Chronic effects of osmotic opening of the blood-brain barrier in the monkey.

In the monkey, the blood-brain barrier and the blood-aqueous and blood-vitreous barriers of the eye can be opened by internal carotid perfusion of solutions of 2 molar urea in a way compatible with survival and, in some few cases, without detectable neurological deficits. Urea presumably acts by osmotically shrinking the endothelial cells of the cerebrovascular vessels and opening their tight junctions. The high incidence of brain necrosis with neurological sequelae after perfusion of urea by the present technique precludes the use of osmotic opening of the blood-brain barrier for pharmacotherapy at this time.

Associative learning in premature hydranencephalic and normal twins.

A hydranencephalic infant lacking cerebral hemispheres and a normal twin were tested for associative learning. After repeated trials in which two stimuli were temporally paired, test trials were given in which the second stimulus was omitted. Cardiac orienting responses to stimulus omission indicated that learning had taken place in both infants.

Pemoline-induced Tourette's disorder: a case report.

The author describes the case of a 14-year-old boy who developed Gilles de la Tourette's disorder during pemoline therapy. Unlike other reported cases, the boy's tics did not remit after the pemoline was discontinued.

Use of valproic acid in treatment of infantile spasms.

Nineteen babies with infantile spasms were treated with valproic acid over a two-year period. Eleven of the patients were also treated with purified corticotropin, but in no cases were the two drugs used simultaneously. Approximately 40% of the patients had good control of their infantile spasms with valproic acid. Side effects from valproic acid in these babies were not frequent and were, for the most part, minor. Though the percentage of infants with infantile spasms responding to valproic acid may be less than the percentage responding to corticotropin, the incidence and severity of side effects are less with valproic acid.

Electroencephalographic abnormalities in children with congenital heart disease.

Ninety-eight consecutive patients with clinically suspected congenital heart disease were prospectively studied with electroencephalographic (EEG) recordings before cardiac catheterization. Twenty-five patients had abnormal EEGs. Fifty-five patients had acyanotic heart disease and normal neurologic examination results, of whom 15 had abnormal EEGs. Thirteen had spikes or spike and wave discharges and two had mildly abnormal EEGs. Twenty-seven patients had cyanotic heart disease and normal neurologic examination results, of whom four had abnormal EEGs. Seven patients (8%) had abnormal neurologic examination results, of whom four had abnormal EEGs. There was a higher incidence of seizures with increasing age. Based on their medical history two children with acyanotic heart disease had had seizures without EEG abnormalities. Five children with normal catheterization findings and four children with Down's syndrome (two with abnormal EEGs) were excluded from the total of 98. These findings suggest that subclinical nervous system involvement may occur in congenital heart disease.

Long-term treatment of juvenile Huntington's chorea with dipropylacetic acid.

Since the proposed mode of action of dipropylacetic acid, an anticonvulsant, is to increase central nervous system gamma-aminobutyric acid levels, we used this agent to treat identical twins with juvenile Huntington's chorea. Their clinical status did not improve immediately after they received dipropylacetic acid. Furthermore, long-term administration (over a year) of high doses of the agent (up to 2,400 mg per day; 92 mg per kilogram per day) did not seem to alter the slow progression of their disease. Prior to treatment with dipropylacetic acid, the twins had normal cerebrospinal fluid gamma-aminobutyric acid levels. In addition, cerebrospinal fluid 5-hydroxyindoleacetic acid and homovanillic acid were determined before and after 18 hours of high-dose probenecid. The former showed a normal threefold to fourfold increase after probenecid administration, but homovanillic acid had a distinctly subnormal turnover after probenecid, with only a threefold rather than the normal tenfold increase.

Hemophilus meningitis: comparison of H. influenzae and H. parainfluenzae.

Eleven cases of Hemophilus meningitis seen in the last year are reported. Three were H. parainfluenzae and eight were H. influenzae. The number of patients is small but probably indicates that there is little difference in the clinical or laboratory data in meningitis caused by these two organisms. The children with H. parainfluenzae tended to be less anemic and had more normal admission spinal fluid sugars and proteins, but this was probably because these patients were older and had shorter prodromes. As more cases of H. parainfluenzae meningitis are noted, it seems likely that there will not be any difference in the clinical or laboratory data. Two of the three cases of H. parainfluenzae meningitis had the complication of ataxia secondary to severe bilateral vestibular deficits. Finally, it should be noted that these two organisms will not be distinguished by routine bacteriological studies, and that differentiation must be carried out by an experimental laboratory.

Computerized axial tomography in neurologic disorders of children.

Computerized axial tomography offers major advantages over air encephalography and angiography for studies of neurologic disorders in children. The low morbidity and the ease of the procedure permit the accurate diagnosis of intracranial pathology in situations where more invasive procedures would not be undertaken. The techniques of the procedure and its uses and limitations are emphasized in a number of neurologic problems of children.

Computerized axial tomography in chronic seizure disorders of childhood.

Ninety-eight children with chronic seizure disorders were studied by computerized axial tomography (CAT). Structural abnormalities were identified in 30% of these children. The greatest incidence of abnormalities was in children with focal motor seizures (43%) and in those whose EEG demonstrated focal slowing together with focal spikes (38%). The most common abnormality was either focal or generalized atrophy (13%). Only about 2% of the abnormalities discovered by CAT were potentially of therapeutic significance. However, the demonstration of a static process, or the finding of a normal CAT, may be quite helpful to the family and physician in certain children with chronic seizure disorders.

24 hour ambulatory electroencephalographic monitoring in pediatrics.

Prolonged ambulatory electroencephalographic monitoring was evaluated in 38 children, aged five weeks to 20 years. Eleven children with known seizure disorders who also had additional episodic symptomatology of unknown etiology were monitored, in eight of these children the "spells" were recorded. For 38% of these cases (3/8) the symptoms were shown to be seizures, while for the other 62% the episodic symptomatology did not represent a seizure. In another 23 children without previously documented seizure disorders, the "spells" were recorded in 11 cases. Only two of these 11 (18%) children with episodic symptomatology were shown to have seizures. This study demonstrates the usefulness of outpatient electroencephalographic monitoring in pediatrics for evaluation of episodic symptomatology of unclear etiology.

Cursive and gelastic epilepsy: case report.

A child with cursive and gelastic epilepsy is reported. This particular case in unique in that the patient had no underlying neurological disease, his running and laughing seizures represented his only seizure type; and recorded ictal episodes originated bilaterally and anteriorly.