2/17), p=0.737] in the hemisphere of epileptic side. In patients who showed ictal hyperperfusion in striatum and thalamus, the average intensity of hyperperfusion in DP vs. Non-DP was caudate nucleus 1.67 vs. 0.0, putamen 2.20 vs. 1.05, globus pallidus 1.2 vs. 0.65, thalamus 2.00 vs. 0.88 in the epileptic hemisphere. CONCLUSIONS: Caudate nucleus as well as putamen appeared to be important for producing ictal dystonia during TLE seizures. The greater intensity of ictal hyperperfusion in putamen, caudate nucleus and thalamus seems to be related to ictal dystonia.

Ictal Hyperperfusion of Brain Structures Related to Ictal Dystonic Posturing in Temporal Lobe Seizures

BACKGROUND: Although dystonic posturing (DP) during temporal lobe seizures is known to be related to basal ganglia activation, the mechanism of the dystonic posturing has not been investigated in greater details . METHODS: Thirty-two patients with mesial temporal lobe epilepsy (TLE) underwent ictal and interictal SPECTs. They were classified into two groups: 1) DP with ictal dystonia during ictal SPECT (N=15) and 2) Non-DP without dystonia (N=17). Ictal-interictal SPECT subtraction was performed as follows: co-registration, intensity normalization, subtraction, thresholding and then an overlay to SPGR MRI. The presence and intensity of ictal hyperperfusion were determined in frontal lobe, basal ganglia, temporal lobe and insular cortex. RESULTS: The incidences of ictal hyperperfusion in DP vs. Non-DP were caudate nucleus [80.0%(12/15 patients) vs. 0% (0/17), p=0.001], putamen [93.3% (14/15) vs. 48.2% (8/17), p=0.005], globus pallidus [53.3% (8/15) vs. 23.5% (4/17), p=0.082], thalamus [80.0% (12/15) vs. 41.2% (7/17), p=0.026], insular cortex [46.7% (7/15) vs.23.5% (4/17), p=0.051], orbitofrontal [46.7% (6/15) vs. 35.3% (7/17), p=0.053], medial frontal [6.7% (1/15) vs. 18.7% (2/17), p=0.621], dorsolateral frontal [13.3% (2/15) vs. 18.7%(2/17), p=0.737] in the hemisphere of epileptic side. In patients who showed ictal hyperperfusion in striatum and thalamus, the average intensity of hyperperfusion in DP vs. Non-DP was caudate nucleus 1.67 vs. 0.0, putamen 2.20 vs. 1.05, globus pallidus 1.2 vs. 0.65, thalamus 2.00 vs. 0.88 in the epileptic hemisphere. CONCLUSIONS: Caudate nucleus as well as putamen appeared to be important for producing ictal dystonia during TLE seizures. The greater intensity of ictal hyperperfusion in putamen, caudate nucleus and thalamus seems to be related to ictal dystonia.

Seizure Induced by Photosonic Device

BACKGROUND & SIGNIFICANCE: Photosensitive epilepsy may occur by the diverse new implements. We experienced three patients suffered from the first seizure while using photosonic devices. The device is composed of light stimulating goggles and sound producing headphones. CASE: All the patients were teen-aged school girls and the types of seizure were generalized tonic-clonic seizure, focal motor seizure with secondary generalization, and complex partial seizure. They lost their consciousness while using the devices with the red colored light. Events began without aura in two but one patient felt continuous red flash light until after taking off the device. EEG revealed right frontal dominant spike-wave complexes in one but other patients showed no epileptiform discharges. During a year follow-up the patient who showed EEG abnormalities experienced another seizure that was focal motor seizure with secondary generalization but remained two did not. COMMENTS: Though the video game epilepsy is regarded as a kind of photosensitive epilepsy, the emotional excitement may contribute to the occurrence of seizure. But, this photosonic device is used for relaxation and our three patients showed normal EEG while photic stimulation during the tracing. We suggest that seizure induced by the photosonic lev genuine type of photosensitive epilepsy.

Variables Associated with Delayed Hospital Arrival of Stroke Patients Living in Taejon and Its Suburban Areas

Recent stroke researches have re-emphasized the critical therapeutic time window for antithrombotic and neuroprotective trials for the stroke victims. In this prospective study , we tried to reveal the variables that had delayed the presentation time of the acute stroke patients living in Taejon and its suburban areas. The time of stroke onset, distance from the place of stroke occurrence to the Chung-nam National Univorsity Hospital (CNUH), level of consciousness, basic demographic data, place of residence, and referral routes were assessed. During the study period of 8 months, 173 new patients visited the emergency department of the CNLTH.in the acute phase of stroke. Of 173 patients, 122 had cerebral ischemia (CI), 40 intracerebral hemorrhage (ICH), and 11 subarachnoid hemorrhage (SAH). Only 91 patients (52.6%) presented within 6 hours. Fourty-six percent of Cl, 65% of ICH, and 72% of SAH patients presented within 6 hours. There was no correlation between the presentation time and the age, sex, stoke subtype, distance from CNLTH, and place of residence. The vat-la ' bles that had significantly delayed the presentation time included the better initial consciousness level and referral route through the oriental medicine clinics. These findings suggest that the need for prompt management of stroke patient is poorly understood and that the onental medicine is still preferred by the general population. Tlius, we need to develop an education program and public activities as well as an effective patient dehvery system to nunmum the neuronal damage following stroke.