226 Evoked potentials monitoring of lamotrigine and vigabatrin in epileptic children

AS4

Abstracts

included abdominal pain (n = 24 or 54.5%), nausea (n = 19 or 43.2%), vomiting (n=14 or 31.8%), tachycardia (n= 13 or 29.5%), incontinence of urine (n=13 or 29.5%). They were found in parallel with the classical symptoms of complex partial seizures i.e. automatic movements, swallowing, perioral cyanosis. The clinical characteristics of syncope included dizziness, growing dimness, pallor, atonia. In six children (16%) muscular hypertonia was diagnosed, while in four children (10%) incontinence in urine; and recurrent syncopes in 19 children (49%). In the group with conversion neurosis the most frequent autonomic symptoms were found to be face flushing and hyperhydrosis. The role of the complex clinical analysis of the symptoms, the results of the EEG, the autonomic tests and the psychological examinations facilitate the differential and the final diagnosis of the autonomic dysfunction attacks.

098

Vomiting patients

as an ictal phenomenon

in epileptic

N ZELNIK, I GOIKHMAN Department of Medicine,

of Paediatrics, Carmel Medical Technion, Haifa, Israel

Centre,

Faculty

We report four patients (three children, one adult) with epilepsy, whose seizures were manifested by nausea, vomiting, behavioural changes or lethargy. One child who had Sturge-Weber syndrome later developed episodes of vomiting which were accompanied by unexplained fever and ictal occipital EEG slowing. The other two children had episodic vomiting. One child had nocturnal vomiting and abdominal pains. EEG showed right temporal spikes. The other child had peculiar episodes of nausea and vomiting associated with feeling of fear. On clinical observation, one episode was clearly diagnostic of complex partial seizure with staring spell, automatism and vomiting. The other patient was a 42year-old male who suffered for 10 years from episodic spells of nausea, vomiting and headache. A diagnosis of migraine was previously given although symptomatic therapy was only partially successful. The last two episodes were complicated by clear partial complex seizures with secondary generalization. We conclude that partial seizures, with temporal or occipital ictal activity might be manifested by nausea and vomiting rather than behavioural or convulsive phenomena. In three cases, the non-dominant hemisphere was involved, and in all cases complete seizure control was easily achieved with anti-epileptic therapy.

226 Evoked potentials monitoring of lamotrigine vigabatrin in epileptic children M ZGORZALEWICZ,

and

R NOWAK

Department of Developmental Neurology, Medical Sciences, Poznari, Poland

University

of

Lamotrigine (LTG) and vigabatrin (VGB) are very useful in treatment of drug-resistant epilepsy in children and adolescents. The evoked potentials studies during long-

term intake of these drugs were carried out for the detection and evaluation of subclinical neurotoxicity. The neurophysiological investigation covered 127 patients (60 male, 67 female), aged 8-18 years. They were treated in polytherapy with LTG or VGB and slowrelease preparation of carbamazepine (CBZ-SR) or valproate (VPA-SR). All patients received a drug dosage which gave an adequate therapeutic plasma concentration and satisfactory seizure control. Evoked potentials were registered by means of Multiliner (Toennies, Germany). The following brainstem evoked potentials parameters were considered: morphology of the potential, absolute latencies of waves I, III, V and interpeak latencies I-III, III-V, I-V. For visual evoked potentials latencies of N75, PlOO, N145 and amplitudes N75/PlOO, PlOO/N145 were measured. The obtained values were compared with age-matched control group. Compared with controls, the subclinical toxicity induced by anti-epileptic drugs was found. The significant differences were observed in brainstem evoked potentials latencies of waves III, V and interpeak intervals I-II. The morphology of the waves and the V/I amplitude ratio were normal in all examined groups. Also the visual evoked potentials studies showed the reduction of N75/PlOO and PlOO/N145. Adding VGB or LTG did not significantly increase the percentage of pathological changes observed from evoked potentials.

165 A new case with generalized epilepsy and inv dup(l5) syndrome C ZIX,’ J-L SCHAFF,’ B LEHEUP,’ E FLOR1,3 F CIRARD3 ‘H6pital SSM Freyming-Merlebach; Strasbourg, France

2CHU

Nancy;

3CHU

Small supernumerary marker chromosomes are found in about 0.5% of patients with mental retardation. Amongst them, duplication of the long arm of chromosome 15 represents about 40% of all marker chromosomes. We describe a boy with mild dysmorphic features, mental retardation and autistic symptoms. His halfbrother had partial symptomatic epilepsy. Cytogenetic study at 15 months of age revealed partial tetrasomy of 15q. Fluorescence in situ hybridization studies showed that the duplicated region contained the Prader-Willi/ Angleman chromosomic region (PWACR). The locus GABRB3 was also duplicated. No anomaly was seen on the parents’ karyotypes. At 5 years of age, brisk downward movements of the neck were seen, corresponding to generalized axial myoclonic seizures. These fits were very short, lasting only a fraction of a second and were not accompanied by loss of consciousness. They occurred around 10 to 12 times a day. The EEG showed polyspikes and waves accompanying the seizures. No regression was seen. Treatment with valproate was effective. Inv dup(15) is a syndrome of particular clinical and genetic interest. The phenotype associated with inv dup(15) is usually severe, with autistic symptoms, and