- Email: [email protected]
BIRTH SPACING IN ZIMBABWE A GENERATION AGO
161 medical advice. A recent example was a 3-year-old boy with moderate eczema, whose diet was grossly deficient in first-class protein, calcium, and vitamin D. We believe strongly that exclusion diets should only be prescribed when of proven necessity; and then only with supervision from a qualified dietician.
DURATION OF BREASTFEEDING, CROWDING, AND CHILD MORTALITY (BALANTAS, MANDINGAS, AND FULAS) IN
FOR THREE ETHNIC GROUPS
A RURAL SETTING. GUINEA-BISSAU
1979-82
Department of Medicine, University Hospital of South Manchester, Manchester M20 8LR
DAVID
Department of Psychiatry, University of Leeds Warrington & District General Hospital
J. PEARSON
KEITH J. B. RIX STEPHEN J. BENTLEY
SPACING, CROWDING, AND CHILD MORTALITY IN GUINEA-BISSAU
SIR,-Prolonged breast feeding and a long birth interval have been associated with better health and survival of children. 1,2 One risk factor for child health seems to be overcrowding: the severity of infections increases when two or more children are sick
simultaneously. 3,4 During a health and nutrition project in Guinea-Bissau we had the opportunity to study ethnic groups with marked variations in child spacing and crowding-namely, Balantas in the Tombali region and Mandingas and Fulas in the Oio region. While rural Mandingas and Fulas breast feed for 30 months on average, the rural Balantas breast feed for 38 months (see table). Since all groups abstain from sexual intercourse while the woman is breast-feeding, Balantas have fewer children than Mandingas and Fulas. A high degree of polygamy increases crowding in all groups. However, whereas adult men among the Balantas have separate households, Mandinga brothers often live together in the same household so their households and living compounds tend to be bigger. On average, there were twice as many children below five years of age in Mandinga as there were in Balanta households. Among the Balantas, each wife ideally has her own room, while wives in Mandinga households live together, with up to ten women in the same circular hut. The difference in crowding is reinforced because Balanta children are said to leave their mother’s bed and move to the bed of a father or grandmother when their mother gives birth to a new child. Mandinga and Fula mothers, on the other hand, may have several children in the bed at the same time. These cultural patterns resulted in a clear difference in mean number of persons sleeping in the same bed as a mother and child (see table). While the youngest Balanta and Mandinga-Fula children aged 0-2 months had similar states of nutrition, the fall in weight-for-age began earlier among the Mandingas and Fulas and was more farreaching (table). In the years 1980 and 1981, when no major epidemic occurred in the populations surveyed, Balanta children below six months of age had a better chance of survival during the following year than did Mandinga and Fula children. While the food production systems are very different, the divergence in the states of nutrition begins before supplementary feeding plays a major role among the three groups, and the difference in mortality occurs while all children are still breastfed. Mandingas in Gambia have a very high child mortality level, but the state of nutrition did not determine risk of death.5 However, variation in severity of infection could cause a difference in state of nutrition and in mortality. Overcrowding increases the risk of early infection and raises the chance of intensive exposure and intercurrent infections. In an urban district of Bissau, we found that Balantas had a significantly lower risk of dying in measles than did other ethnic groups.4 One of the highest case fatality rates ever reported in measles was found among Mandingas in Gambia.5 1. 2
Morley D. Paediatric priorities in the developing world. London: Butterworths, 1973. Gray RH Birth intervals, postpartum sexual abstinence and child health, In: Page HJ, Lesthaeghe R, eds Child-spacing in tropical Africa: Tradition and change. London:
Academic Press, 1981: 93-110. 3 Ross AH Modification of chicken pox
in family contacts by administration of gamma globulin N Engl J Med 1962; 267: 369-76. 4. Aaby P, Bukh J, Lisse IM, Smits AJ. Measles mortality, state of nutrition, and family structure a community study from Guinea-Bissau. J Infect Dis (In press). 5 McGregor IA, Billewicz WZ, Thomson AM. Growth and mortality in children in an African village. Br Med J 1961: 1661-66.
