Epilepsy and pregnancy: lamotrigine as main drug used.

OBJECTIVES: To study the risk of teratogenicity in infants of women with epilepsy. MATERIAL AND METHODS: Prospective data from 1996 to 2000 comprised 147 pregnancies. The most frequent antiepileptic drugs (AEDs) used were lamotrigine (LTG) 35% (n = 51), oxcarbazepine (OXC) 25% (n = 37) and valproate (VPA) 20% (n = 30). Seventy-four per cent (n = 109) received monotherapy. Folic acid supplementation was taken during first trimester by 118 patients (80%). RESULTS: The overall risk of malformations among newborns in the AED-exposed group was 3.1% (n = 4). Two children were born with multiple malformations (VPA monotherapy), two children had ventricular septal defects (one OXC monotherapy, and one OXC and LTG). The risk of malformations was 2.0% in women treated with LTG and 6.7% in women treated with VPA (NS). CONCLUSION: Despite the small number of cases in the study these data indicate that treatment with LTG during pregnancy might be relatively safe. Larger prospective studies are needed to obtain adequate power for statistical analysis.

Intermittent prophylaxis in febrile convulsions: diazepam or valproic acid?

In an open, prospective, randomized, and hospital-based study, comprising 219 consecutive children, 169 were given intermittent prophylaxis for one year, receiving either diazepam or valproic acid after their first febrile convulsion. Children admitted on odd dates (n = 89) were given rectal diazepam in solution every 12 h, whenever the temperature was 38.5 degrees C or more. Children admitted on even dates (n = 80) were given valproic acid as suppositories at times of fever. Twenty-three children in the diazepam group had a recurrence within 1 year versus 14 in the valproic acid group. On an intention-to-treat basis the 12-month recurrence rates in the 2 groups were similar, 27% vs 20%. The latter is well below figures for untreated controls from Denmark (32%), suggesting that intermittent valproic acid at times of fever may be effective, but further studies are needed. The number of complex recurrences, however, were significantly higher in the valproic acid group than in the diazepam group. Parental non-compliance was a major problem, and in the 2 study groups only 5 and 12 children, respectively, with recurrences were treated adequately. Sixty-nine children receiving diazepam had side-effects vs 37 receiving valproic acid. None were serious.

Perinatal risk factors and first-year vocalizations: influence on preschool language and motor performance.

Spontaneous vocalizations of nine children with neonatal risk factors were systematically tape-recorded during the first year of life, as were those of 20 randomly chosen children without such risk factors. All the children were also given a battery of tests measuring language, speech, intelligence and motor function at six years. Cumulated tape-recordings for the periods six to 11 months and six to 14 months showed the infants with risk factors to have a significant reduction in various reduplicated syllables and consonants during the first year compared to those without risk factors. At six years, six of the nine at-risk children had an abnormal language test, as did two of the 20 without neonatal risk factors. Children with abnormal language tests performed significantly more poorly on various motor tasks; they also had had significantly fewer reduplications and consonants during infant vocalizations than the children with normal language tests. Perinatal risk factors may delay the production of prelinguistic sounds, and analysis of vocalizations might help to identify children who are at risk for later language disorders.

Denial and neglect of hemiparesis in right-sided apoplectic lesions.

In a prospective investigation of 55 consecutively selected patients with right-sided apoplectic lesions, denial and neglect of hemiparesis was registered in a standardized way using fixed criteria. The patients were all fully conscious and could cooperate in a detailed investigation. About half of the patients had denial and neglect of hemiparesis (1/4 denial, 1/5 neglect). The syndrome(s) of denial/neglect was not related to sensory defects or defects in the sense of position. Denial of hemiparesis was related to extent of lesion, neglect of hemiparesis was not. Both syndromes were related to age of patients. The resemblance between denial and neglect of hemiparesis is pointed out. It is argued, that the two phenomena could be seen as one syndrome released by right-sided brain lesions, the difference being a matter of degree. The cognitive factors in denial/neglect are thought upon as factors, than can be seen in right-sided lesions together with paresis, visual defects, but apparently not necessarily associated with the named defects.

Visual neglect in right-sided apoplectic lesions.

Fifty-five patients with right-sided apoplectic brain lesions prospectively and consecutively collected, were analyzed as to the frequency of visual neglect. The syndrome was present in 18 patients, 10 of whom had left hemi- or quadrantanopia. In addition, two patients had anopia with Anton's syndrome. Only the visual neglect without field defects was closely related to denial of hemiparesis. The two components of the syndrome of visual neglect, defects in registering visual information from the left side and defective appreciation of own condition are described and analyzed. Psychological theories of the processes behind the syndrome of neglect have difficulties in joining the cardinal features of the syndrome satisfactorily. Theories on the specific role of the right hemisphere in connection with attention/arousal and complex gnostic functions are referred to in the discussion of the syndrome.

Syphilitic normal pressure hydrocephalus.

We report a case of presenile dementia with radiological and cisternographical features suggesting normal pressure hydrocephalus, caused by syphilitic infection. Treatment with penicillin resulted in considerable regression of the neurological and psychological signs.

Dopaminergic agonist Ro 8-4650 in Parkinson's disease. II. Patients not treated with dopa.

An isoquinolone derivative Ro 8-4650 (rac-4-(3,4-dichlorophenyl)-1,2,3,4-tetrahydro-7-methoxy-2-methylisoquinoline hydrochloride) with dopaminergic properties was studied in a randomized crossover trial. The group studied comprised 37 patients with idiopathic parkinsonism, not previously treated with levodopa or dopamin agonists. The trial drug was significantly more effectve than placebo, but the clinical improvement, according to the Webster rating scale, was small. No significant difference was observed as regards involuntary movements, but the trial drug led to more frequent minor side effects. It can be concluded that the trial drug, despite its proven effect in Parkinson's disease, has only limited clinical value.