Sang Do Yi

Bio: Sang Do Yi is an academic researcher from Keimyung University. The author has contributed to research in topics: Epilepsy & Adjunctive treatment. The author has an hindex of 3, co-authored 4 publications receiving 72 citations.

Multi-center study on migraine and seizure-related headache in patients with epilepsy

Abstract: Purpose The purpose of this study is to investigate the frequency and characteristics of migraine and seizure-related headache (SRH) according to the criteria of the International Headache Society. Materials and Methods A questionnaire was undertaken at the initial evaluation of newly referred patients from 32 epilepsy clinics. Results Of a total of 597 patients, 74 (12.4%) patients had migraine. Age at the onset of epilepsy was lower in patients with migraine than in those without. Twenty-six (4.4%), nine (1.5%), and 146 (24.5%) patients experienced prodromal, ictal, and postictal SRH, respectively (n = 169, 28.3%). A pain intensity of prodromal and postictal SRH was 6.1 ± 1.5 (SD) and 6.3 ± 1.9 (SD) on the visual analogue scale, and their duration was 12.6 ± 26.7 (SD) hours and 9.0 ± 17.4 (SD) hours, respectively. Age at the onset of epilepsy was lower in patients with SRH than in those without, and the risk of occurrence of SRH was significantly greater in patients with longer epilepsy duration. SRH could be classified as a type of migraine in 46.2% of patients with prodromal SRH and in 36.3% of patients with postictal SRH. Prodromal SRH occurred more frequently and was more likely to be a migraine-type in patients with migraine compared with those without. Postictal SRH occurred more frequently and was more likely to be a migraine-type in patients with migraine. Conclusion This study suggests that SRH is a frequent accompanying symptom of epileptic seizures causing major impairment in daily life, and migraine is an important comorbidity of epilepsy, affecting the incidence and characteristics of SRH.

Efficacy and safety of levetiracetam as adjunctive treatment of refractory partial seizures in a multicentre open-label single-arm trial in Korean patients.

Abstract: Summary This prospective, open-label study evaluated the efficacy and safety of adjunctive levetiracetam (LEV) in Korean adults with uncontrolled partial epilepsy. Study patients had to have an average of at least 1 and not more than 14 partial seizures per month (averaged over a 3-month historical baseline) despite the use of one or two AEDs. Patients initially received LEV 1000mg/day (administered bid) and could increase to 2000mg/day after 2 weeks, and to 3000mg/day after another 2 weeks, to obtain adequate seizure control. During the 12-week maintenance period, the dose of LEV could be increased or decreased once if seizure control was insufficient or tolerability warranted, respectively. Seizure count and adverse events (AEs) were recorded by patients. Global evaluation scale (GES) and quality of life (QOLIE-31) were also evaluated. A total of 100 patients were enrolled and 92 patients completed the study. The median percent reduction in weekly seizure frequency over the treatment period was 43.2%. The ≥50% and ≥75% responder rates were 45.4% and 36.1%, respectively. Seizure freedom throughout the 16-week treatment period was observed in 17 patients. On investigator's GES, 81 patients were considered improved, with 41 patients showing marked improvement. Most QOLIE-31 scales improved significantly. Treatment-emergent AEs were reported in 59 patients. Three most common AEs were somnolence (36%), dizziness (12%), and headache (8%). Adjunctive LEV therapy was effective and well-tolerated in Korean adults with refractory partial epilepsy.

Short-term efficacy and safety of zonisamide as adjunctive treatment for refractory partial seizures: a multicenter open-label single-arm trial in Korean patients.

Abstract: Objective To evaluate the efficacy and safety of adjunctive zonisamide (ZNS) therapy in Korean adults with uncontrolled partial epilepsy. Methods Study patients had an average of at least one seizure per 4-week (averaged over a 12-week historical baseline) despite the use of one to three antiepileptic drugs. The starting dose of ZNS was 100mg/day, and was increased to 200mg/day after 2weeks. During the 12-week maintenance period, the dose of ZNS was adjusted to 200–400mg/day based on the physicians' discretion. The global evaluation scale (GES) and quality of life (QOLIE-31) were also evaluated. Results A total of 121 patients were enrolled, of which 88 patients completed the study. The median percent reduction in weekly seizure frequency over the treatment period was 59.0%. The ≥50% and ≥75% responder rates were 57.3% and 38.5%, respectively. Seizure freedom over the treatment period was observed in 25 patients, but seizure freedom throughout the 16-week treatment period was attained in only 16 patients. On investigator's GES, 84 patients were considered improved, with 33 patients showing marked improvement. In QOLIE-31 scale, seizure worry improved significantly but emotional well-being deteriorated. Treatment-emergent adverse events (AEs) were reported in 80 patients. The most common AEs were dizziness (28.1%), somnolence (24.0%), anorexia (18.2%), headache (14.0%), nausea (13.2%), and weight loss (10.7%). Twenty-two patients discontinued the trial due to drug-related AEs. Conclusions Our results suggest that adjunctive ZNS therapy for the treatment of refractory partial epilepsy, though efficacious, is associated with significant tolerability problems.