*Data from general child examination, 1979. tCensus, 1979. No census was made in the Fula village *Data from general child examination, 1982. Mandingas constituted 68% and Fulas 29% of the children in the nutritional survey Included are all children aged less than 5 months at time of the general child examination in villages. Children who moved within the following 12 months have been counted as followed for 6 months.
From a preventive health perspective, prolonged spacing may be important because it reduces the risk of small children passing infections to each other. For children aged 1 tla-3 years, breastfeeding did not secure a better state of nutrition (table). However, prolonged breastfeeding and postpartum sexual abstinence, as practised in many parts of the world, may be functionally efficient cultural mechanisms for diminishing overcrowding of small children. Data were collected in a study jointly organised by the Ministry of Health, Guinea-Bissau, and the Swedish Agency for Research Cooperation with Developing countries. The study was supported in part by the Danish Council for Development Research.
-
_
PETER AABY
Institute of Ethnology and Anthropology,
University of Copenhagen DK-1220 Copenhagen K, Denmark
JETTE BUKH IDA MARIA LISSE
ARJON J. SMITS
BIRTH SPACING IN ZIMBABWE A GENERATION AGO
SIR,-A generation ago in Zimbabwe children were deliberately spaced both to ensure they received adequate care and to avoid illhealth. with at least one child under five were asked about for birth spacing in their parents’ generation. Interviews took place at their homes in a rural area 30 miles from Gwanda and in a semiurban area on the periphery of this town, which is 91 miles south of Bulawayo. 89% of the rural and 70% of the semiurban respondents said that spacing was done mainly for the health and care of the children, to ensure that each child was brought up properly. They said that too many children born close together "burn" each other and kill each other by passing on diseases easily and that many children in such families die (rural 67%, semiurban 45%). In wartime, families could get away much more easily if only one child had to be carried (rural 51%, semiurban 57%). More than a quarter of the families (rural 26%, semiurban 30%) said that in their parents’ generation people were ashamed of having chidren too close together because it was not accepted in the culture. It was seen as carelessness on the part of the man. A third of families in both of the groups said that birthspacing facilitated work at home and in the fields. The woman could then work for many months before she had to stop for childbirth. It 204
women
reasons
162 thus aided the mother’s recovery and rest (rural 24%, semiurban 16%). It helped to maintain a good relationship between husband and wife (rural 34%, semiurban 19%). A few (rural 4%, semiurban 2%) said it was useful to limit the number of children overall. These results show that in a traditional society the health benefits of birth spacing to mother and child are clearly well-known. This suggests the need is not for more health education in benefits of birth spacing, but a need for services to be able to put this knowledge into practice.I This study was largely funded by the Overseas Development Administration. Further details in a dissertation M. Phil submitted by M. M. to the department of applied social studies, Polytechnic of North London. Child Health Unit, Institute of Child Health, London WC1N 1EH
Tropical
HERMIONE LOVEL MILDRED MKANDLA DAVID MORLEY
RIFAMPICIN FOR PNEUMOCYSTIS CARINII PNEUMONIA
SiR,—Dr Szychowska and colleagues (April 23, p 935) have suggested that rifampicin (rifampin) may be effective in the treatment of Pneumocystis carinii pneumonitis. This conclusion is based on the recovery of four infants with pneumonitis treated with this drug and subsequently found to have antibody to P carinii. Because of problems with this pneumonitis in the acquired immunodeficiency syndrome and in other compromised patients physicians are eager to find new drugs for the treatment of this otherwise fatal infection. While trimethoprim-sulphamethoxazole (TS) and pentamidine isethionate are effective, some 30% of patients will not respond. The easy availability and low toxicity of rifampicin make-it enticing for empirical trials. However, I would add a word of caution concerning the use of this drug until more definitive data are available. Evidence that rifampicin is ineffective in the prevention and treatment of P carinii pneumonitis comes from experiments in our laboratory. The corticosteroid-treated rat model has provided an excellent corollary to human disease caused by P carinii. In searching for new drugs for this infection we have studied rifampicin.2 Fifteen animals comprised each study group. A