Audiovestibular and neuropsychological outcome of adults who had recovered from childhood bacterial meningitis.

A sample of 22 subjects was studied from a population of adults who had suffered from bacterial meningitis in childhood. Audiovestibular, oculomotor and neuropsychological investigations were performed and quality of life was assessed. An age-matched control group of 20 subjects was recruited. In the meningitis group, nine subjects had abnormal pure tone audiograms. One was previously undiagnosed and a progression was found in four. There was an overrepresentation of subclinical vestibular pathology (6 out of 9 (67%)) in this group. Audiovestibular test results showed a peripheral pattern and oculomotor tests were normal. The quality of life scores of those with hearing loss were significantly higher than those in the control group. Neuropsychological tests of brain dysfunction were abnormal in six out of 22 (27%) who had recovered from meningitis. The prevalence of such dysfunctions was not related to audiovestibular disorder. The quality of life scores of those with brain dysfunctions were similar to those of the control group. The findings of reduced auditory memory and tone level perception in four out of 22 (18%), suggest that lesions of central auditory pathways may follow from bacterial meningitis. The results support the idea that inner ear damage is the major cause of hearing loss after bacterial meningitis. Despite the absence of brainstem involvement, central nervous system lesions with disturbed auditory processing and language functions can be of significance. The high frequency of discrete brain dysfunctions indicate that a thorough neuropsychological investigation is required after bacterial meningitis.

Effects of a broad-spectrum behavioral medicine treatment program on children with refractory epileptic seizures: an 8-year follow-up.

We present an 8 year follow-up on a group of children with refractory epileptic seizures who participated in the early 1980s in a controlled group study on the effects of a broad-spectrum behavior modification treatment program on children with refractory epileptic seizures. In the original study, 18 children were divided into three groups: behavior modification group, attention control group, and control group. The purpose was to investigate the effects of a learning-based treatment program superimposed on a regular medical treatment program. Also, the effects of professional attention were evaluated. At the 10 week and 1 year follow-ups, only the group receiving the behavior modification intervention had a significantly reduced rate of seizure index. The present study investigates these same children 8 years later using the same methods of investigation for an additional 10 week period. The results indicate that a significant reduction in seizures was obtained only for the behavior modification group at the 8 year follow-up.

Long-term prognosis in childhood epilepsy: survival and seizure prognosis.

All children aged 0-19 years who had active epilepsy in a defined Swedish population were traced and given a clinical and psychometric investigation. Twelve years later, a follow-up study was carried out. Eleven of the 194 children had died, 8 of whom had had signs of neurodeficit, i.e., abnormal neurology and/or mental retardation. A long-standing remission of seizures occurred in 124 of the 194 children. Signs of neurodeficit, frequent seizures, and many types of seizures were negative prognostic factors. The presence of all these factors carried a bad prognosis, seizures persisting during 12 years in greater than 80%. For those who were mentally and neurologically normal and had low seizure frequency, prognosis was excellent, only 11% still having active epilepsy after 12 years. A study of the annual remission rate showed that each year approximately 13% of the children without neurodeficit had remission from epilepsy the next year. This rate appeared to be stable over the 12 years studied. Among those children with neurodeficit, the annual remission rate was high only during the first years after onset, later falling to 3% a year.

Effects of a broad-spectrum behavior modification treatment program on children with refractory epileptic seizures.

A group of 18 children with refractory epileptic seizures was divided into three groups--behavior modification treatment, attention control, and control groups--with the purpose of investigating the effects of a learning-based broad-spectrum treatment program superimposed on a regular medical treatment program. The design consisted of a 10-week baseline, 6-week intervention, and 10-week and 1-year follow-ups. A combination of number of seizures and seizure duration--termed "seizure index"--was used as a dependent measure. There was a significant reduction in seizure index only for those children receiving the behavior modification treatment, at both follow-ups. The results indicate that this behavioral treatment program may be of substantial help to children with epilepsy who are resistant to conventional drug therapy.