Efficacy and Safety of Levetiracetam as Adjunctive Treatment in a Multicenter Open-Label Single-Arm Trial in Korean Patients with Refractory Partial Epilepsy: Over 1-Year Follow-Up

Abstract: Kyoung Heo, M.D., Byung In Lee, M.D., Sang Do Yi, M.D., Kyoon Huh, M.D., Jae Moon Kim, M.D., Sang Ahm Lee, M.D., Dong Jin Shin, M.D., Hong Ki Song, M.D., Sang Kun Lee, M.D. and Jeong Yeon Kim, M.D. Department of Neurology, Severance Hospital, Seoul, Keimyung University Dongsan Medical Center, Daegu, Ajou University Medical Center, Suwon, Chungnam National University Hospital, Daejeon, Asan Medical Center, Seoul, Gachon Medical School Gil Medical Center, Incheon, Kangdong Sacred Heart Hospital, Seoul, Seoul National University Hospital, Seoul, Inje University Sanggye Paik Hospital, Seoul, Korea

Epileptic seizures and headache/migraine: A review of types of association and terminology

Abstract: Purpose There are different possible temporal associations between epileptic seizures and headache attacks which have given rise to unclear or controversial terminologies. The classification of the International League Against Epilepsy does not refer to this type of disorder, while the International Classification of Headache Disorders (ICHD-2) defines three kinds of association: 1. migraine-triggered seizure ("migralepsy"), 2. hemicrania epileptica, and 3. post-ictal headache. Methods We performed an extensive review of the literature, not including "post-ictal" and "inter-ictal" headaches. Results On the basis of well-documented reports, the following clinical entities may be identified: (A) "epileptic headache (EH)" or "ictal epileptic headache (IEH)": in this condition headache (with or without migrainous features) is an epileptic manifestation per se , with onset, and cessation if isolated, coinciding with the scalp or deep EEG pattern of an epileptic seizure. EH maybe followed by other epileptic manifestations (motor/sensory/autonomic); this condition should be differentiated from "pure" or "isolated" EH, in which headache/migraine is the sole epileptic manifestation (requiring differential diagnosis from other headache forms). "Hemicrania epileptica" (if confirmed) is a very rare variant of EH, characterized by ipsilateral location of headache and ictal EEG paroxysms. (B) "Pre-ictal migraine" and "pre-ictal headache": when a headache attack is followed during, or shortly after, by a typical epileptic seizure. The migraine attack may be with or without aura, and its seizure-triggering role ("migraine-triggered seizure") is still a subject of debate. A differentiation from occipital epilepsy is mandatory. The term "migralepsy" has not been used uniformly, and may therefore led to misinterpretation. Conclusions On the basis of this review we suggest definitions and a terminology which may become the basis of a forthcoming classification of headaches associated with epileptic seizures.

Population-Based Study of Epilepsy in Cambodia Associated Factors, Measures of Impact, Stigma, Quality of Life, Knowledge-Attitude-Practice, and Treatment Gap

Abstract: Purpose Identify epilepsy-associated factors and calculate measures of impact, stigma, quality of life (QOL), knowledge-attitude-practice (KAP) and treatment gap in Prey Veng, Cambodia. Methods This first Cambodian population-based case-control study had 96 epileptologist-confirmed epilepsy cases and 192 randomly selected matched healthy controls. Standard questionnaires, which have been used in similar settings, were used for collecting data on various parameters. Univariate and multivariate regression was done to determine odds ratios. Jacoby stigma, 31-item QOL, KAP etc were determined and so were the factors associated with them using STATA software. Treatment gap was measured using direct method. Key findings Multivariate analyses yielded family history of epilepsy, difficult or long delivery, other problems beside seizures (mainly mental retardation, hyperthermia), and eventful pregnancy of the subject's mother as factors associated with epilepsy. There was high frequency of seizure precipitants esp. those related to sleep. Population attributable risk (%) was: family history (15.0), eventful pregnancy of subject's mother (14.5), long/difficult birth (6.5), and other problem beside seizures (20.0). Mean stigma (1.9±1.1, on a scale of 3) was mainly related to treatment efficacy. Mean QOL (5.0±1.4 on a scale of 10) was mainly related to treatment regularity. Cause or risk factor could be determined in 56% of cases. Treatment gap was 65.8%. Significance Factors in pre- and perinatal period were found to be most crucial for epilepsy risk in Cambodia which inturn provides major prevention opportunities. A global action plan for treatment, stigma reduction and improvement of QOL should be set-up in this country.

Multicenter double-blind, randomized, placebo-controlled trial of levetiracetam as add-on therapy in Chinese patients with refractory partial-onset seizures

Abstract: Summary Purpose: To evaluate efficacy and tolerability of levetiracetam (LEV; Keppra®) as add-on therapy in Chinese patients with refractory partial-onset seizures Methods: In this multicenter, double-blind, randomized, placebo-controlled trial, 206 patients aged 16–70 years with uncontrolled partial-onset seizures were randomized to receive LEV (n =103) or placebo (n =103); 202 patients (LEV, n =102; placebo, n = 100) comprised the intent-to-treat population An 8-week historical baseline period confirmed eligibility according to seizure count The 16-week treatment period consisted of a 4-week up-titration period (LEV, 1,000–3,000 mg/day in two equal divided doses) followed by a 12-week maintenance period Efficacy assessments were based on weekly frequency of partial-onset seizures during the 16-week treatment period Results: LEV significantly decreased weekly partial-onset seizure frequency over placebo by 268% (p < 0001) Median percentage reductions in weekly partial-onset seizure frequency from historical baseline were 559% for LEV and 137% for placebo (p < 0001) The ≥50% responder rates were 559% for LEV, compared with 260% for placebo (p < 0001) Freedom from partial-onset seizures during treatment period was achieved by 11 LEV patients (108%) and 2 placebo patients (20%) (p = 0012) Adverse events were reported by 65 LEV-treated patients (631%) and 62 placebo-treated patients (602%); most were of mild-to-moderate intensity The most common adverse events were somnolence (LEV, 175%; placebo, 175%), decreased platelet count (LEV, 97%; placebo, 97%), and dizziness (LEV, 78%; placebo, 136%) Discussion: Add-on LEV was effective and well-tolerated in Chinese patients with refractory partial-onset seizures