control group received no therapeutic agent. Other groups received rifampicin or TS prophylactically and rifampicin or TS therapeutically once the pneumonitis occurred. Histopathology of lung sections revealed that P carinii pneumonitis occurred in all of the untreated controls, in none of those receiving TS prophylaxis, and in 87% of those receiving rifampicin prophylaxis. Of those with established P carinii pneumonitis 36% of those treated with TS and 100% of those treated with rifampicin died of the infection. The dose of rifampicin was 50 mg/kg daily. We concluded that rifampicin was ineffective. The aetiology of the pneumonitis in Szychowska’s cases was. not proven by biopsy. Since Chlamydia trachomatis is a frequent cause of pneumonitis in infants of this age,3mimicking precisely P carinii pneumonitis, but often characterised by a pertussis-like cough (as in4 case 1), and since C trachomatis is highly sensitive to rifampicin,4 this diagnosis cannot be excluded in these cases. If further use is to be made of rifampicin in P carinii infections at this time, it would seem wise to limit it to experimental studies in animals. Also, further studies of rifampicin in C trachomatis pneumonitis would be of interest. Division of Infectious Diseases, St Jude Children’s Research Hospital, Memphis, Tennessee 38101, USA
HIGH DOSE GAMMAGLOBULIN FOR INTRACTABLE CHILDHOOD EPILEPSY
SIR,-In animal models epilepsy can be produced not only by brain damage, pharmacological agents, and electrical stimulation but also by autoimmune mechanisms.’ The clinical relevance of an immune mechanism remains obscure, though there are pointers2for example, asialomonoganglioside antibody in serum and cerebrospinal fluid3 and brain nicotinic acetylcholine receptor antibody in serum.4High-dose non-treated gammaglobulin (NTGG) therapy is being tried in autoimmune disorders, and Laffont et al5 and Pechadre et al6 have described the effect of empirical therapy for epileptic encephalopathy with placental gamma globulin. Daute and co-workersfound that immunosuppression greatly benefited children with intractable epilepsy. We describe here experience with intravenous NTGG in the early treatment of sixteen patients with childhood epilepsy. The NTGG (’Globulin-N’; Yamanouchi Pharmaceutical Co) we used is a polyvalent immunoglobulin stabilised with polyethyleneglycol and hetastarch and containing 97% IgG and 3% IgA, with no anticonvulsive properties. (A pepsin-treated gammaglobulin had little effect on the seizures in two epileptics.) NTGG (100-200 mg/kg) was given by drip with intervals of 2 weeks between the first and second administration and 3 weeks after that. Drip speeds (drops per minute) were, for the first 30 min, 2 for patients aged 5 years and below and 3-5 for older children, after which the infusion rate was increased to 5-10 and 10-20 drops/min, respectively. NTGG administration was discontinued when epileptic seizures subsided and paroxysmal EEG waves disappeared. Complete disappearance of both clinical and electrical seizures was expressed
complete remission, 75% or more improvement as markedly effective, 75-50% as moderately effective, 50-25% as fairly effective, and 25% or less as ineffective. Of the eight patients who had had attacks for 2 years or less four showed complete clinical and EEG remission, two showed a marked improvement, and the remaining two showed a moderate improveas
ment in
electrical seizures without any clinical improvement. In the eight patients response was poor; three showed slight improvement of both clinical and electrical seizures. Four of the seven patients who received NTGG therapy within a year of the onset of seizures attained complete remissions. The following two cases illustrate complete remission. Case 1 (15-month-old boy, West syndrome; fig 1).- Neurological development normal until age 5 months when he had a generalised tonic convulsion. At age 5 months subdural effusion was diagnosed. The tonic seizure disappeared but psychomotor development was delayed. At age 11 months he had nodding spasms of the head and the seizures could not be controlled by anticonvulsants. At age 15 months he was transferred here. EEGs disclosed hypsarrhythmia and, later, periodicity. Seizures, one to twelve times daily, persisted despite anticonvulsant medications (nitrazepam, clonazepam). A week after intravenous administration of NTGG 100 mg/kg clinical seizures ceased completely and 1 week later the EEG no longer showed paroxysmal waves. Anticonvulsants were discontinued 2 months after NTGG therapy and there have been no further relapses for 7 months. Case 2 (70-month-old girl, myoclonic seizure; fig 2).-Development normal until age 63 months when she had a myoclonic seizure. An EEG showed polyspike and wave complexes. Despite antiother
1. 2. 3.
WALTER T. HUGHES 4.
1. Potts M. More
marketing than medicine. People 1981; 8: 6-7. 2. Hughes WT. Efficacy of trimethoprim and sulfamethoxazole in the prevention and treatment of Pneumocystis carinii pneumonitis. Antimicrob Ag Chemother 1974; 5: 289-93. 3. Beem MO, Saxon EM. Respiratory-tract colonization and distinctive pneumonia syndrome in infants infected with Chlamydia trachomatis. N Engl J Med 1977; 296: 306-10. 4. Blackman HJ, et al. Antibiotic susceptibility of Chlamydia trachomatis Antimicrob Ag Chemother 1977; 12: 673-77.
Karpiak SE, GrafL, Rapport MM. Antiserum to brain gangliosides produces recurrent form activity. Science 1976; 194: 735-37. Aarli JA, Fontana A. Immunological aspects of epilepsy. Epilepsia 1980; 21: 451-59. Hoshino C, Yotsumiya N, Yata J. Relationship between anti-GA1 antibody and CNS destructions in nervous diseases. Acta Pediatr Japon 1982; 86: 1694. Fontana A, Fulpius BW, Cuénoud S. Antibodies against muscle and brain nicotinic acetylcholine receptors in IgA deficient patients with epilepsy. Adv Cytopharmacol
1979; 3: 287-92. 5. Laffont F, Esnault S, Gilbert A, Peytour MA, Cathala HP, Eygonnet JP. Effect des gammaglobulines sur des epilepsies rebelles. Ann Med Interne 1979; 130: 307-12 6. Péchadre JC, Sauvezie B, Osier C, Gilbert J. Traitement des encephalopathies epileptiques de Penfant par les gamma-globulines. Rev EEG Neurophysiol 1979; 7: 443-47. 7. Daute KH, Hässler A, Klust E Myoklonisch-Astatisches Petit Mal: Immunologische Aspekte in Ätiopathogenese und Therapie. IVth Prague International Symposium of Child Neurology, 1978; abstr p 16.
DURATION OF BREASTFEEDING, CROWDING, AND CHILD MORTALITY (BALANTAS, MANDINGAS, AND FULAS) IN
FOR THREE ETHNIC GROUPS
A RURAL SETTING. GUINEA-BISSAU
1979-82
Department of Medicine, University Hospital of South Manchester, Manchester M20 8LR
DAVID
Department of Psychiatry, University of Leeds Warrington & District General Hospital
J. PEARSON
KEITH J. B. RIX STEPHEN J. BENTLEY
SPACING, CROWDING, AND CHILD MORTALITY IN GUINEA-BISSAU
SIR,-Prolonged breast feeding and a long birth interval have been associated with better health and survival of children. 1,2 One risk factor for child health seems to be overcrowding: the severity of infections increases when two or more children are sick
simultaneously. 3,4 During a health and nutrition project in Guinea-Bissau we had the opportunity to study ethnic groups with marked variations in child spacing and crowding-namely, Balantas in the Tombali region and Mandingas and Fulas in the Oio region. While rural Mandingas and Fulas breast feed for 30 months on average, the rural Balantas breast feed for 38 months (see table). Since all groups abstain from sexual intercourse while the woman is breast-feeding, Balantas have fewer children than Mandingas and Fulas. A high degree of polygamy increases crowding in all groups. However, whereas adult men among the Balantas have separate households, Mandinga brothers often live together in the same household so their households and living compounds tend to be bigger. On average, there were twice as many children below five years of age in Mandinga as there were in Balanta households. Among the Balantas, each wife ideally has her own room, while wives in Mandinga households live together, with up to ten women in the same circular hut. The difference in crowding is reinforced because Balanta children are said to leave their mother’s bed and move to the bed of a father or grandmother when their mother gives birth to a new child. Mandinga and Fula mothers, on the other hand, may have several children in the bed at the same time. These cultural patterns resulted in a clear difference in mean number of persons sleeping in the same bed as a mother and child (see table). While the youngest Balanta and Mandinga-Fula children aged 0-2 months had similar states of nutrition, the fall in weight-for-age began earlier among the Mandingas and Fulas and was more farreaching (table). In the years 1980 and 1981, when no major epidemic occurred in the populations surveyed, Balanta children below six months of age had a better chance of survival during the following year than did Mandinga and Fula children. While the food production systems are very different, the divergence in the states of nutrition begins before supplementary feeding plays a major role among the three groups, and the difference in mortality occurs while all children are still breastfed. Mandingas in Gambia have a very high child mortality level, but the state of nutrition did not determine risk of death.5 However, variation in severity of infection could cause a difference in state of nutrition and in mortality. Overcrowding increases the risk of early infection and raises the chance of intensive exposure and intercurrent infections. In an urban district of Bissau, we found that Balantas had a significantly lower risk of dying in measles than did other ethnic groups.4 One of the highest case fatality rates ever reported in measles was found among Mandingas in Gambia.5 1. 2
Morley D. Paediatric priorities in the developing world. London: Butterworths, 1973. Gray RH Birth intervals, postpartum sexual abstinence and child health, In: Page HJ, Lesthaeghe R, eds Child-spacing in tropical Africa: Tradition and change. London:
Academic Press, 1981: 93-110. 3 Ross AH Modification of chicken pox
in family contacts by administration of gamma globulin N Engl J Med 1962; 267: 369-76. 4. Aaby P, Bukh J, Lisse IM, Smits AJ. Measles mortality, state of nutrition, and family structure a community study from Guinea-Bissau. J Infect Dis (In press). 5 McGregor IA, Billewicz WZ, Thomson AM. Growth and mortality in children in an African village. Br Med J 1961: 1661-66.
*Data from general child examination, 1979. tCensus, 1979. No census was made in the Fula village *Data from general child examination, 1982. Mandingas constituted 68% and Fulas 29% of the children in the nutritional survey Included are all children aged less than 5 months at time of the general child examination in villages. Children who moved within the following 12 months have been counted as followed for 6 months.
From a preventive health perspective, prolonged spacing may be important because it reduces the risk of small children passing infections to each other. For children aged 1 tla-3 years, breastfeeding did not secure a better state of nutrition (table). However, prolonged breastfeeding and postpartum sexual abstinence, as practised in many parts of the world, may be functionally efficient cultural mechanisms for diminishing overcrowding of small children. Data were collected in a study jointly organised by the Ministry of Health, Guinea-Bissau, and the Swedish Agency for Research Cooperation with Developing countries. The study was supported in part by the Danish Council for Development Research.
-
_
PETER AABY
Institute of Ethnology and Anthropology,
University of Copenhagen DK-1220 Copenhagen K, Denmark
JETTE BUKH IDA MARIA LISSE
ARJON J. SMITS
BIRTH SPACING IN ZIMBABWE A GENERATION AGO
SIR,-A generation ago in Zimbabwe children were deliberately spaced both to ensure they received adequate care and to avoid illhealth. with at least one child under five were asked about for birth spacing in their parents’ generation. Interviews took place at their homes in a rural area 30 miles from Gwanda and in a semiurban area on the periphery of this town, which is 91 miles south of Bulawayo. 89% of the rural and 70% of the semiurban respondents said that spacing was done mainly for the health and care of the children, to ensure that each child was brought up properly. They said that too many children born close together "burn" each other and kill each other by passing on diseases easily and that many children in such families die (rural 67%, semiurban 45%). In wartime, families could get away much more easily if only one child had to be carried (rural 51%, semiurban 57%). More than a quarter of the families (rural 26%, semiurban 30%) said that in their parents’ generation people were ashamed of having chidren too close together because it was not accepted in the culture. It was seen as carelessness on the part of the man. A third of families in both of the groups said that birthspacing facilitated work at home and in the fields. The woman could then work for many months before she had to stop for childbirth. It 204
women
reasons
162 thus aided the mother’s recovery and rest (rural 24%, semiurban 16%). It helped to maintain a good relationship between husband and wife (rural 34%, semiurban 19%). A few (rural 4%, semiurban 2%) said it was useful to limit the number of children overall. These results show that in a traditional society the health benefits of birth spacing to mother and child are clearly well-known. This suggests the need is not for more health education in benefits of birth spacing, but a need for services to be able to put this knowledge into practice.I This study was largely funded by the Overseas Development Administration. Further details in a dissertation M. Phil submitted by M. M. to the department of applied social studies, Polytechnic of North London. Child Health Unit, Institute of Child Health, London WC1N 1EH
Tropical
HERMIONE LOVEL MILDRED MKANDLA DAVID MORLEY
RIFAMPICIN FOR PNEUMOCYSTIS CARINII PNEUMONIA
SiR,—Dr Szychowska and colleagues (April 23, p 935) have suggested that rifampicin (rifampin) may be effective in the treatment of Pneumocystis carinii pneumonitis. This conclusion is based on the recovery of four infants with pneumonitis treated with this drug and subsequently found to have antibody to P carinii. Because of problems with this pneumonitis in the acquired immunodeficiency syndrome and in other compromised patients physicians are eager to find new drugs for the treatment of this otherwise fatal infection. While trimethoprim-sulphamethoxazole (TS) and pentamidine isethionate are effective, some 30% of patients will not respond. The easy availability and low toxicity of rifampicin make-it enticing for empirical trials. However, I would add a word of caution concerning the use of this drug until more definitive data are available. Evidence that rifampicin is ineffective in the prevention and treatment of P carinii pneumonitis comes from experiments in our laboratory. The corticosteroid-treated rat model has provided an excellent corollary to human disease caused by P carinii. In searching for new drugs for this infection we have studied rifampicin.2 Fifteen animals comprised each study group. A control group received no therapeutic agent. Other groups received rifampicin or TS prophylactically and rifampicin or TS therapeutically once the pneumonitis occurred. Histopathology of lung sections revealed that P carinii pneumonitis occurred in all of the untreated controls, in none of those receiving TS prophylaxis, and in 87% of those receiving rifampicin prophylaxis. Of those with established P carinii pneumonitis 36% of those treated with TS and 100% of those treated with rifampicin died of the infection. The dose of rifampicin was 50 mg/kg daily. We concluded that rifampicin was ineffective. The aetiology of the pneumonitis in Szychowska’s cases was. not proven by biopsy. Since Chlamydia trachomatis is a frequent cause of pneumonitis in infants of this age,3mimicking precisely P carinii pneumonitis, but often characterised by a pertussis-like cough (as in4 case 1), and since C trachomatis is highly sensitive to rifampicin,4 this diagnosis cannot be excluded in these cases. If further use is to be made of rifampicin in P carinii infections at this time, it would seem wise to limit it to experimental studies in animals. Also, further studies of rifampicin in C trachomatis pneumonitis would be of interest. Division of Infectious Diseases, St Jude Children’s Research Hospital, Memphis, Tennessee 38101, USA
HIGH DOSE GAMMAGLOBULIN FOR INTRACTABLE CHILDHOOD EPILEPSY
SIR,-In animal models epilepsy can be produced not only by brain damage, pharmacological agents, and electrical stimulation but also by autoimmune mechanisms.’ The clinical relevance of an immune mechanism remains obscure, though there are pointers2for example, asialomonoganglioside antibody in serum and cerebrospinal fluid3 and brain nicotinic acetylcholine receptor antibody in serum.4High-dose non-treated gammaglobulin (NTGG) therapy is being tried in autoimmune disorders, and Laffont et al5 and Pechadre et al6 have described the effect of empirical therapy for epileptic encephalopathy with placental gamma globulin. Daute and co-workersfound that immunosuppression greatly benefited children with intractable epilepsy. We describe here experience with intravenous NTGG in the early treatment of sixteen patients with childhood epilepsy. The NTGG (’Globulin-N’; Yamanouchi Pharmaceutical Co) we used is a polyvalent immunoglobulin stabilised with polyethyleneglycol and hetastarch and containing 97% IgG and 3% IgA, with no anticonvulsive properties. (A pepsin-treated gammaglobulin had little effect on the seizures in two epileptics.) NTGG (100-200 mg/kg) was given by drip with intervals of 2 weeks between the first and second administration and 3 weeks after that. Drip speeds (drops per minute) were, for the first 30 min, 2 for patients aged 5 years and below and 3-5 for older children, after which the infusion rate was increased to 5-10 and 10-20 drops/min, respectively. NTGG administration was discontinued when epileptic seizures subsided and paroxysmal EEG waves disappeared. Complete disappearance of both clinical and electrical seizures was expressed
complete remission, 75% or more improvement as markedly effective, 75-50% as moderately effective, 50-25% as fairly effective, and 25% or less as ineffective. Of the eight patients who had had attacks for 2 years or less four showed complete clinical and EEG remission, two showed a marked improvement, and the remaining two showed a moderate improveas
ment in
electrical seizures without any clinical improvement. In the eight patients response was poor; three showed slight improvement of both clinical and electrical seizures. Four of the seven patients who received NTGG therapy within a year of the onset of seizures attained complete remissions. The following two cases illustrate complete remission. Case 1 (15-month-old boy, West syndrome; fig 1).- Neurological development normal until age 5 months when he had a generalised tonic convulsion. At age 5 months subdural effusion was diagnosed. The tonic seizure disappeared but psychomotor development was delayed. At age 11 months he had nodding spasms of the head and the seizures could not be controlled by anticonvulsants. At age 15 months he was transferred here. EEGs disclosed hypsarrhythmia and, later, periodicity. Seizures, one to twelve times daily, persisted despite anticonvulsant medications (nitrazepam, clonazepam). A week after intravenous administration of NTGG 100 mg/kg clinical seizures ceased completely and 1 week later the EEG no longer showed paroxysmal waves. Anticonvulsants were discontinued 2 months after NTGG therapy and there have been no further relapses for 7 months. Case 2 (70-month-old girl, myoclonic seizure; fig 2).-Development normal until age 63 months when she had a myoclonic seizure. An EEG showed polyspike and wave complexes. Despite antiother
1. 2. 3.
WALTER T. HUGHES 4.
1. Potts M. More
marketing than medicine. People 1981; 8: 6-7. 2. Hughes WT. Efficacy of trimethoprim and sulfamethoxazole in the prevention and treatment of Pneumocystis carinii pneumonitis. Antimicrob Ag Chemother 1974; 5: 289-93. 3. Beem MO, Saxon EM. Respiratory-tract colonization and distinctive pneumonia syndrome in infants infected with Chlamydia trachomatis. N Engl J Med 1977; 296: 306-10. 4. Blackman HJ, et al. Antibiotic susceptibility of Chlamydia trachomatis Antimicrob Ag Chemother 1977; 12: 673-77.
Karpiak SE, GrafL, Rapport MM. Antiserum to brain gangliosides produces recurrent form activity. Science 1976; 194: 735-37. Aarli JA, Fontana A. Immunological aspects of epilepsy. Epilepsia 1980; 21: 451-59. Hoshino C, Yotsumiya N, Yata J. Relationship between anti-GA1 antibody and CNS destructions in nervous diseases. Acta Pediatr Japon 1982; 86: 1694. Fontana A, Fulpius BW, Cuénoud S. Antibodies against muscle and brain nicotinic acetylcholine receptors in IgA deficient patients with epilepsy. Adv Cytopharmacol
1979; 3: 287-92. 5. Laffont F, Esnault S, Gilbert A, Peytour MA, Cathala HP, Eygonnet JP. Effect des gammaglobulines sur des epilepsies rebelles. Ann Med Interne 1979; 130: 307-12 6. Péchadre JC, Sauvezie B, Osier C, Gilbert J. Traitement des encephalopathies epileptiques de Penfant par les gamma-globulines. Rev EEG Neurophysiol 1979; 7: 443-47. 7. Daute KH, Hässler A, Klust E Myoklonisch-Astatisches Petit Mal: Immunologische Aspekte in Ätiopathogenese und Therapie. IVth Prague International Symposium of Child Neurology, 1978; abstr p 16.